Pancreatic Cancer

Overview:

Pancreatic cancer is a disease in which cancerous cells arise within the pancreas gland.

The pancreas, an organ that is located behind the stomach, has two functions. It secretes enzymes into the small intestine that aid in digestion (exocrine function), and it produces the hormones insulin and glucagon, which are released into the bloodstream to help regulate blood sugar (endocrine function).

Adenocarcinoma, the most common form of pancreatic cancer, arises from the exocrine cells.

Symptoms:

Symptoms of pancreatic cancer include pain in the upper abdomen, poor appetite, weight loss, and yellowing of the skin and eyes (jaundice).

Jaundice occurs from obstruction of the bile duct (the tube that drains the liver and gallbladder into the intestine) as it travels though the pancreas.

Testing:

Pancreatic cancer is suggested when a mass is seen in the pancreas on an imaging study such as an ultrasound, CT scan, or MRI scan. The diagnosis is confirmed by obtaining a tissue biopsy. This can be achieved by a radiologist passing a needle though the skin using CT scan guidance, by a gastroenterologist during ERCP or endoscopic ultrasound (see description under Our Services) or at the time of surgery.

Treatment:

Treatment consists of surgery to remove the cancerous growth or chemotherapy/radiation therapy to shrink the cancer. If surgery is not an option, a stent (plastic or metal tube) can be passed through the narrowing of the bile duct to relieve obstruction and jaundice.

Most patients with pancreatic cancer have a poor prognosis and less than 5% are living at five years after diagnosis.

Pancreatic Pseudocyst

Overview:

A pancreatic pseudocyst is a fluid filled sac that most commonly arises as a complication of pancreatitis.

Pancreatitis is inflammation of the pancreas gland, which can result in leakage of pancreatic juices (digestive enzymes) into the tissue surrounding the pancreas. If this fluid is not reabsorbed and becomes walled-off, a pseudocyst is formed.

A pseudocyst can be small and asymptomatic, whereas a large pseudocyst may cause symptoms by pressing against adjacent organs such as the stomach or intestines.

Symptoms:

Common symptoms include abdominal pain, nausea, and vomiting. Fever may occur if the fluid becomes infected.

Testing:

A pseudocyst is easily diagnosed with an imaging study of the abdomen such as an ultrasound, CT scan, or MRI scan.

Treatment:

Small asymptomatic pseudocysts require no treatment and will often resolve spontaneously over time.

Symptomatic or infected pseudocysts should be drained. This can be accomplished by draining the pseudocyst into an adjacent organ such as the stomach or small intestine. This can be performed by using endoscopy (passing a thin flexible scope into the stomach or intestine) or by surgery.

Pancreatitis

Overview:

Pancreatitis is a condition in which the pancreas becomes inflamed.

The pancreas, an organ that is located behind the stomach, has two functions. It secretes enzymes into the small intestine that aid in digestion (exocrine function), and it produces the hormones insulin and glucagon, which are released into the bloodstream to help regulate blood sugar (endocrine function).

Pancreatitis is most commonly caused by alcohol consumption or passage of a gallstone through the bile duct, the tube that connects the gallbladder to the small intestine.

Other causes of acute pancreatitis include medications, infection, trauma, elevated triglycerides, abnormal pancreatic anatomy, and a complication from surgery or medical procedures.

Symptoms:

Symptoms of pancreatitis include severe pain in the upper abdomen, which often travels into the back, along with nausea and vomiting.

Testing:

Pancreatitis is diagnosed by detecting elevated pancreatic enzyme (amylase and lipase) levels in the bloodstream. It can also be seen on imaging studies of the pancreas such as an ultrasound, CT scan, or MRI scan.

Treatment:

Most cases of pancreatitis are mild and resolve in several days. More severe cases can be prolonged and associated with complications such as infection, kidney failure, respiratory failure, fluid extravasation, and rarely, even death.

Treatment consists of supportive care with intravenous fluids, medications to relieve pain and nausea and management of any problems that may have contributed to the attack.