The diagnosis of pancreatic cancer can be overwhelming not only because it is one of the most difficult cancers to cure, but because most people know very little about this large, oblong gland located deep in the abdomen.
Knowing the critical role the pancreas plays in the body’s digestive system can help patients to better understand the disease and their treatment options.
The pancreas lies horizontally between the lower part of stomach and the spine. It secretes crucial enzymes that aid digestion and hormones that regulate the metabolism of sugars.
Each year, about 33,000 people in the United States are diagnosed with pancreatic cancer, a malignant tumor of the pancreas. The disease begins in the tissue of the pancreas, but often rapidly spreads to other nearby organs.
Because of the deep location of the pancreas, tumors are rarely felt by pressing on the abdomen. It is also why symptoms, including pain, often do not appear until the tumor grows large enough to interfere with the function of nearby organs such as the stomach, duodenum, liver or gall bladder.
While prognosis is generally regarded as poor, every patient is different, and all pancreatic tumors are not cancerous. Either way, surgical removal of a pancreatic tumor usually provides the only chance for cure.
In some instances, surgery may be used to relieve symptoms of an incurable cancer that cannot be effectively treated by other non-operable means. Surgeons use laparoscopy, a minimally invasive technique in which a telescopic lens connected to a video camera allows doctors to perform operations with small incisions, lessening recover time and improving a patient’s quality of life.
At Saint Francis Hospital and Medical Center, patients diagnosed with pancreatic tumors consult with experienced, highly skilled surgeons who are well-versed in all the surgical and non-surgical options available to them for the treatment of pancreatic cancer and tumors.
These options include:
- Diagnostic Laparoscopy. Modern diagnostic imaging techniques, including CT scans and PET scans, provide accurate and reliable information for the majority of patients. Most patients who would not benefit from surgery to remove the tumor can be ruled out as surgical candidates by these non-invasive procedures. But in some cases, surgeons need more information on the type and size of a tumor and use laparoscopy, often an outpatient procedure that allows the surgeon to visually inspect (and biopsy, if necessary) the tumor. This provides the surgeon with additional information to decide whether to operate or use other treatment methods.
- Surgical Resection. Once a patient has been deemed an appropriate candidate for resection (surgical removal) of the tumor, the surgeon’s goal is to perform the safest and least invasive procedure to successfully remove the growth. Since each patient presents a different case, the surgeon must consider a number of factors relating to the size and location of the tumor, as well as other factors, including the patient’s overall physical condition. The goal of the surgery is to completely remove the tumor and surrounding lymph nodes that may harbor cancer that has spread (metastatic cancer). In some cases, this requires removing a portion of the pancreas or cutting or removing other organs that have been affected by the cancer.
- Whipple Procedure (also know as pancreaticoduodenectomy). This procedure is designed to remove tumors in the head (picture) of the pancreas. First described by Dr. Alan O. Whipple of New York Memorial Hospital (now called Memorial Sloan-Kettering), the operation may include the removal of the duodenum as well as portions of the stomach and bile duct. (picture). In some instances, the surgeon may decide to preserve all of the stomach (“pylorus preserving pancreaticoduodenectomy”). Once the tumor has been removed, the functional gastrointestinal anatomy is restored by reconnecting the intestine to the pancreas, bile duct and stomach.
- Distal pancreatectomy. This operation is used to remove tumors in the tail and body of the pancreas (picture). In most instances, there is no need to cut across the stomach and bile duct so the reconstructive surgery necessary with the Whipple operation is not performed. It may, however, be necessary with this procedure to remove the spleen, an organ connected to the end of the pancreas, which removes unwanted materials from the blood, but is not necessary for survival.
- Total Pancreatectomy. This operation, used to treat multiple (“synchronous”) cancers in the pancreatic head, body and tail, means removal of the pancreas entirely. Its complexity is similar to the Whipple operation, but there is no pancreas left to reconstruct. As a result, patients become insulin dependent and need supplemental pancreatic enzymes to assist with digestion.
- Enucleation. This rare procedure (picture) is only used to remove small benign neuroendocrine tumors and is not appropriate for cancerous tumors.
- Palliative Surgery. Some patients may be diagnosed with tumors which cannot be cured with surgery. While those patients may benefit from successful anti-cancer treatments, such as chemotherapy and radiation, they may experience blockages in the bile duct and more rarely, in the stomach. Relieving those symptoms caused by a blockage often requires an invasive procedure. For many patients, the best approach to relieve a blocked bile duct is through an endoscopic placement of a stent (a plastic or metal tube inside the bile duct) by a gastroenterologist. Bile duct blockages can also be relieved by an interventional radiologist or a surgeon who can connect the intestine to the bile duct or gall bladder. Blockages in the stomach, although rare, usually require surgical intervention in which the blockage is bypassed by connecting the stomach to the intestine (picture). When surgery is required for patients with incurable pancreatic cancer, the procedures are usually less invasive, performed through laparoscopy and smaller incisions. Finally, patients with significant pain caused by pancreatic cancer may benefit from a celiac plexus block, an injection of alcohol into the nerves behind the pancreas.