- What is the pancreas?
A. The pancreas is a digestive and hormone-secreting organ located in the back of the abdomen (picture). Its primary functions are to control the metabolism of carbohydrates (sugars), through the secretion of the hormones insulin and glucagon, and to initiate the digestion of dietary proteins and carbohydrates by secreting enzymes into the intestinal tract. Patients can live without a pancreas but they must take insulin (to control the diabetes that results from loss of pancreatic function) as well as digestive enzymes with their meals.
- What kinds of diseases affect the pancreas?
A. The most common pancreatic disorders patients experience are diabetes mellitus, due to inadequate insulin function, and pancreatitis which is inflammation of the pancreas. Pancreatic tumors are less common and include a wide variety of benign and malignant growths. Pseudocysts are collections of fluid within the pancreas that result from prior attacks of inflammation.
- What kinds of pancreatic tumors are there?
A. There are many different types of pancreatic tumors and each of them has a different prognosis and treatment approach. Some are safe to observe; others are quite lethal and require aggressive treatment plans often including surgery, radiation therapy and chemotherapy.
- What causes pancreatic cancer?
A. The development of pancreatic cancer is thought to be related to multiple genetic and environmental factors. Cigarette smoking is probably the biggest risk factor for the development of pancreatic cancer. While there is an association between pancreatic cancer and diabetes, as well as chronic pancreatitis and obsesity, no causal relationship has ever been definitively proven. True hereditary cases are rare and may be suspected when 2 or more other family members have the disease.
Is there a blood test for pancreatic cancer?
A. There is no sensitive or specific test effective in the early detection or screening for pancreatic cancer. The most common blood test, Ca 19-9, is used primarily in following the tumor’s response to treatment and in surveillance for disease recurrence.
I have been diagnosed with pancreatic cancer- what does that mean?
A. The diagnosis of pancreatic cancer is first based on your doctor’s suspicion that your individual history, physical examination and x-rays are consistent with a malignant tumor arising in your pancreas. Ultimately, the final diagnosis of pancreatic cancer depends on confirmation by microscopic evaluation of tissue removed from your body through a biopsy or surgical removal of the tumor.
What kinds of tests should I have to see if the cancer has spread?
A. A CT scan of the abdomen and chest x-ray should be performed initially. In some instances your doctor may also deem it appropriate to order a positron emission tomogram (PET scan).
Should I have a biopsy of my tumor before surgery?
A. Patients who are candidates for surgical removal of the tumor do not need a biopsy before the surgery. Current biopsy methods are often inaccurate and do not usually influence the decision to proceed with surgery. Biopsies are often reserved for patients who present with metastatic disease or who are suspected of having tumors such as lymphoma that are treated primarily with chemotherapy.
Who are candidates for surgery?
A. Patients whose x-rays show disease limited to the pancreas and who have satisfactory general medical condition are those most likely to benefit from surgery to remove the tumor-bearing pancreas. If the tumor has spread (metastasized), the surgery is unlikely to cure them. If they suffer from significant, chronic debilitating diseases in other organs (heart, lung, liver or kidneys), they may not be able to tolerate the aggressive surgery necessary to remove the pancreas.
- What does the stage of my cancer
A. The stage of your cancer is a summary description of your cancer pulling together all the information known from your physical examination, x-rays, biopsies and surgery. It reflects the extent of your disease both at the site where it started and whether it has spread to other parts of your body such as lymph glands and other organs. It also provides doctors with a guide for counseling you as to your chance for cure (prognosis) and recommending various treatment options.
Should I have my whole pancreas removed?
A. Studies have shown that routine total pancreatectomy (removal of the entire pancreas) does not improve survival in patients with solitary tumors in the pancreas. Most patients with pancreatic cancer require removal of only a portion of the pancreas. In rare instances where multiple cancers are detected in the pancreas, patients may benefit from removal of the entire gland.
What is a Whipple operation?
A. The Whipple operation is a surgical procedure to remove tumors in the head of the pancreas (picture), the most common location of pancreatic cancer. In this operation the duodenum, a portion of the bile duct and surrounding lymph nodes are removed. The surgeon then reconstructs those portions of the GI tract in order to restore a patient’s digestive function.
What is a distal pancreatectomy?
A. A distal pancreatectomy is the operation used in removing tumors in the tail and body of the pancreas (picture). While in some instances it may be necessary to remove the spleen during this operation, it is usually not necessary to remove other digestive organs. As a result, the recovery from this operation tends to be quicker and easier for patients.
What kinds of complications occur after pancreatic cancer surgery?
A. Many patients undergoing pancreatic cancer surgery can expect to experience minor complications such as weight loss and wound infections. Major complications such as bleeding, intra-abdominal infections, leakage from the reconstructed GI tract, blood clots, heart attack, and pneumonia are becoming increasingly rare. This is due to significant improvements in patient selection, pre-operative preparation, surgical technique and postoperative care. When they occur, most of these complications are promptly recognized and readily corrected. As a result, in most centers where pancreatic surgery is routinely performed, mortality rates are less than 1%.
Does it make a difference where I have my surgery performed?
A. During the past decade, multiple studies have definitively demonstrated that patients experience better outcomes (fewer complications, improved survival) when their pancreatic surgery is performed at a high volume center. (greater than 20 operations per year) Surgeons practicing in these centers generally have additional training and experience in performing these complex operations. In addition the support services involved in the peri-operative care of these patients tend to have more experience dealing with the specialized issues involved in this surgery.
How long will I be in the hospital after surgery?
A. In general, most patients will stay in the hospital 7-10 days after a Whipple operation. If they develop complications or have a slower recovery, their discharge from the hospital may be delayed.
- What is my recovery after surgery?
A. Most patients can expect to feel run down 4 to 6 weeks after their surgery. They may experience varying degrees of discomfort in their surgical wound for a similar time period, although most will no longer require pain medications after 2-3 weeks. Return of digestive function and weight gain will vary from patient to patient, though most should return to normal within 4 weeks. Depending on their occupation and lifestyle, full return to normal may take longer. Patients may generally shower as soon as they get home. Driving an automobile may usually be resumed when patients are alert and feel their reflexes and responses permit safe driving.
- What treatments will I need after
A. In many instances patient will be recommended to receive chemotherapy and radiation therapy after their surgery. These treatments are administered with the intent of destroying any microscopic bits of tumor potentially left in your body after surgery. These treatments typically begin 4-6 weeks after surgery.
What kinds of tests and x-rays do I need after my treatments are complete?
A. Most cancer specialists will meet with their pancreatic cancer patients 3-4 times a year to examine them and check for recurrence. Some physicians will order routine blood tests, such as a blood count and Ca 19-9, as well as PET and CT scans to look for recurrence. Between scheduled visits, any new symptoms that patients note may also prompt these evaluations.
What if the cancer comes back?
A. Your doctor will meet with you and, depending on the nature and location of the recurrence, discuss various treatment options which could include more chemotherapy, radiation therapy and/or surgery.