The pancreas is an organ about 16-17 cm long located behind the stomach and in front of the spine. It produces digestive enzymes that help break down hormones and nutrients that help control blood sugar levels. Pancreatic cancer is a rapidly progressing and poorly progressive cancer that occurs in older ages (40-85 years), mostly seen in men. Risk factors;
• Diabetes (diabetes mellitus)
Long-term heavy alcohol use
Chronic pancreatic inflammation
Often times, pancreatic cancer begins in the cells lining the ducts throughout the pancreas. There are two types of pancreatic tumors: exocrine tumors and endocrine tumors. Exocrine tumors make up 95 percent of all pancreatic cancer diagnoses. Treatment for exocrine pancreatic tumors may include surgery, chemotherapy or radiation therapy, or a combination of these therapies. Endocrine tumors are less common, only accounting for about 5 percent of pancreatic tumors. Often referred to as pancreatic neuroendocrine tumors (NETs) or islet cell tumors, they are found in islet (endocrine) cells scattered throughout the pancreas. These tumors have a better prognosis than exocrine tumors.
What are the symptoms in pancreatic tumors?
• Abdominal pain,
Waist and back pains
• nausea - vomiting,
• foul smelling stools,
• Light colored stools,
Unintentional weight loss,
• Symptoms such as general weakness may occur.
If there are symptoms that suggest pancreatic cancer, imaging tests such as blood tests, ultrasonography or computed tomography (CT), and / or an endoscopic examination called endoscopic retrograde cholangiopancreatography (ERCP) should be performed. These tests show whether there is a mass (growth) in the pancreas and whether surgery is possible to remove the mass. In some cases, a biopsy is required to confirm a cancer diagnosis. Biopsy involves removing a small piece of tissue from the mass. Biopsy can be performed with an imaging-guided needle or by using ERCP or endoscopic ultrasonography (EUS). However, if a tumor is seen radiologically in patients with clinical findings such as jaundice, biopsy is not necessary in every case.
Pancreatic cancer can be treated with several approaches. Early-stage pancreatic cancers can usually be treated surgically. Operation procedure; It depends on where the mass in the pancreas is in the pancreas. The procedure to be applied for a cancer in the pancreatic head is an operation called the "Whipple Procedure". During this operation, the pancreatic head, part of the stomach, duodenum and gall bladder are removed and new ways are made. If cancer is in the tail of the pancreas, the last part of the pancreas is removed with or leaving the spleen. After surgery, advanced therapy called "adjuvant therapy" is usually recommended. This may include chemotherapy and radiation therapy.
Surgery is not possible in more advanced pancreatic cancer; pancreatic cancer is usually advanced when diagnosed. If surgery is not possible, radiation therapy, chemotherapy, or both are often used to shrink the cancer, reduce symptoms, and prolong life.
Some cystic structures and their formations in the pancreas are generally benign, but some can be considered "precancerous" (if left untreated, they can become cancerous over time). These cystic structures should be followed by imaging methods. In some cases, these growths do not require treatment, while in some cases surgical treatment may be required. Pancreatic cysts are sac-like pockets that grow in the pancreas. There are many types of cysts, each with different symptoms and treatments.
Serous cystic neoplasms make up 30% of pancreatic cysts. Serous cyst adenomas are always benign and require treatment if they are large or symptomatic.
Mucinous cystic neoplasms are slow-growing precancerous tumors with cysts filled with a jelly-like substance called mucin. It is most common in women. If left untreated, it can become cancerous.
Intraductal papillary mucinous neoplasms (IPMN) grow in the pancreatic ducts. In cases where the risk of cancer may increase depending on the type or location and size of IPMN, they should be treated surgically. These include cases with symptoms such as;
Growth in the nodule part accompanying the cystic structure (> 5mm)
Main pancreatic duct> 10mm
• Accompanying obstructive jaundice
Also, other features that should be followed closely: (worrisome features)
• Cyst ≥3 cm
Those with thickening and contrast enhancement in the cyst wall
Growing mural nodule <5 mm
Main pancreatic duct 5-9 mm
Sudden change in pancreatic canal calibration and distal atrophy
• Increase in cyst size ≥5 mm in 2 years
• Increase in Ca19-9 levels
Patients who are sure to recommend surgical treatment:
IPMNs associated with all main channel
• All other IPMNs showing the above high risk features
All mucinous cystic neoplasms
Pancreatic cysts are usually detected during radiology imaging, such as computed tomography (CT) and magnetic resonance (MRI), and are often confirmed by endoscopic imaging. Pancreatic cysts can be associated with some underlying inherited disorders and occur in about 10 percent of patients with polycystic kidney disease. CT, MRI, and other tests better determine which cysts may need surgery.
Surgical options may include minimally invasive options such as open surgery, laparoscopic, or robotic-assisted surgery.