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Pancreatic pseudocysts are fluid-filled masses in the pancreas. They form as a result of injury to the pancreas after acute pancreatitis.
Large pseudocysts can cause pain and difficulty eating. When pseudocysts get infected, patients present with fevers, chills and low blood pressure, and require immediate treatment.
Most pancreatic pseudocysts cause no symptoms and require no treatment. If a cyst does not resolve without treatment, patients may require a cystgastrostomy*. Infected pseudocysts are treated with antibiotics and need to be drained like an abscess.
*cystgastrostomy – A cystgastrostomy is a procedure or surgery, which allows the fluid from your pancreatic cyst to drain into the stomach. This can be done by your gastroenterologist during endoscopy or surgeon with laparoscopic surgery. A small hole will be made in your stomach right over the cyst, and the edge of the stomach and cyst will be sewn together. You will be able to eat and drink normally after your surgery.
Pancreatic neuroendocrine tumors, which arise from islet cells, but do not make hormones are called nonfunctional. They represent the majority of pancreatic neuroendocrine tumors, and can be benign (not cancer) or malignant (cancer).
Patients with nonfunctioning pancreatic neuroendocrine tumors can have vague symptoms such as diarrhea, indigestion abdominal and back pain, which worsen as the tumor grows in size. If the tumor is in the head of the pancreas, patients may become jaundiced.
In addition to the standard workup for a pancreatic tumor, the patient’s blood will be checked for chromogranin A levels.
Nonfunctioning pancreatic neuroendocrine tumors will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple Procedure and in the body or tail of the pancreas a Distal Pancreatectomy.
Distal Pancreatectomy is a surgery that removes a tumor from the body or tail of your pancreas.
Surgical removal of the tumor in the pancreas might also be recommended, if patients have metastases in other organs i.e. the liver.
The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.
This is a tumor of pancreatic island cells, which make insulin. Insulin controls the blood sugar. If there is too much insulin in the blood, the blood sugar will drop to a dangerously low level. Most insulinomas are benign (not cancer). Some are associated with a genetic disease called MEN 1. Those tumors have a higher chance of being a cancer (malignant).
Patients with an insulinoma may feel light-headed, confused, weak, sweaty, always hungry and have blurry vision.
In addition to the workup for any pancreatic tumor, there is a specific blood test for an insulinoma. The patient’s blood will be checked for blood sugar and insulin levels after fasting for at least 24 hours.
Insulinomas will always be removed by surgery, even if they have spread beyond the pancreas. If the tumor is small, it can be enucleated.
Enucleation means that only the part of the pancreas containing the tumor will be removed. This is almost always done by laparoscopy, which involves a camera and surgical instruments being inserted into the abdomen through small cuts. The tumor can be taken out of the abdomen through one of these small incisions.
For larger tumors in the head or tail of the pancreas, that patient will need a Whipple procedure or distal pancreatectomy.
A distal pancreatectomy is a surgery that removes a tumor from the body or tail of your pancreas.
The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.
This is a tumor of the islet cells that make gastrin. Gastrin stimulates the stomach to release acid, which helps with the digestion of food. Patients with too much gastrin and acid will have diarrhea and stomach ulcers. Gastrinomas are often malignant (cancer) and the most common pancreas tumors in patients with a genetic disease called MEN1.
Patients with gastrinoma can have ulcers that cannot be treated with medication, acid reflux diarrhea and abdominal and back pain.
In addition to the standard workup for pancreatic tumors, gastrin levels in the blood can be measured after fasting for at least 8 hours. A hormone named secretin can be given, and the amount of acid in the stomach can be measured, if the gastrin blood test is not conclusive. A special imaging test called an octreotide scan can be helpful, when a small tumor cannot be found on CT scan, MRI or Endoscopic Ultrasound.
Gastrinomas will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.
A distal pancreatectomy is a surgery that removes a tumor from the body or tail of your pancreas.
This is a tumor of the islet cells that make Glucagon. Glucagon helps regulate the blood sugar by releasing sugar into the blood. Patients with excess glucagon will have a high blood sugar (hyperglycemia), which cannot be controlled with medication. Glucagonomas are often malignant (cancer).
Patients with a glucagonoma can have a rash on their arms and legs, blood clots in their legs or lungs and experience all the effects of having a high blood sugar such as extreme thirst, dry mouth and skin, frequent urination, weakness and fatigue.
In addition to the standard workup for a pancreatic tumor, glucagon levels can be measured in the blood after at least 8 hours of fasting.
Glucagonomas will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.
A distal pancreatectomy is a surgery that removes a tumor from the body or tail of your pancreas.
This is a tumor of the islet cells that make somatostatin, which plays an important role in regulating blood sugar and other aspects of digestion. Somatostatinomas are often malignant.
Patients with a somatostatinoma can experience all the effects of having a high blood sugar such as extreme thirst, dry mouth and skin, frequent urination, weakness and fatigue. They may have diarrhea, foul-smelling, fatty stools (steathorrhea) and gallstones.
In addition to the standard workup for a pancreatic tumor, somatostatin levels can be measured in the blood after at least 8 hours of fasting. A special imaging test called an octreotide scan can be helpful, when a small tumor cannot be found on CT scan, MRI or Endoscopic Ultrasound.
Somatostatinomas will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.
A distal pancreatectomy is a surgery that removes a tumor from the body or tail of your pancreas.
This is a tumor of the islet cells that make vasoactive intestinal peptide (VIP), which plays an important role in regulating other hormones and the body’s salt and water balance in digestions. VIPomas are often malignant.
Patients with a Vipoma will have watery diarrhea and dehydration. The potassium levels in the blood will be low, and they may experience muscle weakness, cramps, tingling or numbness.
In addition to the standard workup for a pancreatic tumor, VIP levels can be measured in the blood. While potassium will be low in the blood, potassium and sodium will be high in the stool.
Somatostatinomnas will be removed with surgery. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.
A distal pancreatectomy is a surgery that removes a tumor from the body or tail of your pancreas.
Cystic neoplasms of the pancreas are different types of fluid-filled masses, which are benign (not cancer), but can become cancer over time. The type of cystic neoplasm is important for treatment.
These are the different types:
Most cystic neoplasms do not cause any symptoms, and are discovered by chance, when patients get a CT scan, MRI or ultrasound for another reason. As they grow, these tumors can cause pain, yellowing of the skin and diabetes.
The patient’s care team will recommend if the pancreatic cyst needs to be removed. Patients with a tumor in the head of the pancreas need a Whipple procedure and in the body or tail of the pancreas a distal pancreatectomy.
A distal pancreatectomy is a surgery that removes a tumor from the body or tail of your pancreas.
Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs as part of a standardized chemotherapy regimen. Chemotherapy may be given with curative intent, or it may aim to prolong life or to reduce symptoms.
If surgery is part of your treatment plan, your doctor will likely suggest one of two surgical procedures:
During surgery, the head of the pancreas, the gallbladder, the first part of the bowel called the duodenum, part of the stomach and bile duct are removed. New connections called “anastomoses” are made between the bile duct and the bowel, the pancreas and the bowel and the stomach and the bowel. These new connections are necessary for you to eat and digest your food.
The body or tail of the pancreas and the spleen are removed. No new connections or “anastomoses” are made. You will need vaccinations before surgery, because your spleen usually eliminates certain types of bacteria.
If your tumor grows into the portal vein, which is the main blood vessel to liver passing behind the pancreas, your surgeon might have to remove a small piece, when removing a tumor. The portal vein can be repaired.
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is therapy using ionizing radiation, generally as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator.
Patients, who have recovered from pancreatitis due to gallstones, may need to have their gallbladder removed surgically. The procedure is called a cholecystectomy, and can be done with a camera and small incisions (laparoscopic) or through a larger cut (open). During the operation the cystic duct and artery have to be clipped and cut. The gallbladder will be separated from the liver, and removed.
Patients can usually leave the hospital the day after the operation after laparoscopic surgery. They able to eat a regular diet, and will be given medication for pain at their incision (cut).
A cystgastrostomy is a procedure or surgery, which allows the fluid from your pancreatic cyst to drain into the stomach.
This can be done by your gastroenterologist during endoscopy or surgeon with laparoscopic surgery. A small hole will be made in your stomach right over the cyst, and the edge of the stomach and cyst will be sewn together. You will be able to eat and drink normally after your surgery.
A Multidisciplinary Tumor Board is a team of doctors and nurses who discuss your individual case to recommend the best treatment options for you based on your specific information. The members of Tumor Board include:
Usually once a week
The Tumor Board needs to have the latest imaging available to make accurate recommendations. Patients are typically presented after all of the appropriate tests are completed.
Because multiple patients are presented at a single Tumor Board, having patients attend is discouraged for privacy concerns. However, you will learn the recommendations of the Tumor Board at your next clinical appointment.
A cystgastrostomy is a procedure or surgery, which allows the fluid from your pancreatic cyst to drain into the stomach.
This can be done by your gastroenterologist during endoscopy or surgeon with laparoscopic surgery. A small hole will be made in your stomach right over the cyst, and the edge of the stomach and cyst will be sewn together. You will be able to eat and drink normally after your surgery.
A Multidisciplinary Tumor Board is a team of doctors and nurses who discuss your individual case to recommend the best treatment options for you based on your specific information. The members of Tumor Board include:
Surgeons, Oncologists, Radiologists, Pathologists & Gastroenterologists.
Usually once a week.
The Tumor Board needs to have the latest imaging available to make accurate recommendations. Patients are typically presented after all of the appropriate tests are completed.
Because multiple patients are presented at a single Tumor Board, having patients attend is discouraged for privacy concerns. However, you will learn the recommendations of the Tumor Board at your next clinical appointment.
