The pancreas is the ‘sweetbread’ organ at the back of the abdomen. It is a flat glandular organ. It has a hormonal (endocrine) component that makes insulin and some other hormones. It also has an exocrine function which is the production of digestive juices that assist in the breakdown of proteins and fat. These juices are excreted through a duct into the duodenum (the first part of the small intestine) where they mix with the food we eat. The bile duct (bringing bile into the gut from the liver) passes through the pancreas on the way to the duodenum.
Tumours of the pancreas can be solid or cystic, and can arise from the exocrine duct cells or the endocrine gland cells. They can be benign or malignant. Rarely, the pancreas is a site for secondaries from cancers elsewhere (particularly melanoma). Most cysts in the pancreas are benign and can be safely watched. Most solid lumps should be removed because of the risk for cancer.
The most common cancer of the pancreas is ‘ductal adenocarcinoma.’ This is an aggressive tumour with poor outcomes unless it can be completely removed. Adenocarcinoma of the pancreas is associated with alcohol abuse, smoking and a history of chronic pancreatitis, although many patients will have none of these risk factors. Most patients are in the older age group. Unfortunately, most patients with adenocarcinoma of the pancreas present too late to be removed by surgery. When the tumour is small and has not spread then surgery can usually be performed in otherwise healthy candidates. Even after resection, only around one in five patients will be cured.
Other tumours that affect the pancreas include: cancers of the bile duct, cancers of the duodenum, cancers of the endocrine cells, and mucinous cystic neoplasms. In general, these are removed where possible.
What tests are done?
At a minimum, patients undergoing pancreas surgery will have a CT scan (or sometimes MRI), and blood tests. If the tumour involves the bile duct then it is often necessary to have an ERCP (Endoscopic Retrograde Cholangio Pancreatogram) which is a fibreoptic technique through the mouth like a gastroscopy. Sometimes a gastroscopy and ultrasound are used to identify a lump or to determine operability. It is unusual to require a biopsy prior to surgery.
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