Pancreatic Cancer

What is Pancreatic Cancer?

Pancreatic cancer is a malignant tumor of the pancreas. Each year approximately 38,000 new cases of pancreatic cancer are diagnosed in the United States and about 60,000 in Europe. Survival is directly proportional to the stage when diagnosed. The commonest type of cancer of the pancreas is an adenocarcinoma of the pancreas (>90%). Although it is the 4th leading cause of cancer deaths in men and women in the United States, survival is getting better everyday. Almost 30-40% of the patients have disease confined to the pancreas. The key is to find an experienced surgeon who can completely resect (remove) the cancer. This is the key to success. There is growing evidence to suggest that post-op chemotherapy improves long term survival and is slowly becoming the norm.

In over half the patients the disease has sometimes grown beyond the pancreas. There are two subtypes. One is locally advanced, i.e. involving the superior mesenteric vein or superior mesenteric artery. The second is the presence of metastatic disease, i.e. disease spread beyond of the pancreas. Involvement of the portal vein or superior mesenteric vein does not always preclude surgery, so if your surgeon turns you down, a second opinion is in order. On the other hand, involvement of the superior mesenteric artery is a relative contraindication. However with slow growing tumors such neuroendocrine tumors, it may be reasonable to consider resecting this and reconstructing the artery with a graft.

Less than 5% of the tumors are of neuroendocrine origin (NET). There are 2 distinct types of NET tumors: 1. Pancreatic endocrine tumors (PET), also know as “Endocrine tumors of the Pancreas” or “Islet Cell Tumors of the Pancreas” and 2. Carcinoid tumors. These tumors have a completely different diagnostic and therapeutic profile, and generally have a more favorable prognosis.

What is a Whipple Resection?

The whipple operation involves “removing the head of the pancreas”. As you will note from the illustration the common bile duct, the ampulla, the duodenum are all integrally related to the head of the pancreas and all share their blood supply. Therefore the Whipple operation is a fairly complex operation removing portions of all these structures and then re-hooking these back up to a new loop of intestine. Dr. Allen Whipple was a Professor of Surgery at Columbia University in New York City who popularized this operation in the early 1930’s. It has since undergone several minor modifications and therefore goes by different names. It is an operation that should only be done by experienced surgeons who do these routinely. Dr. Singh has been doing this operation for over 15 years with excellent outcomes. The average hospital stay ranges from 7-14 days.
 

 

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