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Medical Edge Newspaper Column from Mayo Clinic
PANCREATIC GROWTHS: TO OPERATE OR NOT TO OPERATE?
DEAR MAYO CLINIC: A couple of years ago, after an attack of pancreatitis, a CT scan revealed two growths at either end of my pancreas. I want them removed, but my doctor is hesitant because I’ve had such a difficult time with surgery in the past. He says I could react badly to the Whipple procedure, the longest-established and most common operation for my problem. Do I have any alternatives?
ANSWER: Growths in the pancreas often — though not inevitably — turn cancerous, and pancreatic malignancies tend to be aggressive. But without knowing exactly what is present, your doctor is justified in not wanting to rush you into surgery.
If further evaluation indicates your growths are premalignant, however, established surgical methods would be the best approach.
There are three basic options. All are complex procedures that involve excision of the abnormality and, for anatomical reasons, removal of some adjacent organs and restructuring of the digestive tract. One method, the Whipple procedure (pancreatoduodenectomy), deals with growths only at the head of the pancreas. Another — distal pancreatectomy — applies to growths only at the opposite end. Neither by itself could address your two growths.
If surgery is indicated in your case, you most likely would need the third surgical option — total pancreatectomy, or complete pancreas removal. After this procedure, you would require insulin and pancreatic enzymes to, among other things, digest fats, proteins and carbohydrates, and regulate blood sugar. However, depending on the precise location of the growths within the pancreas, it is sometimes possible to leave enough nonmalignant pancreatic tissue in place (subtotal pancreatectomy) so that the body can continue to produce at least some of these vital substances.
Your growths may not be invasive cancers, because, frankly, you would not likely be writing about them two years later — untreated pancreatic tumors tend to spread quickly throughout the body. Moreover, multiple pancreatic tumors are rare in the configuration you report.
The abnormalities in your case are unlikely to be pseudocysts (sacs lined with scar tissue), which are often found on an imaging study after a bout of pancreatitis. These lesions, which are usually harmless and often disappear on their own without treatment, do not often occur at both ends of the pancreas, and in any case they would be readily identifiable by imaging analysis.
Most likely your growths are cysts — sacs consisting of fluid or semisolid material. Several types of cysts exist; some are benign and others have varying degrees of malignant potential.
To determine the kind of cystic lesion that is present, additional evaluation would be required. First, using endoscopic ultrasound, the pancreas is imaged. As part of this procedure, a fine needle-aspiration biopsy is performed to identify the abnormal tissue, and therefore the cyst type, that is present.
Then, if surgery appears to be indicated, magnetic resonance imaging/magnetic resonance cholangiopancreatography might be performed to accurately image the pancreatic ducts, the bile ducts with which they connect, and the relationship to surrounding major blood vessels.
Although your growths were documented after a bout of pancreatitis, that illness may not have been the cause. In fact, it’s possible that the abnormalities were pre-existing and instead caused the pancreatitis. If so, this may actually have been a blessing in disguise. Most often, patients diagnosed with pancreatic cancer have malignancies so advanced they are inoperable. Only rarely are lesions identified early enough for surgery to cure the disease.
Testing may indicate that your pancreatic abnormalities are harmless and can be left alone or simply followed. But if they do turn out to be premalignant and surgery is indicated, you’d be among the lucky few with excellent prospects.
— J. Kirk Martin, M.D., Surgical Oncology, Mayo Clinic, Jacksonville, Fla.
Additional Resources:
Pancreatic Growths
Tumors of the Pancreas
Appointment Information
Pancreatic Cancer
Pancreatitis
Pancreatic Cysts
Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave.,
Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2005 TRIBUNE MEDIA SERVICES, INC.
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