If the cancer in the ampullary , periampullary or head region .............
Cancers of the pancreas are the 4th most common cause of cancer death worldwide , incidence
of pancreatic of cancer increases with age. More in male then female The vast majority of patients are aged between 50 and 80 years of age.
The only known risk factor is smoking. Diabetes is not known to increase the risk of pancreatic cancer. Dietary factors such as alcohol and fat have been implicated but not proven as yet to cause pancreatic cancer.
The symptoms of pancreatic cancer are generally vague and non-specific. Weight loss is one of the earliest symptoms Abdominal pain is not uncommon late in the disease. Another late symptom is jaundice, or yellowness of the whites of the eyes
If pancreatic cancer is suspected, the initial diagnostic test would be a CT or computerized scan of the abdomen. The CT scan is able to detect any pancreatic mass greater than 2cm in 95% cases. Smaller cancers are more difficult to detect. Magnetic resonance imaging (MRI) scans can visualize the pancreas and the ducts in the pancreas. This can be particularly useful when planning surgery.
Another procedure that is often done is an endoscopic retrograde cholangiopancreaticography (ERCP) which involves using a fiberoptic scope to look into the stomach and small intestine where the ducts of the pancreas drain into duodenum. The tumour can also be biopsied during this procedure. If a blockage of the ducts is seen, a small plastic tube, called a stent, can be placed during this same procedure to release the block.
Sometimes, when a biopsy cannot be obtained via ERCP, a percutaneous biopsy of the pancreatic lesion is performed to obtain tumour tissue for diagnosis. This involves inserting a needle through the abdominal wall to the pancreas under CT or ultrasound guidance.
Surgery continues to be the treatment of choice for pancreatic cancer. Early diagnosis increases the resection rate The nature of surgery depends on the site of pancreatic cancer.
If the cancer in the ampullary , periampullary or head region , then the standard surgery is partial pancreato duodenectomy, popularly known as Whipple’s Procedure. It involves resection of portions of multiple structures like distal part of stomach, head of the pancreas, gall bladder, distal bileduct, duodenum and part of proximal small bowel leaving behind the major blood vessels. After removal of these structures the anatomical and functional integrity is restored by anastmosis of bowel with the structures like pancreas ( pancreato jejunostomy), bileduct ( hepatico jejunostomy), Stomach ( gastro jejunostomy) and bowel with bowel ( entero- enterostomy).
Distal pancreatectomy: Tumours in the body and distal part ( ie Left side) of pancreas needs distal pancreatectomy This involves dividing the left side of the pancreas to remove areas of disease in the tail and body of the pancreas. This operation is used more often with islet cell tumors found in the tail and body of the pancreas. The tail of the pancreas lies directly in front of the blood vessels to the spleen. Sometimes it become difficult to separate the blood vessels of the spleen from the tumor, in that situation spleen also must have to be removed. The spleen is an important part of the immune system; Splenectomy causes increase chance infection by some of the organism. Prophylactic vaccine against infection is given prior to its removal
Middle pancreatectomy: If the tumor in the pancreas is in the middle part, then middle portion of the pancreas removed. This is a pancreatic parenchyma preserving procedure. The proximal part with head of the pancreas and also the distal part. is preserved. Duct of the proximal part closed and the distal part anastomosed with bowel ( pancreato jejunostomy) for drainage of pancreatic juice.
It is known that only 18% to 20% pancreas cancers are respectable. Most patients are not candidates for curative surgery because of the advanced stage of disease when diagnosed. Even if curative surgery is not possible, bypass procedures performed for patients with blockage of the bile duct (causing jaundice) or duodenum caused by pancreatic tumours that cannot be removed during the time of surgery .It is performed to improve the patient’s quality of life Prognosis of Pancreas Cancer: Even with curative surgery, about half of patients with pancreatic carcinoma survive between 2 to 3 years. The chance of surviving to 5 years after curative surgery is about 20%.