The pancreas is a complex organ with many different types of cells in it. Each of these cell types may give rise to different types of tumors. The correct diagnosis of the tumor type is important since the prognosis for survival is dependant on the tumor type and surgical removal of some tumors in the pancreas can be associated with a normal life span. Often the type of tumor that is present in the pancreas can be diagnosed from specialized studies such as radioisotope studies and CT scans.
There are many different types of tumors that can develop in the pancreas. A pancreatic specialist can evaluate your tumor and determine which type of tumor is present in your pancreas. Approximately 85% patients have very aggressive type of tumor called adenocarcinoma of the pancreas. In about 15% of patients other tumors in the pancreas are found that areless aggressive types of tumors which are often curable. An evaluation in a center that is experienced in the treatment of pancreatic cancer is important for determining appropriate treatment for pancreatic tumors.
What are the steps in the work up and treatment of the tumor in the pancreas
The following questions are sequentially addressed when a patient is seen at USC with a pancreas mass:
Adenocarcinoma of the pancreas
The most common type of cancer of the pancreas is an adenocarcinoma which is a tumor that arises from the cells that line the duct of the pancreas. 85% of all cancerous tumors of the pancreas are adenocarcinomas. Approximately 30,000 new cases of pancreatic adenocarcinoma are diagnosed each year and approximately 28,000 patients die from pancreatic cancer each year. Only about 20 to 40% of patients with adenocarcinoma of the pancreas have a tumor that is confined to the pancreas at the time of diagnosis. The 5-year survival for patients who undergo surgical resection of adenocarcinoma of the pancreas is about 20 to 40%.
Surgery is a treatment of choice for patients who have adenocarcinoma of the pancreas that is surgically removable. Careful selection of patients for surgery is important. since surgical removal is associated with the best outcome diagnosing testing to identify patients suitable for surgery is extremely important. Appropriate diagnostic testing will also avoid unnecessary surgeries in patients whose tumors are too advanced for surgical removal.
The surgical procedure that is done depends on the location of the tumor in the pancreas. For tumors that occur in the head (which is the first part) of the pancreas, the Whipple operation is usually performed. For tumors that are located in the body and tail of the pancreas a distal pancreatectomy that removes the bottom half of the pancreas is recommended.The results of surgery have dramatically improved in the last two decades such that today the mortality (death) rate from surgery is less than 3 to 4% in tertiary care centers.
Most patients will require chemotherapy and radiation therapy after the surgery. Patients with unresectable tumors are often treated with chemotherapy and radiation therapy, and in some patients response to the treatment may allow subsequent surgical removal of the tumor.
Other tumors in the pancreas
85% of tumors that are found in the pancreas are adenocarcinoma of the pancreas. 15% of tumors that develop in the pancreas are not adenocarcinomas and these tumors often have a far better prognosis. Since many patients with these tumors are often cured after surgery, identification and aggressive treatment of these tumors is important.The tumor types that are found in this group include:
The majority of these tumors are non-malignant or benign, however even malignant tumors have five year survival rates in the order of 40 to 80% depending on the tumor type. In view of the excellent outcome, aggressive surgical therapy is indicated for these tumors, and the part of the pancreas that is affected by the tumor is removed.
At USC our emphasis has been to preserve as much of the pancreas as possible when removing benign and precancerous tumors to minimize the consequences of removal of large amounts of the pancreas such as diabetes and malabsorption (inability to digest food).
Specialized pancreatic procedures that are performed only in few centers in the United States such as a pancreatic head resection where only the head of the pancreas is removed preserving the duodenum and the bile duct that would otherwise be removed in a Whipple operation, central pancreatectomy where only the central portion of the pancreas is removed for tumors in this location preserving the head and body and tail of the pancreas and laparoscopic procedures that emphasize minimal access surgical technique for more rapid recovery are offered to patients at USC with benign tumors of the pancreas.