Pancreatic Cancer

As the name implies, the pancreatic tumor arises from the pancreas. Pancreas is an organ that lies in the back of the abdomen behind the stomach. Normally the pancreas functions to help digestion and secretes hormones that control the blood sugar.

There are two types of cells from which the Pancreatic tumor can arise

  1. hormone-producing cells ( Pancreatic neuroendocrine tumor PNET).
  2. Pancreatic ductal cells (Pancreatic adenocarcinoma).   The majority of pancreatic cancers are adenocarcinomas.

If resected Pancreatic Neuroendocrine tumors have good prognosis.

Contrary, Pancreatic adenocarcinoma has a poor prognosis, with surgery the only chance of cure in cases when there is no detectable cancer spread. Pancreatic cancer typically spreads rapidly and is often detected at late stages, which is a major reason why it's a leading cause of cancer death.

Pancreatic cancer typically causes symptoms like

  • Upper abdominal pain that may radiate to your back

  • Yellowing of your skin and the whites of your eyes (jaundice)

  • Loss of appetite

  • Weight loss

  • Depression

Some of the common test done for pancreatic cancer are abdominal ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).

Many times we will order further evaluation of the pancreatic tumor using Endoscopic Ultrasound with Fine Needle Aspiration. An endoscopic ultrasound (EUS) uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through a thin, flexible tube (endoscope) down your esophagus and into your stomach in order to obtain the images.  This procedure is done by our Gastroenterologist under anesthesia.  Through this test, pancreatic tumor tissue can be evaluated for accurate diagnosis of the type of pancreatic tumor.

If you have jaundice, Gastroenterologist may also have to do Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts in your pancreas. During ERCP, an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. A dye is then injected into the pancreatic and bile ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts. A stent will be placed to relieve the obstruction of the bile duct.

  • A tissue or cell sample (biopsy) can be collected during ERCP.

  • A stent can be placed to bypass the blockage to help with the obstruction jaundice.

 

Little is known about the cause of pancreatic cancer. However most pancreatic cancer have mutation called K ras mutation. This mutations cause the cells to grow out of control. K ras mutation is the most frequent mutation in the pancreatic cancers.  

Factors that may increase your risk of pancreatic cancer include:

  • Smoking

  • Being overweight or obese

  • Personal or family history of chronic inflammation of the pancreas (pancreatitis)

  • Personal or family history of pancreatic cancer

  • Certain familial genetic mutations can increase the risk of pancreatic cancer. eg. BRCA2 gene mutation, Peutz-Jeghers syndrome, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM)

  • Pancreatic cancer occurs most often in older adults. Most people diagnosed with pancreatic cancer are in their 70s and 80s

  • Pancreatic cancer occurs more commonly in African Americans.

Using available information, pancreatic cancer can be staged as follow.

  • Stage I. Cancer is confined to the pancreas.

  • Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.

  • Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes.

  • Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).

The surgery takes at least 3-4 hours (this is lowest time compared to our Peers) . You will likely need to stay in the hospital for 5-7 days afterward.

Before the surgery

We will schedule you to get cardiac clearance if required.  If you smoke, we will require you to quit smoking for 2 weeks.  If you take blood thinners like Plavix or Coumadin, we will work with your cardiologist to stop the medications. If you taking aspirin, we are generally OK with you taking until the day of the operation.

During the surgery

You will see anesthesiologist before the operation who will discuss the anesthesia with you. An IV line will be placed in your vein in order to give you medication, fluids, blood products if needed.   

The actual surgery will be discussed by Dr. Sukharamwala and will be discussed in details including the risk, benefits, alternative and complications.

After the surgery

You’ll be taken to a recovery room or intensive care unit. Nurses will monitor your condition. You’ll be moved to a hospital room when you’re stable. Medications are given to help manage pain and to relieve symptoms. When you are able, you will be encouraged to get up and walk. This helps prevent lung and blood flow problems. You won’t be able to eat for a few days. You’ll receive nutrition through your IV. Several days after surgery, you will start on a liquid diet. You will then slowly return to your normal diet. Before you go home, be sure you have all the prescriptions and home care instructions you will need.

If the tumor is located in Body or tail of the pancreas, distal pancreatectomy splenectomy is advised.

      

If the tumor is located in the head of the pancreas, Pancreaticoduodenectomy ( Whipple ) procedure is recommended.

       

The only curative option for pancreatic cancer is surgical resection. If the tumor is identified in stage I, prognosis is better.  

  • Please call us today at (813) 879-5010 to schedule an appointment at a location nearest to you.

 

All surgeries have risks. The risks of this procedure include:

Infection

Bleeding

Pain

Leakage of the connection between the intestine and the bile duct, pancreas, or stomach

Failure of the surgery to resolve the problem

Death

Many times pancreatic cancer will involve major vessels like portal vein, superior mesenteric vein and superior mesenteric artery. Dr. Sukharamwala has done advanced training and has expertise in safely removing the pancreatic tumor with vascular reconstruction.  If you have been told that your pancreatic cancer is unresectable, it may be prudent to visit us for a second opinion as we specialize in advanced pancreatic cancers with vascular involvement..

We approach such locally advanced pancreatic tumors very aggressively with Pancreaticoduodenectomy (Whipple procedure) with portal vein (PV) or superior mesenteric vein (SMV) resection.  In such cases, we would take a vascular graft from your neck vein (Internal Jugular Vein) or your Left kidney vein and use it as a patch to bridge the vein resected along with the tumor. Such a procedure is very challenging and we are proud to be the only tertiary care center in West Coast Florida to offer such a complex operation.

If you have been told your pancreatic cancer is unresectable, you may seek our second opinion to further explore newer approach we offer.

Please call us at (813) 879-5010 seek further treatment of pancreatic cancer.

Pancreatic Cancer

As the name implies, the pancreatic tumor arises from the pancreas. Pancreas is an organ that lies in the back of the abdomen behind the stomach. Normally the pancreas functions to help digestion and secretes hormones that control the blood sugar.

There are two types of cells from which the Pancreatic tumor can arise

  1. hormone-producing cells ( Pancreatic neuroendocrine tumor PNET).
  2. Pancreatic ductal cells (Pancreatic adenocarcinoma).   The majority of pancreatic cancers are adenocarcinomas.

If resected Pancreatic Neuroendocrine tumors have good prognosis.

Contrary, Pancreatic adenocarcinoma has a poor prognosis, with surgery the only chance of cure in cases when there is no detectable cancer spread. Pancreatic cancer typically spreads rapidly and is often detected at late stages, which is a major reason why it's a leading cause of cancer death.

Symptoms

Pancreatic cancer typically causes symptoms like

  • Upper abdominal pain that may radiate to your back

  • Yellowing of your skin and the whites of your eyes (jaundice)

  • Loss of appetite

  • Weight loss

  • Depression

Some of the common test done for pancreatic cancer are abdominal ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).

Many times we will order further evaluation of the pancreatic tumor using Endoscopic Ultrasound with Fine Needle Aspiration. An endoscopic ultrasound (EUS) uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through a thin, flexible tube (endoscope) down your esophagus and into your stomach in order to obtain the images.  This procedure is done by our Gastroenterologist under anesthesia.  Through this test, pancreatic tumor tissue can be evaluated for accurate diagnosis of the type of pancreatic tumor.

If you have jaundice, Gastroenterologist may also have to do Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts in your pancreas. During ERCP, an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. A dye is then injected into the pancreatic and bile ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts. A stent will be placed to relieve the obstruction of the bile duct.

  • A tissue or cell sample (biopsy) can be collected during ERCP.

  • A stent can be placed to bypass the blockage to help with the obstruction jaundice.

 

Causes

Little is known about the cause of pancreatic cancer. However most pancreatic cancer have mutation called K ras mutation. This mutations cause the cells to grow out of control. K ras mutation is the most frequent mutation in the pancreatic cancers.  

Factors that may increase your risk of pancreatic cancer include:

  • Smoking

  • Being overweight or obese

  • Personal or family history of chronic inflammation of the pancreas (pancreatitis)

  • Personal or family history of pancreatic cancer

  • Certain familial genetic mutations can increase the risk of pancreatic cancer. eg. BRCA2 gene mutation, Peutz-Jeghers syndrome, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM)

  • Pancreatic cancer occurs most often in older adults. Most people diagnosed with pancreatic cancer are in their 70s and 80s

  • Pancreatic cancer occurs more commonly in African Americans.

Using available information, pancreatic cancer can be staged as follow.

  • Stage I. Cancer is confined to the pancreas.

  • Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.

  • Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes.

  • Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).

Perioperative Care

The surgery takes at least 3-4 hours (this is lowest time compared to our Peers) . You will likely need to stay in the hospital for 5-7 days afterward.

Before the surgery

We will schedule you to get cardiac clearance if required.  If you smoke, we will require you to quit smoking for 2 weeks.  If you take blood thinners like Plavix or Coumadin, we will work with your cardiologist to stop the medications. If you taking aspirin, we are generally OK with you taking until the day of the operation.

During the surgery

You will see anesthesiologist before the operation who will discuss the anesthesia with you. An IV line will be placed in your vein in order to give you medication, fluids, blood products if needed.   

The actual surgery will be discussed by Dr. Sukharamwala and will be discussed in details including the risk, benefits, alternative and complications.

After the surgery

You’ll be taken to a recovery room or intensive care unit. Nurses will monitor your condition. You’ll be moved to a hospital room when you’re stable. Medications are given to help manage pain and to relieve symptoms. When you are able, you will be encouraged to get up and walk. This helps prevent lung and blood flow problems. You won’t be able to eat for a few days. You’ll receive nutrition through your IV. Several days after surgery, you will start on a liquid diet. You will then slowly return to your normal diet. Before you go home, be sure you have all the prescriptions and home care instructions you will need.

Treatment

If the tumor is located in Body or tail of the pancreas, distal pancreatectomy splenectomy is advised.

      

If the tumor is located in the head of the pancreas, Pancreaticoduodenectomy ( Whipple ) procedure is recommended.

       

The only curative option for pancreatic cancer is surgical resection. If the tumor is identified in stage I, prognosis is better.  

  • Please call us today at (813) 879-5010 to schedule an appointment at a location nearest to you.

 

Complications

All surgeries have risks. The risks of this procedure include:

Infection

Bleeding

Pain

Leakage of the connection between the intestine and the bile duct, pancreas, or stomach

Failure of the surgery to resolve the problem

Death

Second Opinion

Many times pancreatic cancer will involve major vessels like portal vein, superior mesenteric vein and superior mesenteric artery. Dr. Sukharamwala has done advanced training and has expertise in safely removing the pancreatic tumor with vascular reconstruction.  If you have been told that your pancreatic cancer is unresectable, it may be prudent to visit us for a second opinion as we specialize in advanced pancreatic cancers with vascular involvement..

We approach such locally advanced pancreatic tumors very aggressively with Pancreaticoduodenectomy (Whipple procedure) with portal vein (PV) or superior mesenteric vein (SMV) resection.  In such cases, we would take a vascular graft from your neck vein (Internal Jugular Vein) or your Left kidney vein and use it as a patch to bridge the vein resected along with the tumor. Such a procedure is very challenging and we are proud to be the only tertiary care center in West Coast Florida to offer such a complex operation.

If you have been told your pancreatic cancer is unresectable, you may seek our second opinion to further explore newer approach we offer.

Please call us at (813) 879-5010 seek further treatment of pancreatic cancer.