Mass in the Head of the Pancreas resected to negative margins |
|
What is Pancreatic Cancer?
Pancreatic cancer is a malignant tumor of the pancreas. Each year approximately 37,000 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.
About 5% of the pancreatic tumors are of exocrine origin (e.g. serous cystadenomas), acinar cell cancers, and pancreatic neuroendocrine tumors (such as insulinomas). These tumors have a completely different diagnostic and therapeutic profile, and generally have a more favorable prognosis.
|