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Gastroenterology  (Expert Forum)
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Pancreas Questions
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
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MedHelp Member's Question

Pancreas Questions

by PCQ, Jun 30, 2003 12:00AM
This patient is in his late 50s and, after a single attack of acute pancreatitis (which has since resolved), had a CT scan that showed a "mass" in the body of the pancreas and dilated pancreatic duct, suggesting possible pancreatic cancer or "IPMT". A subsequent abdominal sonogram reported the mass as 2cm x 2.5cm. Both tests indicated that other organs are not affected. Questions: (a) How common is it for PC to appear as acute pancratitis? (b) (2) Doctors indicated that, if this turns out to be PC, it is "early stage". How long does it take for PC to grow from "early" to "advanced"? Is "early" stage PC in the body operable? How urgent is it for an operation to be done -- if it is PC?



Most available information points out that PC is usually discovered at an advanced stage. What is the outlook if it is discovered early? Any other pertinent info?
Doctor's Answer

by Kevin Pho, MD, Jul 02, 2003 12:00AM
Hello - thanks for asking your questions.



Surgeon has kindly addressed your questions.  Here are some additional thoughts.



PC typically presents with pain, weight loss and jaundice.  Tumors in the body of the pancreas tends to present with weight loss and pain.  



You may want to consider obtaining tumor markers.  The CA 19-9 marker has a sensitivity and specificity between 80 to 90 percent for pancreatic cancer and varies with tumor size.  



As surgeon has mentioned, with a history of alcohol, it is possible that this would be related to pancreatitis rather than PC.  



If the mass continues to be present, further testing with an MRI or fine needle aspiration can be considered.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (7)

by surgeon, Jun 30, 2003 12:00AM
One question is whether there's an explanation for why he had pancreatitis: most commoly it's due to gallstones or alcohol excess. If neither of these apply, then it's more possible that the mass is cancer, although it's not the typical way cancer presents. It can be very difficult to prove a mass in the pancreas is NOT cancer without removing it. You don't state what the time frame is between the pancreatitis and the discovery of the mass. If it's very soon, it might be appropriate to recheck in a few weeks to see if it's getting bigger or smaller. I assume it's certain it's not a cyst: they can occur after pancreatitis, and when small may not need any treatment at all. As to the cure rate of pancreatic cancer: it's not good. Cancer of the body of the pancreas is practically never cured, because it's never found early enough, before it's spread. In general, the ones that are cured are the ones that occur close to the bile duct, so the patient gets jaundice, which leads to discovery, very early in the course.  Even then, the cure rate is discouragingly low. Nor is there really much time to wait: if this was a lucky accident leading to discovery, it needs attention right away. The good news is that removing the body and tail of the pancreas is much less of a big deal than removing the head, where the bile duct is .

by PCQ, Jun 30, 2003 12:00AM
To: surgeon
Thanks for the response. Time from pancreatitis attack to CT scan was 4 weeks. History of moderate drinking but not excessive, I believe. Sonogram showed no gallstones.



The main question was, and I think you answered it, what if a tumor in the body of the pancreas is discovered early -- just by luck. Would 2.5cm in size and no mets qualify as "early"?



And, is anything known about how fast these things grow? Because it appears that there may be a tradeoff between "let's wait a couple of months and look again" and "it's too late to operate now".

by PCQ, Jun 30, 2003 12:00AM
To: surgeon
Just checked, and time from end of acute pancreatitis attack to CT scan was 3.5 weeks. Evidently, AP attack started after a night of significantly heavier than average drinking. "Normal" had been 3 drinks/day.

by surgeon, Jul 01, 2003 12:00AM
Not knowing all the details, including seeing the films, any opinion I give is pretty much in a vacuum. Nevertheless, that close to the episode, which may be alcohol related, I might well be inclined to re-image in a short interval, because it could be residual inflammation from the pancreatitis. There's probably no "scientific" data on how long of a wait is safe -- this situation doesn't come up much. The typical presentation of cancer in the body of the pancreas is pain, due to extention into surrounding tissues, by which time it's already too late.

by lemonhead, Jul 02, 2003 12:00AM
I was Dx'd with an IMPN (or IPMT) in February and just had the operation (called a Whipple) to remove the head of the pancreas, the bile duct, the duodenum etc about a month ago.



As others have pointed out, it's very difficult to know whether it's cancerous or not unless you take the tumor out and send it to pathology, but mine was about the same size as yours was. I elected to have a Whipple operation bc I have PC in the family and didn't want to risk the tumor evolving to PC at some point in the future. As it turns out, mine wasn't cancerous but it could have turned into that at some pt. I also had a precancerous polyp in my duodenum so that came out at the same time.



The whipple is a tough surgery to go through and it makes a difference who does it. You need someone who has a lot of experience with it bc there's a direct link between the surgeon's experience and how many complications you have.



However, it wasn't an emergency operation or anything. My pancreatic surgeon suggested that I have it out sometime over the next 3 years or so, with occasional monitoring with CT scans etc. I elected to have it taken out sooner than later, just bc I am probably about to be laid off from my job and wouldn't have the health insurance if i waited longer. Plus it worked best with my schedule etc.



I highly recommend you searching the net for more info on this so you're more educated about it and can make a decision that's right for you. Google.com has lots of hits if you type in IMPT and pancreas. There's also a good site linked with Johns Hopkins Hospital and pancreatic cancer that I found helpful/



Good luck to you.

lemonhead

by PCQ, Jul 02, 2003 12:00AM
I appreciate all the responses, and I am impressed with the quality of this website.



Lemonhead, if you had a Whipple, that means your tumor was in the head, correct? In this case it is in the body, and one of the possibilities that have been suggested (and "surgeon" here also mentioned) is distal pancreatectomy, or possibly "central" pancreatectomy (where the tail is preserved and sewn to the intestine to preserve its function). The latter sounds pretty complex -- I wonder if it is as complex as a Whipple.

by seven7, Jul 05, 2003 12:00AM
I am keeping a close watch on this site, because I have an enlarged pancreas.  I found out about this by accident as a result of a CT scan  I was given on my one year check up   after a mastectomy (because OF cancer