What Are Intrapapillary Mucinous Neoplasms?

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Tumors of the Pancreatic Duct

Intrapapillary mucinous neoplasms are tumors that can arise within the duct of the pancreas. These tumors are called mucinous because the tumor cells produce a thick, mucinous fluid. If these tumors are detected late or left untreated, a benign lesion may grow into a malignant one. These are also known as intraductal papillary mucinous neoplasm (IPMN) which can become an aggressive pancreatic cancer if left untreated. There is a rising incidence of this tumor and it is important to manage them and treat them effectively before they become more invasive. Among the elderly people, these tumors are particularly more common.

Symptoms of IPMNs

These neoplasms may be diagnosed clinically due to various symptoms. Nausea, vomiting and pain in the abdomen are the most common signs. Other typical symptoms include weight loss, appetite loss, severe pancreatitis and jaundice. When the patient seeks medical treatment for these problems, intraductal papillary neoplasms may be detected. Since these symptoms are not very specific in nature, the doctor will usually order additional tests to diagnose the disease. Sometimes the pancreatic lesions may be discovered when the patient gets an X-ray or CT scan done for another reason. In most cases, when the doctor suspects this disease, he may use advanced imaging tests such as endoscopic ultrasound, computerized tomography, or MRCP test.

Treatment for Main Duct Type Intrapapillary Mucinous Neoplasms

Nearly 70 percent of all main duct type IPMNs harbour high grade dysplasia, which is just one step before an invasive cancer development. These are prominent lesions, and in most cases the doctor may decide to surgically remove the neoplasms if the patient is in a position to tolerate surgery. The operating surgeon should be ideally experienced in handling pancreatic surgeries. In most cases, the treatment may involve only partial resection of the tail or head of the pancreas to remove the tumors. However, in exceptional situations it may be necessary to remove the complete pancreatic gland if the neoplasm involves the entire length of the pancreas.

Treatment for Branch Duct Type IPMNs

This treatment is relatively more complex, therefore the doctor has to consider the benefits of treatment versus the risks associated with it. A majority of branch duct IPMNs are benign, so it may be a good idea to avoid surgery if the lesions are small. The international treatment guidelines on this issue suggest that if the lesion is below 3 cm in size for an asymptomatic patient, does not contain solid mass, and is not connected with ballooning of the main duct, there is no need to remove it surgically. However, a periodic radiographic monitoring of the lesion is important to evaluate if it is undergoing any change.

Risk of New Pancreatic Lesions

IPMN lesions can be multiple, and even if a patient has had an IPMN removed surgically, he still continues to be at a higher risk for developing a second lesion. Therefore, periodic monitoring in such cases becomes important. It has also been observed that patients with an IPMN are slightly higher of developing colorectal tumors. Due to such risks, an experienced specialist will always advise the patient to have regular follow-up visits and periodic tests for early detection of any new tumors.