Tumors in the Pancreatic Duct
About 37,000 people in the United States, mostly men aged 50 and above, are affected yearly with tumors in the pancreas.
Only 2 percent of pancreatic tumors are benign. Cystic tumors that are benign may however be pre-cancerous or develop into cancer if left untreated. Many of these benign tumors are also misdiagnosed as pancreatic pseudocysts and are inappropriately treated. Benign cystic tumors should be surgically removed because they have a high cure rate.
Most tumors in the pancreatic duct are cancerous and develop in the main duct and its branches. The pancreatic duct is where pancreatic juices are secreted into the small intestine to aid in digestion. Tumors may develop in the cells of its walls and produce copious amounts of mucous material that can cause obstruction of the duct.
The most common (95%) of these malignant tumors is the adenocarcinoma of the pancreas. Most of these tumors develop near the duodenum or the first part of the small intestine. Smokers and those who have a history of chronic pancreatitis and diabetes are prone to have the disease.
Symptoms of Pancreatic Duct Tumors
Because of its location, the most common symptom of these tumors is yellowish discoloration (jaundice) of the skin, at first not associated with abdominal pain. Jaundice occurs because the tumor also blocks the passage of bile from the liver and gall bladder into the part of the small intestine near the pancreas. It is often disregarded, and as the tumor grows other symptoms like nausea and vomiting with abdominal pain become prominent. The pain can extend to the back and to the neck. The white part or the eyes (sclera) also turn yellow, and the urine becomes dark colored. Finally, the patient loses appetite and weight loss is significant.
These symptoms often appear late when the tumor is inoperable, owing to its contiguity with many structures. Lymph nodes are also involved, as well as other nearby and distant organs.
Complications include esophageal bleeding and enlargement of the spleen and abdomen. Repeated blood transfusions may be done to treat anemia due to the bleeding esophageal varicose veins.
Diagnosis, Treatment and Prognosis of Pancreatic Duct Tumors
Owing to the difficulty in detecting early signs and symptoms of this disease, diagnosis is usually late. Initial history and physical examination, including blood tests may appear normal. Only radiologic exams may help in the initial detection, such as CT scan, MRI and ultrasound. Final diagnosis is made from a biopsy guided by these imaging methods.
Surgical removal of the tumor is often not completely possible. Radiotherapy and chemotherapy may be added to the therapeutic regimen to prolong life. Obstructions to the flow of pancreatic and bile secretions may be relieved by creating bypasses to allow flow.
Pain management has the most prominent role in the therapy. If non-steroidal analgesic drugs are not able to relieve pain, stronger alternatives like narcotics are given. Nerve blocks can also done, where local anesthetics are injected near nerves to produce long-lasting pain relief.
Since these malignancies have a poor 5-year survival rate (less than 20 percent) after surgery, doctors usually discuss end-of -life care with the family and care givers.
USC, Department of Surgery, “Cystic Tumors of the Pancreas” accessed 12/11/10
Merck Manuals, “Pancreatic Cancer” accessed 12/11/10