Pancreatic Tumors
Understanding Pancreatic Tumors:
Tumors in the pancreas can be non-cancerous (benign) or cancerous (malignant). They are generally grouped into three main categories: adenocarcinomas, neuroendocrine tumors (NETs), and cystic neoplasms.
1. Pancreatic Adenocarcinoma:
This is the most common and often the most serious type of pancreatic cancer.
Risk Factors:
Factors that increase the likelihood of developing this tumor include:
- Cigarette smoking and tobacco chewing.
- Genetic mutations (inherited risks).
- A history of chronic pancreatitis.
Symptoms:
When symptoms appear, they often include:
- Pain in the upper abdomen.
- Jaundice (yellowing of the skin and eyes).
- Loss of appetite and resulting weight loss.
Diagnosis:
To confirm adenocarcinoma, doctors typically use:
- Ultrasonography and CT scan of the abdomen.
- The diagnosis is confirmed with Endoscopic Ultrasound (EUS), which is used to guide a fine needle aspiration (FNA) to collect a tissue sample.
Treatment:
- The best chance for a cure is surgical resection (removing the tumor entirely).
- However, only about 20% of tumors are found early enough to be fully removable by surgery.
- For unresectable tumors, treatment focuses on chemotherapy and palliation (relieving symptoms) through stent placement in the common bile duct (for jaundice relief) and the duodenum (for vomiting relief).
2. Neuroendocrine Tumors (NETs):
NETs arise from the hormone-producing islet cells of the pancreas. They are classified based on the hormone they secrete:
- Insulinoma
- Gastrinoma
- Somatostatinoma
- VIPoma
- Non-Functional Tumor (does not secrete excess hormones)
Symptoms:
Symptoms vary greatly depending on the type of hormone being secreted, but common signs may include:
- Diarrhea.
- Recurrent ulcer formation (seen with Gastrinoma).
- Attacks of hypoglycemia (low blood sugar, seen with Insulinoma).
Treatment:
- The primary treatment for localized NETs is surgery.
- For tumors that have spread (metastatic disease), chemotherapy and hormone-controlling medications like somatostatin analogues are often used.
3. Cystic Neoplasms:
These are fluid-filled sacs within the pancreas that need to be carefully distinguished from the non-cancerous fluid collections called pseudocysts.
Common Types:
The most frequently encountered cystic lesions are:
- Serous cystadenoma
- Mucinous cystadenoma
- IPMN (Intraductal papillary mucinous neoplasm)
- Solid pseudopapillary neoplasm
Symptoms:
- Small lesions usually cause no symptoms and are found accidentally during imaging tests.
- Large lesions can cause problems like pain or jaundice.
Diagnosis:
- EUS (Endoscopic Ultrasound) is considered the best test for diagnosis and for telling one type of cyst from another.
- During EUS, fluid can be safely aspirated from the cyst for detailed analysis.
- Additional imaging like Ultrasonography and CT scan of the abdomen are also used.
- The final diagnosis and differentiation are confirmed by EUS-guided fine needle aspiration.
Treatment:
- Small, asymptomatic lesions can usually be simply monitored with follow-up scans.
- Large or symptomatic lesions that pose a risk of becoming cancerous should be surgically removed.