What is the pancreas?
The pancreas is a gland, which lies behind the stomach, in the back of the abdomen. It is a solid organ which produces hormones, including insulin which controls the sugar levels in the blood. It also produces “pancreatic juices” which contain important enzymes required for the break down of food and absorption of nutrients.
What is pancreatic cancer?
Pancreatic cancer is an abdominal malignancy originating from the pancreas and in many cases shows an “aggressive behaviour” as it may spread to other organs relatively soon from the time of diagnosis. There are different types of pancreatic cancer depending on the origin of the tumour cells. The vast majority of them (approximately 8 out of 10 cases) are made from cells in the lining of the pancreatic duct and are called “pancreatic ductal adenocarcinoma.”
There are however, other types of pancreatic tumours such as neuroendocrine tumours which are less common and carry different prognosis.
What are the treatment options?
All new diagnoses of pancreatic cancer should be discussed in dedicated cancer meetings (such as the weekly meeting at the German Medical Institute) where healthcare professionals who manage patient with such malignancies convene in order to draw a management plan for each patient. The management plan for each case depends on the type of cancer, the stage of the disease and the medical background of each patient. The options usually offered to patients are pancreatic surgery, chemotherapy and in some cases radiotherapy, often in combination.
When is surgery possible for pancreatic cancer?
Pancreatic cancer surgery is major abdominal surgery and requires expertise from the surgeon’s part and detailed staging of the disease utilising a plethora of imaging modalities such as CT scans, MRIs, Endoscopic Ultrasounds and in some instance the more sophisticated Positron Emission Tomography (PET scans). This sort of surgery is offered to patients who are considered to be fit for such a big operation and do not have evidence of their cancer spreading beyond the pancreas or involving major abdominal vasculature adjacent to the tumour. The surgery is usually followed by chemotherapy. If chemotherapy is given after the surgery, then it is called “adjuvant chemotherapy” and this is something that will be discussed in depth between the patient and the oncologist. In some cases, where the pancreatic tumour may be involving critical vessels (veins/arteries) next to the pancreas chemotherapy may be given prior to the pancreatic operation in order to achieve the best oncological result for the patient (this is called “neoadjuvant chemotherapy).
What are the types of surgery for pancreatic cancer?
The type of surgery offered for pancreatic cancer depends upon the location of the tumour in relation to the pancreas.
- Pancreaticoduodenectomy (often described as Whipples procedure):
This is a complex and major operation to remove the head (the ‘right end’) of the pancreas. The surgeon removes the head of the pancreas, 12-15cm of the first part of the small intestine (called the duodenum), a small part of the stomach, the gallbladder and part of the bile duct. Once the cancer has been removed the surgeon will join back the bowel to the remaining pancreas, the remaining bile duct and the stomach in order to restore the continuity.
- Distal pancreatectomy (with/without removal of the spleen):
In this operation the surgeon removes the tail and body (“left end”) of the pancreas with the surrounding tissues. The spleen is also removed in some cases and this is something that will be discussed with your surgeon prior to your surgery.
- Total pancreatectomy and splenectomy
This type of surgery is less frequently performed and involves removal of the whole pancreas and the spleen for oncological reasons (lymph node clearance). Removal of the whole pancreas carries significant implications for the rest of the patient’s life as in the absence of insulin production (normally done by the pancreas) they develop a form of insulin dependent diabetes.
What are the patient benefits of having surgery to remove pancreatic cancer?
Surgery to remove the cancer from the pancreas along with removal of the local lymph nodes (lymph glands) is the only cure in order to achieve long term survival. Aside from the surgery other systemic therapies (e.g. chemotherapy) are usually required in order to offer the maximum benefit to the patient in order to eradicate the cancer cells.
Why selecting your surgeon is important for a good outcome?
Surgery for pancreatic cancer is complex and requires advanced surgical skills from the surgeons who perform it. Aside from the technical aspect, favourable outcomes from this sort of surgery also depend upon appropriate pre-operative patient selection. It is therefore better delivered by surgeons who have undertaken extensive training in the field. In order to offer the best results to cancer patients, centres of excellence abroad (western Europe, USA) have endorsed the approach of “cancer services centralisation” where complex abdominal cancer cases are managed in only a few units so that local expertise increases and patient outcomes become more favourable. Therefore, identifying and selecting a surgeon with substantial surgical experience in the field is highly recommended.
Management of pancreatic cancer, as mentioned above, requires input from various medical specialties (oncology, radiology, gastroenterology) and we are privileged to be able to provide this service to our patients in the German Oncology Centre in Limassol. In our centre we would happily assess any patient with the diagnosis of pancreatic cancer, even those who have been deemed as not being appropriate candidates for surgery elsewhere. Expertise in the field varies and us being able to evaluate each cancer patient individually as a team of cancer specialists, allows us to serve out patients to the best of our abilities.
Useful resources for further reading: