The pancreas is an organ that resides in the upper abdomen, lying behind the stomach and over the spine, that helps in digestion. The pancreas along with the liver and the gallbladder create digestive juices that help your body digest food. The pancreas makes digestive enzymes that help dissolve proteins, fats, and sugars. It creates it juices that go through a tube called the pancreatic duct and this duct plugs into the intestines along with the common bile duct. The common bile duct helps drain bile from the liver and gallbladder. Bile helps solubilize fats.

Sometimes a mass or cancer can grow in the head of the pancreas and block the bile duct or block the pancreas. This blockage can result in pancreatitis or elevation of bile such as in jaundice. Bile blockage can result in the skin becoming yellow or even orange. Because the bile cannot be excreted in the stool the stool becomes not the normal brown color but it becomes light and clay colored. The bile backs up in the blood stream and because the liver cannot get rid of the bile the kidneys try and filter it out and as a result the urine becomes very dark. This is a classic presentation for a cancer of the head of the pancreas.

Pancreatic cancer is unfortunately a very aggressive cancer that requires multiple modalities (surgery, radiation therapy, and chemotherapy) to offer the best chance of curing or at least controlling the tumor. Often studies are needed such as blood tests (CEA 19-9) and x-ray studies such as a CT scan of the abdomen look to see if the cancer has spread to other organs or if it is resectable. Often endoscopy is needed where a scope is passed through the mouth into the digestive tract and ultrasound as well as cameras are used to determine if the cancer is wrapped around blood vessels that hamper its ability to be excised or if there are enlarged lymph nodes implying that the cancer is widely spread.

If in the evaluation it is felt that a person has no evidence of the cancer spreading beyond the pancreas, that person could benefit from having surgery. This is a complicated surgery and that requires a surgeon experienced in pancreas and major surgery. Surgery involves a pancreaticoduodenectomy (the Whipple procedure) wherein patients are placed under complete general anesthesia. The abdomen is opened up through an upper abdominal incision. The stomach and colon are pulled out of the way as the pancreas is exposed. The pancreas is sliced in half and the head of the pancreas, the gallbladder and the bile duct are removed. Because the pancreas wraps around the first part of the intestine (the duodenum), this part of the intestine must be removed as well. Sometimes part of the stomach has to be removed with this. After this tumor is excised, the stomach, the pancreas, and the liver and its bile duct are reconnected to the intestines to allow food and digestive juices to be used by the intestine. This surgery takes several hours and hospital stay is usually at least a week but surgery offers the best chance of survival against pancreatic cancer in selected patients.

There are serious risks with this surgery but fortunately with improved surgical techniques and experience as well as good anesthesia and improved hospital care the risks of surgery are much less and patients can tolerate the surgery better than ever.

Surgeons at Regional Surgical Specialists can perform this procedure. If you have any questions or concerns, please contact us at 828-252-3366.