What Is The Pancreas?
The pancreas is an organ located at the back of the abdominal cavity behind the stomach and colon. The pancreas is shaped like a tadpole and is nestled in the curve of the duodenum. It has a larger portion called the head of the pancreas, a neck and body, and then a tail. The head is on the right side of the body, the tail is on the left, and the neck and body are in the center. The pancreas is surrounded by several major blood vessels including the superior mesenteric artery, the celiac artery, common hepatic artery, splenic artery, superior mesenteric vein, and portal vein.
It is considered an endocrine gland because some of its cells (islet cells) secrete hormones directly into the bloodstream. These hormones include insulin and glucagon, which help regulate blood sugar. There are other hormones made in these cells which can create major changes in your body if overproduced.
It also is an exocrine gland, in that the other main cell type (ductal cells) make enzymes that help digest fats and proteins. These enzymes are secreted through the pancreatic duct into the first part of the small intestine (duodenum). The pancreatic duct meets the common bile duct and exits into the duodenum through a structure called the Ampulla of Vater.
The Pancreas Can Cause Disease Through a Variety of Ways.
Patients can develop pancreatitis, or inflammation of the pancreas through several means. Most of these are centered on obstruction of the pancreatic duct from gallstones, alcohol, calcifications, or obstructing tumors. There are other rare causes including some medications. Pancreatitis usually resolves without surgical intervention, but it can be very severe. Surgery to remove the gallbladder is indicated for pancreatitis secondary to gallstones. Surgery on the pancreas for severe pancreatitis is sometimes indicated if portions of the pancreas appear infected.
The pancreas can also develop tumors. These can be benign or malignant (cancer). Tumors can develop from the endocrine cells (islet cell tumors or neuroendocrine carcinoma which can be functional or non functional) or the exocrine cells (serous cystadenoma, IPMN, mucinous cystic neoplasm, solid pseudopapillary neoplasm, acinar cell carcinoma, ductal adenocarcinoma, etc.).
Why May You Need Surgery and How Does It Work?
Some tumors need to be removed because of mechanical effects such as decreased ability to eat from pressure on the stomach or small intestine. Others need to be removed because of potential to turn into cancer or being cancer. Some need to be removed for ductal obstruction and jaundice.
Surgery to remove tumors in the head of the pancreas generally consists of a “Whipple” procedure. This involves removing the head of the pancreas, the duodenum, the gallbladder, part of the common bile duct, and +/- a portion of the stomach. Such an extensive surgery is done due to the intricate network of blood vessels and lymphatics around the pancreas. Also, this keeps the tumor intact in order to minimize the risk of spread.
Tumors in the tail are generally removed laparoscopically with or without the assistance of one of the surgeons’ hands inside the body. Sometimes this requires removal of the spleen if the pancreas does not free off the splenic artery or vein easily. The lymph nodes around the pancreas are along this vein and artery as well. In cases of frank cancers, the spleen has traditionally been removed with the tail of the pancreas.
Malignant tumors (cancer) cannot always be removed. No matter what the cell type, if the cancer has spread out of the pancreas, radical surgery to remove the tumor is not indicated. This is because pancreatic cancer rarely has symptoms until later stages. The most common presenting symptoms are abdominal pain, jaundice, weight loss, diabetes and nausea/vomiting.
Pancreatic cancer generally grows and spreads quickly. The 5 year survival rate is around 5%, even if surgery is able to be performed. It generally does not respond well to treatment, though many studies have shown improvement in survival with chemotherapy and radiation. Patients generally have to be in reasonable shape to undergo surgery.
Ask your doctors about specifics that are relevant to your condition.