About the Pancreas
The pancreas is a digestive gland located behind the stomach in the upper part of the abdomen. One of its functions is to produce enzymes and secrete them directly into the intestinal tract. These enzymes are critical in digesting both fats and carbohydrates. The other main function of the pancreas is the production of insulin, which is essential for normal glucose metabolism.
Symptoms of Pancreas Tumors
There are several types of tumors that can arise in the pancreas. The most common is adenocarcinoma. These tumors generally don’t cause symptoms when they are small but as these cancers enlarge, they typically cause pain in the abdomen or back. Smaller tumors may cause jaundice if there are located near the bile duct as it passes through the head of the pancreas. Hormone producing tumors arising in the pancreas, such as gastrinomas and insulinomas are more likely to cause symptoms related to the hormones they produce. Even small gastrinomas can cause ulcers in the stomach with associated bleeding. This type of tumor may also be associated with the simultaneous occurrence of other endocrine type tumors. Insulinomas cause an over production of insulin, resulting in very low levels of glucose in the blood. They are often small and difficult to locate within the pancreas.
Testing for Pancreas Tumors
Blood tests often show significantly elevated levels of the specific hormone produced by gastrinomas and insulinomas. The diagnosis of adenocarcinoma may also be suggested by the presence of a chemical called CA 19-9, a tumor marker found in the blood. While these blood tests can be used to diagnose the presence of a tumor, they are not capable of locating it. The commonly used tests to show the exact location and size of pancreatic tumors are a CAT scan or an MRI of the upper abdomen. Once the tumor is located a strategy can be developed to deal with the tumor.
Minimally Invasive Treatment Options
Laparoscopic techniques can be used in the management of pancreas tumors but not all of these tumors can be removed. One of the major roles that laparoscopic surgery can play is the determination of whether a tumor is safely removable or not. Laparoscopic intraoperative ultrasound can visualize the tumor within the pancreas as well as its relationship to other surrounding blood vessels. Biopsies of the tumor can also be performed guided by the ultrasound image. This additional information can be critical when making a decision as to how to approach the tumor surgically. Benign hormone producing tumors and even some malignant cancers may be removed laparoscopically, but cancers located in the head of the pancreas may require a very complex procedure called a Whipple resection, which cannot be safely performed laparoscopically.