The pancreas is a vitally important organ, according to its function it belongs to both the digestive organs and endocrine system. The pancreas is a gland of mixed secretion. As an exocrine gland, it secretes digestive enzymes into the lumen of duodenum. They take part in digestion food process. As an endocrine gland it secretes hormones (insulin, glucagon, and some others) into blood. Accordingly, with neoplasm development in parenchyma of this organ, both functions may suffer with corresponding symptoms and consequences development.
All pancreas neoplasms can be divided into benign (benign tumors, cysts) and malignant (cancerous tumors). Neoplasms can also be hormonally active (produce certain hormones) and hormonally inactive (not secrete additional portions of hormones into blood).
Pancreas neoplasms, especially of a malignant nature, are serious diseases, they must be treated immediately after detection. Therefore, in any case do not delay a visit to the doctor, contact qualified specialists with experience in managing pancreas tumors patients. Such doctors work in Oncology Department of Maimonides Multidisciplinary Medical Center. Our institution closely cooperates with the best oncology clinics in Israel, functions according to Israeli medicine model as one of the best in the world. Each individual case of pancreas malignant tumors is managed jointly by the attending oncologist, the head of the department – Dr. Iryna Stefanska and responsible oncologist directly from Israel. Thanks to such a qualified and coordinated team work, we manage to achieve success in treatment of even the most difficult cases.
All our patients have the opportunity to receive financial assistance, which partially or fully covers treatment costs of a serious illness, because the Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation.
One of the main principles of providing medical care in our institution, which corresponds to Israeli medicine model, is an individual approach to each person, because there are no two identical patients or two identical diseases. Making up an examination plan and treatment scheme, specialists do not use one template or protocol for everyone, all medical and diagnostic manipulations are modified, depending on each patient’s needs and his disease characteristics. Of course, all treatment measures comply with global clinical recommendations and standards of medical care in oncology , so patient may not worry about the quality of medical services.
Not only oncologists work in our department, a whole multidisciplinary teamhelps the patient. If necessary, surgeons, radiation therapists, chemotherapists, rehabilitators, psychologists, gastroenterologists, endocrinologists and other narrow specialists are involved in treatment process, depending on clinical situation. All our specialists are highly qualified and have extensive experience working in Oncology Department, most of them have repeatedly completed internships at the best oncology centers in the world. Our medical center uses only modern and safe medical and diagnostic equipment of expert class. If a certain narrow specialist or rare medical and diagnostic equipment is not available, patient is referred to subsidiary institutions of Maimonides Medical Center or our Israeli partner clinics , where he is guaranteed to receive the full range of necessary medical services.
Types of pancreas neoplasms
All pancreas neoplasms are divided into benign and malignant according to signs of aggressive, invasive growth and ability to spread metastases. Also, all tumors are divided into hormonally active and hormonally inactive tumors based on their ability to produce additional portions of hormones.
Among hormonally active pancreas tumors, the most common are:
- ACTH producing adenoma – secretes an ACTH hormone excess. It is clinically manifested by symptoms similar to Cushing's syndrome endocrine disease.
- Gastrinoma. Produces gastrin hormone. Symptoms include peptic ulcer disease of stomach and duodenum, abdominal pain, dyspeptic symptoms.
- Glucagonoma. This tumor produces glucagon hormone. Violations of carbohydrate metabolism occur, reminiscent of type 2 diabetes, skin pustular rash, anemia, body weight loss.
- Tumor that synthesizes growth hormone releasing factor. It is clinically manifested by an endocrine disorder similar to acromegaly.
- Insulinoma. The tumor produces an excess of insulin hormone. Symptoms include hypoglycemia episodes (low blood glucose).
- Somatostatinoma. Produces somatostatin hormone. It is clinically manifested by diabetes symptoms, chronic diarrhea, and gallstone disease development.
- Vipoma. Releases vasoactive intestinal peptide. Symptoms are chronic watery diarrhea, dehydration, hypokalemia.
A benign, hormonally inactive tumor, called an adenoma, can also appear in pancreas. As a rule, it does not manifest itself until it reaches significant sizes and begins to compress neighboring organs. In this case, the first sign of tumor presence in pancreas (especially in its head area) may be mechanical jaundice.
A cyst is often found among benign neoplasms in pancreas tissue. Cysts can be true or pseudocysts (depending on membrane presence), and can also be congenital and acquired. Sometimes there are pancreas parasitic (echinococcus, alveococcus) or after an inflammatory lesion (acute or chronic pancreatitis). Cysts can also form in case of pancreas malignant lesions (tumor).
Among pancreas malignant tumors, the most common are:
- Pancreatic Adenocarcinoma. A malignant lesion that grows from exocrine part of the organ cells, that is, those that produce pancreatic digestive juice. The tumor is aggressive, grows quickly and metastasizes early.
- Pancreatic acinar cell carcinoma. This pancreas malignant lesions, which is characterized by relatively slow growth, has the ability to infiltrate neighboring tissues and give distant metastases.
- Undifferentiated pancreatic cancer. This is a malignant, aggressive tumor made of undifferentiated cells variety.
- Neuroendocrine malignant tumors are various malignant neoplasms that have additional hormonal activity and produce various hormones.
- Pancreatic squamous cell carcinoma. It is squamous epithelial cells malignant tumor, has an aggressive course, is accompanied by sprouting of neighboring tissues and distant metastases.
- Cystadenocarcinoma. This is a malignant neoplasm that grows from a primary benign cystadenoma tumor.
Pancreas tumors causes and symptoms
Pancreatic cancer ranks 9th among all malignant tumors and 5th among oncological mortality causes. Every year, 5 thousand new cases of this pathology are registered in Ukraine. Pancreatic cancer is a serious medical problem, which consists of late disease diagnosis due to clinical manifestations paucity. Unfortunately, even nowadays, the exact causes of malignant neoplasms development of this location are unknown. But there are certain factorsthat increase the likelihood of pancreatic cancer developing:
- History of surgeries on stomach with it’s part resection, especially for peptic ulcers.
- Age over 55 years, male gender.
- Chronic pancreatitis and diabetes presence.
- Hereditary disorders of pancreas function.
Pancreatic cancer symptoms, such as pain and weight loss, are nonspecific, leading to late diagnosis. At the time of diagnosis, 90% of patients have a locally advanced tumor that grows into retroperitoneal space structures, spreads to regional lymph nodes, or metastasizes to liver and lungs.
Most patients have pain in upper abdomenirradiating to the back (girdling). Unmotivated weight loss is often observed. Adenocarcinomas of the pancreatic head are accompanied by mechanical jaundice development, and 80–90% of patients experience itching . Body and tail cancer can be accompanied by blood flow violation through splenic vein, which leads to splenomegaly presence (spleen enlargement), esophagus and stomach varicose veins, and gastrointestinal bleeding development.
Cancer causes diabetes development in 25–50% of patients, and they feel hyperglycemia symptoms (thirst, frequent urination in large portions). Pancreatic cancer can also interfere with digestive enzymes production (exocrine pancreatic insufficiency) in some patients and interfere with food digestion and nutrients absorption. This causes bloating, gas and watery, oily, foul-smelling diarrhea, which leads to weight loss and hypovitaminosis of fat-soluble vitamins.
Diagnosis methods of pancreas tumors
As you know, the earlier malignant tumor diagnosis is established, the better prognosis and treatment result. Therefore, high-quality and quick diagnosis is an extremely important stage. Maimonides Clinic uses only modern equipment of the expert class, all our doctors perfectly master all examining methods of a patient with suspected pancreatic cancer, are able to correctly interpret received data, which helps them create a modern, individual and effective treatment plan.
The main study that allows us to detect the tumor and determine its spread is multispiral computed tomography (MSCT) with contrast or magnetic resonance cholangiopancreatography (MRI/MRCP). After these studies, our specialists perform a modern procedure of endoscopic ultrasonography with fine needle aspiration (EUS/FNA) for histopathological diagnosis (biopsy of tumor tissue) and assessment of radical surgery possibility.
Even if imaging studies reveal an unresectable mass or distant metastatic disease, endoscopic ultrasound-guided fine-needle aspiration (EUS/FNA) or percutaneous fine-needle aspiration of an accessible tumor site is still performed to obtain a tissue sample.
We send all materials after the biopsy to the world's best pathogistological laboratories (Israel, Germany, USA).). Thanks to such double checks, we are absolutely sure of diagnosis correctness and effectiveness of selected treatment tactics.
Our patients also have access to innovative molecular diagnostics of biopsy specimens of material after biopsy (molecular genetic studies). This is an obligatory part of oncological diseases modern diagnosis. As is known, the direct cause of many tumors is a mutation in a certain gene. Thanks to molecular genetic diagnostics, we can find these mutations and choose the most effective treatment regimens, because the response to the effect of certain drugs depends on the type of changes. An example of such modern diagnostics is test systems for molecular genetic testing, like Foundation One and Caris Molecular Testing .
In patients with obstructive jaundice, endoscopic retrograde cholangiopancreatography (ERC) may be performed as the first diagnostic procedure. All our specialists are perfectly mastered indicated procedures, and for their performance at Maimonides Medical Center, modern expert-class equipment is applied, which ensures accuracy and safety during diagnosis.
The СА-19-9 antigen (pancreatic tumor marker), which is produced in pancreas, can be used to monitor disease course with an already established pancreatic cancer diagnosis, as well as a screening test in groups at high risk of pancreatic cancer developing. The initially elevated CA-19-9 level should decrease against the background of effective treatment. A further increase indicates disease progression.
Based on obtained data during examination, doctor makes an accurate diagnosis indicating the stage of malignant process and formulates a treatment scheme, according to patient’s individual characteristics and modern clinical recommendations. All necessary diagnostic procedures can be performed directly in clinic, without leaving Ukraine.
Pancreas tumors modern treatment
One of the most important treatment advantages in our Oncology Department is a comprehensive treatment approach application. In struggle against malignant tumor, doctor uses the entire available arsenal of methods. Therapy is always a combination of two, or three, or more techniques. Typically, treatment regimen includes tumor surgical removal in combination with chemotherapy and/or radiation therapy. In some cases, certain innovative treatment methods (targeted drugs, immunobiological drugs, etc.) or even experimental ones are added to treatment program.
In most cases, depending on tumor localization, the method of choice for tumor surgical removal is Whipple surgery (pancreatoduodenectomy). The essence of the intervention is to remove the head of pancreas with duodenum, distal part of common bile duct, gallbladder, lower stomach two-thirds and regional lymph nodes in a single block with subsequent reconstruction. The second stage uses various restoration methods of food passage and digestive juices with gastroenteroanastomosis, hepaticoenteroanastomosis and pancreatoenteroanastomosisimposition. This is a very technically complicated surgical intervention, which only individual surgeons are capable of. In our medical center, all patients can get access to such surgical manipulation.
Chemotherapy for pancreatic cancer has the character of adjuvant therapy (prescribed in complex treatment after surgery). The most commonly used drugs are fluorouracil in combination with folates, gemcitabine, cisplatin, epirubicin, mitomycin, streptozocin, and tegafur. In our clinic, patients receive only modern chemotherapy drugs from well-known global pharmaceutical manufacturers. So we are sure of drugs quality, their predicted effect and side effects minimum number. Chemotherapy scheme, drugs doses, its duration and number of courses are selected for each patient by an oncologist and a chemotherapist.
Remote beam radiation therapy is also usually prescribed after surgery in combination with chemotherapy. In our department, radiation therapy is performed with the help of modern new devices – linear accelerators. Modern linear accelerators allow intensity modulated radiation therapy (IMRT), rotational (moving radiation) with beam intensity modulation (VMAT), as well as stereotaxic radiation therapy (SRT) and stereotaxic radiosurgery (SRS) and stereotaxic radiosurgery (SRS). This modern equipment allows us to fight cancer diseases that were previously considered incurable by purposefully delivering high doses of radiation directly to pathological focus, with maximum protection of healthy surrounding tissues, which guarantees the patient high treatment quality and minimal side effects.
In each individual clinical case, the decision about certain therapy methods combination (with which methods to start, what to add next, at what stage of treatment to perform surgery, when and according to which scheme to apply chemotherapy, whether to use targeted drugs or other immunobiological drugs) is made jointly by the team specialists. Every person and their disease is different, so our doctors, relying on their experience in oncological pathologies treatment, often go beyond the standard protocols, changing treatment regimens and necessary drugs doses, radiation method in order to get the best possible results for their patients.