The diagnosis as well as management of pancreatic cystic lesions is a general problem. Nearly 1% of the patients in the chief medical centers have been observed to have pancreatic cystic lesions on cross sectional imaging. It has also been observed that a quarter of all pancreas scanned in an autopsy series contain pancreatic cysts. Earlier, these cystic lesions were regarded benign but with increasing evidence made available from the cystic lesions, they are regarded as origin of pancreatic malignancies.


Information on asymptomatic neoplastic pancreatic cysts
The most vital medical tools that are used in the diagnosis and management of pancreatic cystic lesions include the endoscopic ultrasound and cross sectional imaging. These are used to distinguish non-mucinous cysts from mucinous cysts. The identification of pancreatic cysts creates a lot of anxiety for the clinicians as well as the patients related to the probable presence of a fatal tumor. The findings of a macro cystic lesion that enclose viscous fluid loaded in cea are helpful in the analysis of a mucinous lesion. 


The most common pancreatic cysts are the non-neoplastic inflammatory pseudo cysts, and they can be detected easily by imaging. The identification of pancreatic irregularity with probable association with malignant cells is a vital source of referral for the specialist. The set of guidelines that have been proposed for the management and diagnosis of patients with asymptomatic neoplastic pancreatic cysts are based specifically on the analysis of the quality of the data. It is also designed to address the most important and frequent clinical scenarios. The diagnostic suggestions are provided based on the clinical problem as well as the risk of malignancy.


Imperative guidelines to follow
To achieve accurate diagnosis of asymptomatic neoplastic pancreatic cysts is indeed a great challenge. It is all the more important to find the reproducible methods that can be used to stratify threat of cancer for the patients. The main guidelines include a two year screening interval of cysts that can be of any size as well as stopping observation after 5 years, in case there is no change. The new guidelines, for the most part, recommend surgery if more than one concerning feature is confirmed on the mri by use of endoscopic ultrasound. The new guidelines even suggest discontinuation of inspection after the surgery if no dysplasia or invasive cancer is identified. The guidelines have mainly been developed by use of grading of recomendations assessment, development and evaluation.

Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

Pancreas Transplant is a surgical procedure where the damaged pancreas is taken out of the body of the patient and transplanted with the healthy ones from the donor s body.
The pancreas is located in the middle part of the body that helps in the secretion of insulin in the body. Insulin helps in the absorption of sugar in the body and helps in maintaining glucose level. If the pancreas is not producing insulin in sufficient quantity than the patient is likely to suffer type 1 diabetes.

Most of the pancreas transplants are done to cure the extreme conditions of type 1 diabetes. However, the transplants are done only in case of severe diabetic conditions because the pancreas transplant has serious side effects and not always pleasant after surgery recovery.

Why is the Pancreas Transplant Done?
There are several reasons for doctors choosing for pancreas transplantation. One of the most reason is the type of diabetes. However, they are also performed along with the kidney transplantation, when damage to the kidney is done by diabetes.

Following reasons are worth considering for pancreas transplantation:
  Extreme and severe type 1 diabetes
  Kidney damage
  Type 2 diabetes due to a lower level of insulin usage in the body
  Poor blood sugar level

Types of Pancreas Transplantations-

  Pancreas Transplant Alone: The pancreas transplantation is done solely for the diabetic patient whose kidney is unaffected and does not require any surgery along with pancreas transplant.

  Pancreas Transplantation Along with Kidney Transplant: This kind of surgery is done by the doctors when the patient has weak kidney and damaged pancreas. In such a scenario, only kidney transplantation is not sufficient and requires new pancreas for overall development.

  Pancreas-after-kidney Transplantation: For patients who have been waiting long enough for a donor for pancreas and kidney both, this is a better solution. Since the waiting list to get, such donor is long and not probable. Doctors prioritize and perform kidney transplantation first since the condition for kidney transplantation is rather severe and affected. Then after pancreas transplantation is done when a suitable donor is found.

  Pancreatic Islet Cell Transplant: Pancreatic islet cells are responsible for producing insulin into the body. So, doctors perform surgery on the patient and inject the pancreatic islet cells from donor s pancreas to the patient under operation.

Complications of the Procedure-
Some of the common complications of the procedure are:

  Blood clots
  Bleeding
  Infection
  Excess sugar in the blood
  Failure of the donated pancreas
  Transplant rejection
  Urinary tract complications

Conclusion-
Pancreas Transplant is done when the patient is severely diabetic and is not curable with only medication. The doctors suggest the post-surgery rest. The patient is required to be hospitalized for one week at least and keep strict follow-up routine to look after the effects of transplantation.

Pancreas Transplant - When Is It Required?

Pancreas are a small, but a pretty important part of a person s digestive system. So when it needs to be removed, the reason has got to be quite serious, to say the least, doesn t it? The procedure is known formally as a pancreatectomy and it is most often required for people who are suffering from cancer of the pancreas. Ideally, these people would only need the cancerous tumours removed, but things are not always this simple. As a matter of fact, only a little more than a tenth of the people who have pancreatic cancer can have the tumour alone removed. As a result, most need to go for a pancreatectomy, which involves removing the entire pancreas. Whether the pancreas can be kept is usually related to how soon the cancer was detected, with people who have done so in time being a majority of the 10% of people with pancreatic cancer who have not needed pancreatectomies.

If a person does not have cancer, the reason he or she may need a pancreatectomy due to an accident which has injured the area significantly badly. In this case, a procedure which is known as a partial pancreatectomy is carried out on the patient. The good news is that the success rate of this sort of operation is generally quite high and the long-term effects on the body are nil. This is the case in spite of a lot of the normal tissue of the pancreas being removed, pretty amazing, isn t it?

While it may be called a pancreatectomy, it does not always mean that the pancreas is the only thing that is removed. In fact, in a lot of pancreatectomies, the surgeons also remove other parts of the digestive system which are usually the common bile duct, the spleen and the gallbladder.

There is, of course, the case of chronic pancreatitis, which occurs when the organ just swells up repeatedly. The repeated swelling leads to permanent damage of it, which affects the rest of the body, too. In most cases, the cause of this happens to be a sustained addiction to alcohol. When this is the case, it is really hard to perform a pancreatectomy and the utility of the pancreas is greatly reduced. Not a good situation to be in, under any circumstances, at all!

A pancreatectomy is a process which nobody would voluntarily wish to undergo, but there are advantages to knowing what it is, in any case!

Pancreatectomy - When To Go For It?

An inflammation of the pancreas is known as pancreatitis. The pancreas is an organ that produces digestive enzymes. Pancreatitis might start any day and continue for long period and it requires immediate medical attention. It is of two types- acute pancreatitis and chronic pancreatitis. Although the treatment usually requires hospitalization, pancreatitis can be easily stabilized and the underlying cause can be treated thereafter.

Causes
Pancreatitis may be caused due to various reasons:
1. Gall bladder stone: The pancreatic duct lies next to the bile duct. The gallstones enter the small intestine after passing through the common bile duct. Often the stones that remain in the common bile duct have a negative effect on the pancreas, which causes a hindrance to the normal flow of the pancreatic fluids, causing pancreatitis. Also a back flow of the bile into the pancreas can cause pancreatitis. 
2. Alcohol: Long time alcohol use also causes pancreatitis. Alcohol can damage the pancreas tremendously causing it to get inflamed.
3. Other causes: Hereditary disorders in the pancreas, cystic fibrosis, high level of triglycerides, and a few medicines may also cause pancreatitis.

Symptoms: 
1. The first symptom of pancreatitis is abdominal pain: The pain may be sudden or gradually increasing, but is usually aggravated after eating. It is severe and constant, and may continue for a few days. If you are suffering from pancreatitis, you will feel very sick after a sudden attack and you might require medical assistance immediately.
2. Swollen abdomen: Pancreatitis may cause your abdominal area to swell up and become tender.
3. Nausea: If your abdomen suddenly starts paining due to the onset of pancreatitis, you tend to feel extremely nauseous. You might end up vomiting and may also have violent heaves.
4. Fever: The inflammation will cause you to run a temperature, along with a searing pain in your stomach, which will make you feel extremely uncomfortable.
5. Rapid pulse: Pancreatitis affects the rate, at which the heart beats, causing a rapid increase in the pulse rate.

Causes and Symptoms of Pancreatitis

Diabetes which was earlier called a lazy person's disease does not live up to the name anymore. Owing to the sedentary lifestyle and bad eating habits, diabetes has become an epidemic in the recent years.
As as we all know, diabetes is a condition characterized by an increased concentration of blood glucose level. If not managed and treated on time, the condition can prove to be life threatening. Diabetes is known to trigger a host of health complications and disorders including cancer. In fact, research has established that there is a link between diabetes and pancreatic cancer. The report suggests that people with chronic diabetes for more than 5 years stand at an increased risk of suffering from pancreatic cancer. In some patients, diabetes may be one of the symptoms associated with pancreatic cancer. Whether diabetes triggered pancreatic cancer or was it the precancerous cells that caused the diabetes is difficult to explain.

The pancreas is an important organ involved in the production and secretion of many important hormones including the insulin (by the Beta cells of the pancreas). A diseased condition, such as pancreatic cancer may bring about changes, affecting the proper functioning of the pancreas. This, in turn, may interfere with the production of insulin. Decreased production of insulin or insulin resistance may result in elevated concentrations of glucose in the blood, a condition that will eventually give rise to Diabetes.

According to another published article (NCBI), in many patients with pancreatic cancer, diabetes was detected almost simultaneously along with cancer or 2 years prior to the diagnosis of cancer. These findings indicate the fact that both diabetes and pancreatic cancer not only occurred concomitantly but were also correlated.

Another experiment suggested that in people with Type-2 diabetes, the pancreas was for long subjected to a condition termed as hyperinsulinemia (increased level of insulin in the blood as compared to the blood glucose level). The experiment shows that insulin does have a role to play in establishing a relationship between diabetes and pancreatic cancer.

Managing Diabetes and Pancreatic Cancer
The conditions of diabetes and pancreatic cancer should be managed well to avoid further complications.

The diet plays a significant role in the proper management. The diet should be well balanced with all the essential nutrients. Include more fruits and vegetables in the diet. Berries such as raspberries, blackberries can go a long way to regularize the blood glucose level. Opt for whole grain cereals and food items. Avoid foods rich in fats and carbohydrates.
A healthy body weight can work wonders, both in the case of diabetes and pancreatic cancer. If you are a couch potato, give up the habit at the earliest. Indulge in more physical activities (not necessarily rigorous or strenuous) such as exercise, jogging, morning walk. In addition to keeping your weight in check, these physical activities are excellent stress busters.
The unhealthy lifestyle habits such as drinking, smoking, substance abuse can harm your body beyond imagination. Give up these unhealthy habits as early as you can.
There may be a strong connection between pancreatic cancer and diabetes. However, to avoid one affecting the other, one should take care of themselves and manage the conditions well.

Pancreatic Cancer - Are Diabetic Patients At A Higher Risk?

Pancreatic cancer is an aggressive form of cancer. The disease shows no early symptoms and often spreads to other organs long before it is properly diagnosed. Due to such poor prognosis, only around 6% of the pancreatic cancer patients are healthy and alive 5 years after the first diagnosis.

One of the most common surgeries to remove tumours from the pancreas is Pancreaticoduodenectomy, that is commonly called Whipples surgery. The primary aim of the procedure is to cure cancers or disorders that are identified in the pancreas, bile duct or the duodenum. Here, the tumour is removed to prevent it from spreading to other organs, thus improving the life expectancy of the patient. 

Whipple's Procedure

Before the surgery, an intravenous line will be injected to your arm, to provide you with the necessary medication. Medicines may be passed through this line to soothe your nerves. A spinal injection or an epidural catheter may be placed. This helps you to recover painlessly after the surgery.

The surgery can be carried out in different ways  

Open surgery

Here, the surgeon makes a small incision in your abdomen to access the pancreas and other organs. This is the most common method. This is a complicated operation where the tip of the pancreas, the gallbladder, the bile duct and the initial portion of the small intestine are removed. It is performed to treat cancers that are present on the head of the pancreas. 

Laparoscopic surgery

Here several small incisions are made in your abdomen to insert a camera that transmits the live video of the abdomen to a monitor. According to the live feed, the surgeon performs the operation by using surgical tools. It is a common form of minimally invasive surgery.

Robotic operation

This is another type of minimally invasive surgery where the surgical tools are attached to a special robot. Here, the doctor uses a console to control the robot to perform the surgery. This is used because surgical robots can reach and operate in spaces and corners where the human hands may not reach during surgery.

 The Whipples surgery can take 4 to 12 hours depending upon the approach being used and the complexity of the process. During the surgery, you will be given general anaesthesia, so you will be asleep.

In some cases, a part of your stomach or nearby lymph nodes may be removed to treat the cancer growths. After the process, the doctor will reconnect the other organs so that you can digest food normally.

After the procedure, you may face problems while emptying your bowels. The condition improves around 7 to 10 days after the surgery. Most patients are able to return back to their normal life usually around 6 weeks after the procedure.

It is recommended that you follow the doctor s instructions after the surgery and stick to the diet prescribed. Additionally, keep the incision protected from sunlight and remove the bandages only after consulting the doctors. 

 

 

Whipples Surgery & Pancreatic Cancer - Know About Them!

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