What is the Pancreas?
The pancreas is a gland that has a big role in digestion and blood sugar control. It is about six inches long and located deep within the abdomen, near the spine. The wide end of the pancreas (the head) lays on the right side of the abdomen and is connected to the first part of the small intestine, the duodenum. The narrow end of the pancreas (the tail) extends to the left side of the abdomen.
The pancreas is made up of two types of glands - exocrine and endocrine. The exocrine gland secretes digestive enzymes that help break down food into small molecules. These enzymes include:
- trypsin and chymotrypsin to digest proteins
- amylase to digest carbohydrates
- and lipase to break down fats
The endocrine gland, or islets of Langerhans, releases hormones into the bloodstream. Insulin and glucagon (which play a role in regulating blood sugar levels) and somatostatin (which inhibits the release of insulin and glucagon from pancreatic islets) are the main hormones secreted by the endocrine portion.
Problems with the pancreas can lead to a range of health problems, including pancreatitis, pancreatic cancer, and diabetes. However, you can keep your pancreas healthy by following a balanced diet and making other healthier lifestyle choices.
Fortis Hospitals, Mumbai Pancreas Clinic offers comprehensive evaluation and world-class care to patients with pancreatic diseases, including pancreatitis, pancreatic cancer, neuroendocrine tumour of pancreas and cystic neoplasm of pancreas.
Pancreatitis is a condition in which your pancreas becomes inflamed. It occurs when the powerful digestive enzymes begin to digest the pancreas itself.
Pancreatitis can be either acute or chronic. Acute pancreatitis occurs suddenly, and the inflammation usually subsides in a few days to few weeks with treatment. Gallstones are the main cause of acute pancreatitis, which can also develop into chronic pancreatitis in those who smoke or regularly drink alcohol. Common symptoms are moderate to severe abdominal pain, fever, nausea and vomiting.
Chronic pancreatitis occurs because of long standing inflammation of pancreatic parenchyma leading to permanent damage and other complications. While heavy alcohol use is the main culprit, autoimmune and genetic diseases, including cystic fibrosis, can also cause chronic pancreatitis in some individuals. Common symptoms are persistent pain in the upper abdomen and back, nausea, vomiting, diarrhoea, weight loss, and mild jaundice.
Hereditary pancreatitis, a rare genetic condition, can happen if there is an inherited problem in the pancreas or the intestine.
Management of pancreatitis
A surgical gastroenterologist or medical gastroenterologist may use one or more of the following methods to treat pancreatitis:
- Hospitalisation with supportive care and monitoring.
- Medicines to relieve pain.
- Surgery - several types of surgery such as endoscopic procedure, pancreatic necrosectomy, enteric drainage procedures or pancreas resection surgery may be recommended to treat more severe cases.
- Supplemental pancreatic enzymes and insulin, if the pancreas isn’t functioning well due to extensive damage.
- Nutritional support – A low-fat, healthy diet can be beneficial. Focus on foods that are high in protein and other nutrients. Try to avoid or limit red meat, fried food, full-fat diary, sweetened foods and beverages, caffeine, etc. Drink lots of fluids to stay hydrated. Patients may be advised to eat small meals throughout the day to help with digestion. Artificial versions of some enzymes may be recommended to aid digestion.
- Lifestyle changes such as giving up drinking and quitting tobacco use can help you recover more quickly and completely.
Pancreatic cancer starts in the tissues of the pancreas, usually from the cells that line the pancreatic duct. Pancreatic cancer arising from body or tail of pancreas is often advanced by the time it is diagnosed because signs and symptoms often don’t show in early stages. Later stages are associated with symptoms such as loss of appetite, nausea, vomiting, unintended weight loss, jaundice, dark-coloured urine, pale or grey stool, etc.
Pancreatic cancer is generally linked to smoking or heavy drinking, although the exact cause is unclear. Other risk factors include chronic pancreatitis, diabetes, liver problems, stomach infections, and certain inherited gene mutations.
Treatment options are surgery, chemotherapy, radiation therapy or a combination of these.
Cystic lesions of the pancreas
Different types of cystic lesions can be found in the pancreas. Pancreatic cystic lesions are pockets of fluid develop in the pancreas that can be benign (noncancerous) or malignant (cancerous). They are often found when conducting an imaging test like a CT scan for another health problem.
Common ones include:
- Pseudocysts: a common complication of acute pancreatitis
- Serous cystadenomas (SCAs), which are usually benign
- Intraductal Papillary Mucinous Neoplasms (IPMNs): these are precancerous cystic lesion
- Mucinous Cystic Neoplasms or MCNs: precancerous cystic lesion.
A benign cyst does not need treatment if it’s not bothering you. But patients should still watch closely for any symptoms that may develop. However, some pancreatic cysts may require treatments such as surgery to remove the cyst. Fortis’ Pancreas Clinic has a team that includes some of the country’s finest pancreatic surgeons, gastroenterologists, and radiologists to take care of you.
Neuroendocrine tumour of the pancreas
According to Cancer.Net, approximately 7% of neuroendocrine tumours (NETs) develop in the pancreas. Pancreatic neuroendocrine tumours start in hormone-producing islet cells (endocrine component) found in the pancreas. Pancreas NETs may be classified as either ‘functional or non-functional’.
Functional pancreatic NETs such as insulinomas, gastrinomas and glucagonomas continue to secrete hormones that are released into the blood and cause symptoms.
Non-functional pancreatic NETs don’t make excess hormones to cause symptoms, hence, they are often diagnosed at a more advanced stage.
Depending on the type and stage of the cancer as well as other factors, Fortis Pancreas Clinic care team will discuss treatment plan with each patient. Common treatment options for pancreatic NETs include surgery, ablation or embolization treatments, chemotherapy, radiation therapy, or other types of medicines.
Endoscopic procedures: ERCP & EUS
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to diagnose and treat diseases involving the liver, gallbladder, bile ducts and pancreas. This test uses a combination of X-rays and an endoscope, which is passed through the mouth, oesophagus, and stomach to the first part of small intestines. The doctor then passes a small catheter through the scope into the pancreatic and biliary duct and injects a special dye. This shows the organs on X-rays, helping doctors detect abnormalities and diseases of the liver, gallbladder, bile ducts and pancreas. Patients are sedated for this procedure lasting 30 minutes to an hour, and sometimes, a local anaesthesia is applied to the throat. ERCP can be used to treat conditions like bile duct blockages due to stones, pain in chronic pancreatitis, as a diagnostic and biliary drainage procedure in pancreatic and biliary cancer.
Endoscopic ultrasound (EUS) is a procedure used to diagnose diseases of the bile duct, gallbladder, and pancreas, as well as determine the stage of cancers. During EUS, the doctor inserts a thin, lighted tube (endoscope) into the mouth and down into the stomach and the duodenum. A small ultrasound probe (at the tip of the tube) emits sound waves that produce images of the surrounding structures, including the pancreas. EUS can also be used to take biopsy from pancreatic cancer or lymph node biopsy. These visual pictures are then interpreted by the doctors. Patients receive sedation for EUS, which takes between 20 and 45 minutes and is considered a safer test than ERCP.
Pancreatic surgeries are of two type: resection procedure and drainage procedure. Resection procedures include Whipple procedure, distal pancreatectomy, central pancreatectomy and total pancreatectomy. Drainage procedures include lateral pancreatico-jejunostomy, cysto-gastrostomy, cysto-enterostomy etc. Whipple procedure is the one of the most common surgeries for removing pancreatic cancer. Also known as pancreaticoduodenectomy, the Whipple procedure is a complex, multistep procedure that involves the removal of the head of the pancreas, the duodenum, gall bladder and bile duct and reconnection of the intestine to remaining part of the pancreas, bile duct and stomach.
Other types of pancreatic surgical procedures include:
Distal pancreatectomy - removes tumours from the body or tail of the pancreas.
Total pancreatectomy - removes the entire pancreas.
Central pancreatectomy - removes central part of pancreas.
Lateral pancreatico-jejunostomy – performed for chronic pancreatitis.
Cysto-gastrostomy/ cysto-enterostomy – performed for pseudocyst of pancreas.