Pancreas

The pancreas is located behind the stomach and performs three important functions: it regulates blood sugar, neutralizes stomach acid, and produces over 20 different enzymes for digestion, which break down food in the intestine into the smallest building blocks. The most common diseases of the pancreas include acute pancreatitis, chronic pancreatitis, and pancreatic cancer. The treatment and surgery of pancreatic diseases are complex and require an interdisciplinary therapeutic approach at a specialized center.

Benign diseases of the pancreas

Acute pancreatitis

As the name suggests, it sets in suddenly. This results in damage to the pancreatic cells, for example due to Alcohol, which can lead to severe, sometimes life-threatening inflammation. Depending on the severity, it can also lead to the death of pancreatic cells. Gallstones that block the pancreatic duct can also trigger such inflammation.

Therapy: is almost always conservative and carried out interdisciplinarily.

Chronic pancreatitis

Due to the long-lasting, chronic inflammation or frequent flare-ups, the cells are slowly destroyed. As a result, the pancreas can no longer perform its function adequately. This leads to diarrhea, weight loss, and vitamin deficiency – and if no insulin is produced, diabetes mellitus can develop. The main symptom is a severe, belt-like upper abdominal pain that radiates to the back.

TherapyMultiple procedures tailored to the disease are available. Usually, either the pancreatic duct is opened and connected with a loop of the small intestine to allow digestive juices to flow again; alternatively, the main focus of inflammation - usually the pancreatic head - is removed.

Cysts/IPMN (intraductal papillary mucinous neoplasia)

Cysts are mucous-containing areas in the body. An intraductal papillary mucinous neoplasia (IPMN) is an initially benign cystic growth located within the 'ductal' cells of the pancreas (so-called duct cells). They are often incidental findings during ultrasound or CT examinations because IPMNs often do not cause symptoms. A confirmed diagnosis can often best be made with an MRI, supplemented by an endoscopic ultrasound through the stomach, where samples can also be taken (so-called endosonography).

Intraductal papillary mucinous neoplasms can be precursors for a malignant pancreatic tumor. The affected ducts are classified as main duct and side ducts. The location regarding the ductal system (main duct, side duct, mixed), the number and size of the cystic expansions are relevant for the risk of degeneration into a malignant tumor. Prognostically favorable for the development of cancer are involvement of the main duct, an increased number of cysts, and a cyst diameter greater than 3 cm.

Cystic neoplasms are often located in the head of the pancreas, but other parts of the gland can also be affected. If there is a high risk of cancer development, preventive surgery with removal of the affected section is recommended. With low risk of degeneration, regular annual check-ups by MRI may suffice. With medium risk constellation, surgical treatment should be individually weighed in close dialogue with the patient, as it is a preventive intervention.

Malignant Diseases of the Pancreas (Pancreas)

Pancreatic carcinoma

Pancreatic carcinoma is rare but feared because the tumor grows aggressively and symptoms are usually absent in the early stages. By the time of diagnosis, unfortunately, almost 80% of patients are no longer eligible for surgical therapy. A typical indication is the sudden yellowing of the skin and eyes without causing pain (so-called painless jaundice). Depending on which part of the pancreas is affected, abdominal pain, nausea, and newly onset diabetes mellitus may also occur. Since these complaints can also be due to other diseases, diagnosis should be made after evaluating a series of findings.

Therapy: It results from the stage of cancer at the time of diagnosis. The disease is potentially curable only by removing the malignant tumor, i.e. through surgery. In the meantime, a whole range of differentiated algorithms have been established for treatment, which usually involve a combination of chemotherapy before or after surgery. In centers that frequently deal with this disease, genetic testing from tumor material is routinely established. This so-called “Next Generation Sequencing” (NGS) allows for an exact analysis of several hundred genes from the patient's individual tumor and thus offers another potential therapeutic approach.