Types of Cancer Pancreatic

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My name is anne-marie Lennon I am an assistant professor of medicine here at Johns Hopkins and I am the director of the pancreatic cyst clinic

the pancreas is at the top of your tummy and in fact it sits on top of your spine sits at the back and it's divided into three portions the top of the pancreas is called the head the middle

of the pancreas is called the body and the end of the pancreas is called the tail of the pancreas

 it has a tube running through it which we call the main pancreatic duct and these have got

little small tubes called branch ducts which bring one of the things that the pancreas makes

pancreatic juice into the main pancreatic duct and then it flows into the small banner that you Dina where it helps you digest your food pancreatic cysts are like a balloon there it's filled

with fluid and it can occur in the top or the head of the pancreas or you can have a cyst in the body or in the tail in some people you can have several sets for example you can have three

or four cysts in the tail and sometimes you can get multiple cysts throughout the pancreas you can have assists in the tail the body and the head of the pancreas we are seeing more and more

people with what we call incidentally find pancreatic cysts and what I mean by this is that

they went into hospital for an entirely different reason for example they had blood in their in

 their urine and the doctors were worried about a kidney stone they had a scan and they

happen to find the pancreatic cysts and one of the reasons that this is is occurring is that

people are getting more and more scans done more frequently so if you go into the emergency room for any cause you often get a cat scan the cat scan and MRI scans are getting better and

therefore we're picking up more pancreatic cysts the first question we ask for somebody

comes to the pancreatic cyst clinic is what type of cysts do they have and the reason that

that's important to try and work out what type cysts that a patient has is because it

determines firstly what is their management and how do we look after the cysts and secondly

what is the risk of it developing into a cancer the calmness type of cysts that you'll see in the

pancreas is a thing called a pancreatic pseudocyst and this occurs in people who have had

pancreatitis it has no risk of ever developing into pancreatic cancer and usually just needs to

be watched and often resolves by itself there are several other different types of cysts that

you can get on the pancreas one type is called a serous cyst this is common in women and has a very low risk of ever developing into cancer there is a third type of cyst which we call

mucinous cyst and this is because the fluid inside the cyst is thick and gloopy or mucinous and

these type of cysts are have got a risk of developing into cancer so it's very important that

we identify people who have these type of cysts and that we follow them or if necessary

remove the cyst to prevent somebody developing cancer one of the types of cysts that are

precancerous are called and intraductal papillary mucinous plasm or an IP MN for short there are three different types of IP amounts one type affects the main pancreatic duct which is a

tube that runs through the pancreas and this has got a very high risk of developing or

changing into pancreatic cancer the risk in series is between up is between 50 to 70 percent

and that's such a high risk that people who in whom we think may have a main duct ipmn

should undergo surgery the second type of ipmn is called a branch duct my payment and that's

where one of the small side branches gets larger and develops into assists this is also a

precancerous type of cyst but the risk of it developing into cancer is much lower series say

that it's somewhere between 15 to 20 percent thus not all a very small number of people with these branch duct ipmn actually change or develop cancer but these type of cysts need to be

followed so that we if a cyst is changing that we pick it up and those people undergo surgery

there are several different tests that we can use to look at a pancreatic cyst we can use a

abdominal imaging for example CT or MRI and we can also use endoscopic ultrasound that's

like an upper endoscopy it's where we put a small camera down into the stomach which has an ultrasound probe on it and the ultrasound waves pass through the stomach and into the

pancreas and generate beautiful images of the bank this is probably the best chance to look

within the Pank within the cyst to make sure that there's nothing changing within the cyst

and it also allows us to put a tiny needle in and take a sample of the lining of the cyst and also of the cyst fluid the best tests that we currently have for differentiating what type of cyst

we're dealing with is called cyst fluid CEA it's good in that it has an accuracy of 78% but it's

not perfect one of the things that we need is we need better tests to tell us firstly what type of sister we're dealing with is this the type of cyst that has a cancerous potential and needs to be

 followed or is this a type of cyst which has a very low or no cancerous potential in which

case it doesn't need to be followed as closely and secondly what in those type of cysts which

are precancerous which are the ones that are likely to change or develop into cancer this is

something that we've been working on in Johns Hopkins dr. vogelstein and colleagues have

recently published a paper which showed that two genes are altered or mutated in people with ipmn but are not mutation changes serious and this these tests appear to be far higher

accuracy than what is currently available with this fluid CEA I think that these are very

exciting times we need to see if these tests are as good as we think they are if they are they

may change alter the way in which we manage my create exists branch duct ipm ends have a small the definite risk of changing and developing into pancreatic cancer we know from

studies done here at Johns Hopkins and elsewhere that the time that it takes for these sister

change is quite long studied by dr. a caballo here at Johns Hopkins showed that in pancreas

cancer the cancer develops over many years as approximately seven and therefore we have a long time to intervene and remove cysts before develops into a cancer one of the questions

that patients always ask us is when do you need to go to surgery and we have very good

guidelines called the international consensus criteria which tell us who should go to surgery if

you're having symptoms for example the cyst is causing yellow jaundice or pancreatitis then you need to consider surgery we also know that if the cyst gets very large greater than 3

centimeters the risk increases and again surgery should be considered finally it's important to

look very carefully within the cyst with the imaging tests that we've discussed earlier to make

 sure that there's nothing growing within the cyst which is what we call a mural nodule or a solid component because again that suggests that the cyst may be changing and surgery needs

should be considered these guidelines seem to be very safe and in people who don't fulfill them

the risk of there being a cancer within the cyst is very small the pancreatic multidisciplinary

program because so many people are being diagnosed with pancreatic cysts I consists of a

group of pancreatic specialists there is a myself as I'm an interventional endoscopist we also

have five dedicated pancreatic surgeons pancreatic pathologists as well as dedicated abdominal

CT and MRI specialists we make once a week to review all the cases of patients who are seen

 at the pancreatic cyst clinic and then come up with a consensus as to what is the cause of the

cyst and what our recommendations are for management and we're very happy to see people

 who are have just been diagnosed with the cysts or people who've had it for a while or looking for a second opinion. Related posts Top Most Common Types of Tumors and Cancers in Dogs

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