Re: [MOL] Tumor/Reply [00552] Medicine On Line


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Re: [MOL] Tumor/Reply



Hi Donna!  Welcome to our wonderful forum.  Here is the information you
requested and if we may be of further help to you, just ask.  Your friend,
lillian

http://www.goto.com/d/search/?Keywords=Pancreatic+cystic+adenoma


The Whipple Procedure



In 1935, Allen O. Whipple described an operation in which portions of the
pancreas, duodenum and bile duct are removed to treat tumors of the ampulla
of Vater. Although this was not the first time an operation such as this was
described, his success with the 3 cases brought national attention to this
operation. Over the years, the Whipple procedure has been modified, but
continues to be used primarily for tumors of the pancreas, ampulla of Vater,
duodenum, and distal bile duct. In the past, the operation had a high
mortality rate, over 20%. Now, at centers where a few surgeons perform many
of these each year (such as MUSC), the risk of dying from the surgery is
less than 2%. This, plus improvements in diagnostic testing has also
resulted in increases in long term survival. Although the actual rate
depends on the site of origin of the tumor and how advanced it is, the 5
year survival rates range from 15% to 50%.

In the Whipple procedure, portions of the upper gastrointestinal (GI) tract
are removed. This includes the "head" of the pancreas, the attached
duodenum, a portion of the common bile duct, the gallbladder, and sometimes
a portion of the stomach. Once this is complete, the remaining portions of
the pancreas, bile duct and stomach are sutured back to the intestine to
restore continuity of the GI tract. Two tubes are then inserted through the
skin for drainage of fluids from the abdomen until the suture lines start to
heal. Another tube goes into the stomach (gastrostomy tube) to prevent
postoperative vomiting. An additional one enters the intestine (jejunostomy
tube) for feeding the patient while he/she recovers from the surgery. The
operation takes from 5-8 hours to perform, and the average recovery time in
the hospital is about 2 and a half weeks.

Since this is an extensive procedure, the goal is to only operate on
patients who may have removable tumors. This is facilitated by studying the
patients prior to surgery with a number of different types of xrays and/or
endoscopic procedures. Patients with incurable disease are those with spread
of the cancer to other organs such as the liver. A spiral CT scan is the
best method for evaluating the liver. Another important piece of information
is to rule out extensive involvement of the blood vessels adjacent to the
pancreas. This can be done with either CT scan, endoscopic ultrasound (EUS),
or angiography. EUS involves a special type of endoscope that has an
ultrasound transducer at the end to evaluate the structures adjacent to the
pancreas. Angiography involves injecting dye into the blood vessels around
the pancreas to determine whether the tumor is growing into them. We rarely
perform angiography as much as in the past since CT and EUS have become so
accurate.

Once a decision is made to operate, the surgeon must first determine whether
the tumor is removable or not. A number of tools may be used for this.
Laparoscopy is sometimes performed. This is a method of looking at the
organs through a scope placed in the abdomen while the patient is under
general anesthesia. The purpose of this would primarily be to look for
spread of the tumor to the liver or the lining of the abdomen. If this looks
free, then the abdomen is opened with a fairly extensive incision. The belly
is explored and the pancreas mobilized from the surrounding tissues. The
main goal at this time is to determine whether the tumor is free of the
underlying major blood vessels. If it is free of adjacent structures and has
not spread, then the Whipple should be performed. The most common
complications from a Whipple procedure include bleeding, infection, leakage
from where the pancreas is sewn to the intestine, and delay in function of
the stomach.

It should also be noted that it is sometimes difficult to obtain a
definitive diagnosis of cancer either before or during the surgery. The
pancreas tends to develop a great deal of scarring or reaction that
interferes with interpreting a needle biopsy. It is common to biopsy a
cancer in this region and only obtain a benign report. Thus, it is up to the
surgeon's judgement whether or not the patient has cancer. At times, a
Whipple procedure will be performed without a definitive diagnosis of
cancer. In these instances, cancer will often be found in the final
pathology specimen. It should also be noted that a Whipple procedure is
sometimes performed for benign disease in order to control pain from
pancreatitis or to remove a premalignant tumor that may progress to invasive
cancer with time. These are further reasons why it is important to be
operated on by a surgeon with a great deal of experience with operations for
cancer of the pancreas and periampullary region. His/her judgement will be
valuable in determining whether or not a tumor is present and if it is
removable. This is in addition to the above information that the mortality
risk from the surgery will be much lower.

Long term results for the Whipple procedure have been examined by a number
of authors. Most studies have shown that the five year survival for the
Whipple procedure for pancreatic cancer is about 20%. Even though this
relatively small number shows that few patients are cured, patients that do
undergo a Whipple will have a better long term survival when compared to
those who do not have the tumor removed. Similarly, it should be noted that
patients who have the Whipple procedure for non-pancreatic cancers such as
those arising in the ampulla vater, duodenum or the distal bile duct, will
have five year survivals of about 40-50%. In either instance, patients can
have a good quality of life following a Whipple procedure.


Warmly, lillian

We invite you to take a look at our Album.
www.angelfire.com/sc/molangels/index.html

  ( Very informational, good tips, Molers pictures, art work and much
more....

----- Original Message -----
From: Donna Dolwick <ddolwick@traverse.com>
To: <mol-cancer@meds.com>
Sent: Saturday, November 20, 1999 6:44 AM
Subject: [MOL] Tumor


> Do you know of any good sites where I can obtain info on Benign Pancreatic
> Cystic Adenoma and or the whipple surgery?
> Thank you
> Donna
>
>
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