Pancreatic Mass

[bdidonato]

My wife was having some abdominal discomfort and has for years been plagued by IBS and/or spastic colon (abdominal cramping,constipation,etc...). Recently she underwent a diagnostic endoscopy that revealed a pancreatic abnormality. Follow up MRI showed a mass in the tail of the pancreas, although it did not reveal active cell growth around it. Just today she underwent a diagnostic ultrasound that revealed a 4 cm. solid mass in the tail of the pancreas with cysts within its parameters. The doctor said that the margins are very well preserved and there is no indication of spreading, growth or inflamation or abnormality with of the surrounding lymph nodes. We are scheduling a biopsy at Jefferson University Hospital in Philadelphia. She has no real physical symtoms other than the slight discomfort when sleeping on her stomach, and has had no diarrea or nausea. We are really worried given the survival rate for pancreatic cancer, and wonder what you think of what little info we have provided. Anything you could offer would be much appreciated.

[bdidonato]

Is the fact that the MRI showed no active cell growth around the mass signifigant? The same question for the fact that the mass seems to have very well maintained borders, no sign of spreading and the nodes are not inflamed or otherwise abnormal. Just trying to get a handle on this before the biopsy.
Thanks

[surgeon]

there are both benign and malignant pancreatic tumors which have cysts within them. It's also possible to be an inflammatory process which isn't a tumor at all, although that sounds unlikely from your description.

[bdidonato]

Thanks for the repsonse, but it appears that you are presupposing a malignant tumor. My question was really trying to pick your brain as to wheteher the mass presnted provided any prebiopsy clues as to whether it might be benign, malignant or perhaps something other than a tumor. I understand it is difficult to determine without vidualizing the films, but again what we know is: it is a 4 cm solid mass with cysts within its borders. Their is no evidence of cell activity surrounding it and the borders are well maintained, not irregular. The lymph nodes do not appar abnormal or inflamed.
Just trying to get a sens e of where we stand.

[Kevin Pho, MD]

A variety of diagnostic studies are available for the diagnosis and staging of pancreatic cancer, with varying sensitivity and specificity. Routine laboratory tests may reveal a rise in the serum bilirubin concentration and alkaline phosphatase activity, and the presence of mild anemia. The diagnosis of pancreatic cancer, however, is typically made radiographically and histologically (i.e. via biopsy). The differential diagnosis includes chronic pancreatitis, pancreatic endocrine tumors, autoimmune pancreatitis, lymphoma, and a variety of other rare conditions.

Surgical resection is the only potentially curative treatment for pancreatic cancer. Unfortunately, because of the late presentation of the disease, only 15 to 20 percent of patients are candidates for pancreatectomy.  Whether the mass is a candidate for surgery is determined by a variety of staging tests - including various imaging studies which can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Fernandez del-Castillo et al.  Surgery in the treatment of pancreatic cancer.  UptoDate, 2004.

Steer.  Clinical manifestations, diagnosis, and surgical staging of exocrine pancreatic cancer.  UptoDate, 2004.