"chronic" pancreatic tail mass?

My dad has had 3 CT scans (abdominal pain); 2005, 2008, May 2009.  His last colonoscopy (all negative findings) was also in 2005.  Over the past three months, he has had increasingly worse abdominal pain, mostly left lower quadrant with radiation to his rectum. No jaundice, no weight loss, no back pain, no change in stools. His physician at that time ordered the latest CT scan.  The results showed "thickening" in the wall of the lower colon as well as a mass in the tail of the pancreas (2.4 x 2.8 x 2.5 cm).  

My dad  was admitted to the hospital for pain control.  The following day his colonoscopy showed severe diverticulitis of the sigmoid colon and a deep gastric ulcer (benign biopsy).  Surgery has been consulted for possible sigmoid resection.  The more concerning finding from the recent CT is the mass in the tail of the pancreas.  The 3 CTs over the past 4 years have been reviewed, and the surgeon has told us that the mass is unchanged in size from the first CT in 2005 to the most recent CT three days ago, May 2009.  We get the impression that this is encouraging news. From what we understand, the CT report does not mention other lesions in surrounding organs.  From everything I have read about tumors of the pancreas, the prognosis is grim.  If this is cancer, why has he not had other symptoms, and why has it not changed size?

My question is what could this mass be?  If it was cancer, would it have changed size in any way over the course of 4 years?  Should we have the mass needle-biopsied via endoscopic ultrasound?  I believe my dad should have the mass removed regardless of what it may be.  What will the surgery entail? Or is this "chronic" mass to be only monitored with radiologic modalities?

Please help.  My dad is currently in the hospital awaiting some sort of answer as to how to proceed, and his surgeon has already made him aware that he does NOT specialize in pancreatic surgery and therefore is searching for more information himself.

Thank you...

[Kevin Pho, MD]

Pancreatic masses can be difficult to diagnose, and indeed, cancer is among the possibilities.  Other causes can be a pancreatic pseudocyst as well as chronic pancreatitis.

I agree that an endoscopy ultrasound would help, as well as an abdominal MRI.  Both of these conditions should be considered to further evaluate the pancreas.

As for surgery and prognosis, I can't comment on those issues without knowing the diagnosis.

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.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd