The pancreas is a combined endocrine and exocrine organ situated in the retroperitoneum and lying slightly obliquely transversely across the upper abdomen, draped over the aorta and vertebral bodies. The large bulk of the organ comprises exocrine glands that produce digestive enzymes, which are secreted into the pancreatic ducts, which drain into the duodenum via the major and minor papillae. The common bile duct also drains into the duodenum via the major papilla and the common bile duct and main pancreatic duct join to form the ampulla of Vater, immediately proximal to the papilla, which is controlled by the sphincter of Oddi. The endocrine glands of the pancreas are located in microscopic structures known as the Islets of Langerhans and they produce several hormones, including insulin, glucagon, somatostatin, gastrin, pancreatic polypeptide and bombesin among others
Pancreatic ductal adenocarcinoma (PDAC) is a particularly lethal form of cancer as indicated by its being the fourth ranked cause of death by cancer in Western countries, while representing only 3% of the new cancer cases each year.
Tobacco, diabetes, obesity and chronic pancreatitis are described as risk factors for PDAC, but, with the exception of familial PDAC, no high risk population is defined.
Due to the absence of specific symptoms PDAC is usually diagnosed late and up to 60% of patients have advanced PDAC at the time of diagnosis, when median survival is only 3 to 6 months.
Resection is the only potentially curative treatment but is only appropriate for patients whose general condition is still good and whose tumour does not show any evidence of local invasion or metastatic spread. Because of its poor prognosis, improvement of PDAC prognosis requires detecting and managing this cancer before regional invasion and metastasis.
Three types of neoplastic precursor lesions to PDAC have been described and characterized. Such lesions are, most of the time, asymptomatic, and they may occur together with unresectable carcinoma.
PanINs and IPMNs exhibit similar histological and molecular features and the distinction between those two types of lesions is based on their size and location. Depending on the lesion origin (main duct or peripheral ductules), PanINs and IPMNs can be considered as similar lesions with different clinical outcome. A transgenic mouse model which develops PanIN lesions in addition to cystic lesions of the pancreas resembling human IPMNs following TGF-α overexpression in mutant K-RAS favours of a common origin of both types of lesions.
Dr Graham Stapleton is registered with the Health Professions Council of South Africa as a General Surgeon.
He specialises in liver and pancreatic surgery, with particular emphasis on removal of tumours of the liver and pancreas as well as other gastrointestinal cancers. He also supervises palliative treatments such as endoscopic and percutaneous stenting of obstructed bile ducts for those patients whose cancers are advanced and not resectable.
+27 (0) 21-6716181
+27 (0)82-569-4427
drstapleton@webafrica.org.za
graham@hpbsurgery.co.za
1406 Netcare Christian Barnard Memorial Hospital
Cnr DF Malan Street & Rua Bartholemeu Dias Plain
Foreshore, Cape Town, 8001