Digestive System Surgery:
Cystic Fibrosis Disorder
A bag filled with liquid inside and outside of pancreas is appeared.
Pancreas is positioned at backside of stomach, and divided into head, body and tail part, and produces digestive liquid called as pancreatic fluid. Pancreatic fluid is then flowed into central pancreas duct from branch pancreas duct in pancreas. Finally, it reached to duodenum and help digesting.
Cyst is a balloon-like bag filled with liquid. Cyst developed inside of pancreas or surrounding of pancreas is called as pancreas cyst. No symptoms in most cases, and because of image diagnosis is advancing these days, the case where pancreas cancer is happened to be found at medical checkup, is increasing.
IPMN which has a possibility to become a cancer.
Pancreas cyst is basically divided to Tumor cyst and non-neoplastic cysts. Further the former is grouped into Papillary mucus tumors in the pancreatic duct (IPMN), mucus cyst tumors (MCN), serous cyst tumors (SCN), and the latter is grouped into pancreatic pseudo cyst and lymphatic epithelial cyst.
- Papillary mucus tumors in the pancreatic duct (IPMN)
Tumor developed from pancreas duct epithelium and grouped into main pancreatic duct type, branched pancreatic duct type, combination type. Tumor producing mucus is stood up in pancreas duct, then duct is looked as cyst. There is no symptom in most of the case, but when flow of pancreas fluid in pancreas duct is getting worse, it turns into pancreatitis. It may create severe pain for epigastrium to back side.
IPMN has a several levels from good to bad and advanced gradually over the long period of time. The cause for the development is unclear yet, but chronic pancreatitis, obesity, smoking and alcoholic drinking are considered as risk factor.
Careful points on IPMN are; “Cyst itself may turns into cancer” and “Cancer may be developed in pancreas other than the location of cyst in pancreas.” They say that cancerous of IPMN is about 1% per annum, so that careful follow-up is necessary, and important to find the development of normal type cancer at earliest possible timing. Later explained image test (contrast CT or MRCP), endoscope exam (EUS or ERCP) are combined to monitor the progress.
When malignant finding is found at the exams, or strongly suspicious of malignancy, surgical treatment is considered.
- Mucus cyst tumors (MCN)
- Common among middle aged female. It forms cyst filled with mucus and has high possibility of malignancy, surgical operation is recommended.
- Serous cyst tumors (SCN)
- Common among middle aged female. Different from above MCN, this has an high possibility of benignancy, but for the case where the size is increasing, surgical operation is necessary.
- Pancreatic pseudo cyst
- It is a cyst developed after pancreatitis or external injury. Cyst ingredients are pancreas fluid, dead tissue, or distilled liquid by inflammation. If it is small one, it may disappear naturally but since it has no firm membrane, liquid may stand still and becomes enlarged.
With large pancreatic pseudo cyst, abdominal pain may occur or may lead to the virus infection. Also, because pancreas fluid is a strong digestive liquid so that it effects on surrounding organs or blood vessel, resulted in perforating hole on digestive duct or bleeding from blood vessel.
Gastric camera is used for large and the treatment to drain the liquid in cyst out to stomach, with inserting tube into cyst from inside of stomach, is conducted. Surgical operation may be applied to pancreatic pseudo cyst which causes bacterium infection.
On ERCP, diagnose benignancy/malignancy by extracting pancreas fluid.
At ERCP, diagnose malignancy and benignancy by extracting pancreas fluid.
- Ultrasonic Test
- Ultrasonic is applied to one’s body and this is not a stressful test at all. This is conducted at Health Check as well. Brief diagnosis for pancreas is made.
- Abdominal Contrast CT Exam
- Injecting a contrast agent in blood vessel so that high accuracy image test which can evaluate entire pancreas including cyst.
For those having iodine allergy cannot have this test so that please declare oneself in prior to medical check.
- By MRI exam, detailed relation between cyst and pancreas duct can be diagnosed. Because it will use magnet, person who has pace maker inside its body cannot receive this exam.
- With proceeding endoscope to the deep end of duodenum, insert tube into pancreas duct then make contrast agent flow-in to be able to evaluate the traffic between pancreas duct and cyst. With extracting pancreas fluid, it can evaluate tissue malignancy and benignancy.
- Endoscopic Ultrasonography (EUS)
- Using gastric camera which has ultrasonic apparatus on its top, evaluation is made for pancreas conducting ultrasonic test from inside of stomach and duodenum. Unlike normal ultrasonic test, as camera does not receive any interference from stomach, fat or air in the digestive duct, detailed evaluation is possible.
For pancreatic cystic disease, continuous medical check is important.
Pancreatic cystic disease led by IPMN, is important to have periodical follow-up. With having the continuous diagnosis, early and appropriate medical treatment can be found. In case when diagnosed as pancreatic cystic, medical check conducted at experienced and reliable medical facility is recommended.