Diseases of the Pancreas

The pancreas is a major internal organ that constitutes an important part of our digestive system. It is located in the middle of the abdomen, behind the stomach and liver, and produces enzyme juices that aid in digestion. It also secretes hormones into the bloodstream that regulate blood sugar and metabolism.

There are many disorders of the pancreas. Type I diabetes, or childhood diabetes, is a disorder in which the pancreatic beta-islet cells, which secrete insulin, are mistakenly destroyed by the body’s immune system. Other pancreatic disorders can result in hormonal imbalances that cause excessive stomach acid, ulcers, diarrhea, and flushing. Patients with cystic fibrosis, which primarily affects the lungs, can also develop pancreatic problems.

Pancreatitis is generalized inflammation of the pancreas. This painful condition can cause serious metabolic imbalances and life-threatening infections. Patients require intensive therapy with intravenous fluid and supportive medicine, and must not eat until the inflammation subsides. Some patients are given nutrition through intravenous catheters. Severe pancreatitis may require surgical removal of the pancreas, and cleaning of the infected debris from the abdominal cavity. Common causes of pancreatitis include alcohol abuse, gallstones, and elevated blood  lipids.

Another disorder is pancreatic cancer. Although only the 9th most common cancer in the US, with 23,524 cases in 2000, it carries a high mortality. Symptoms include loss of appetite, weight loss, and jaundice (yellowing of the skin and eyes). Jaundice is caused by tumor blockage of the duct through which bile passes. The blockage is corrected with a stent, or by a surgical end-around procedure, which relieves the jaundice. An internal biopsy is required to make the diagnosis of pancreatic cancer.

Most cases are diagnosed at an advanced stage, because there is no screening test for pancreatic cancer, and there are few symptoms in the early stages. In appropriate cases, surgery offers the best hope of cure. After surgery, patients may be treated with radiation and chemotherapy to prevent relapse. Patients with inoperable tumors are treated with chemotherapy, radiation, or both.

Newer drugs are being developed for the treatment of pancreatic cancer. A new drug called Tarceva is a targeted therapy used in lung cancer that was just approved by the US Food and Drug Administration for treatment of pancreatic cancer. When used together with the drug Gemcitabine it results in a modest improvement in survival. Many other new drugs are under investigation for the treatment of pancreatic cancer.

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