Intraductal Papillary Mucinous Neoplasms (IPMN)

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IPMN

Intraductal papillary mucinous neoplasms (IPMNs) are tumors that grow within the pancreatic ducts.

About IPMNs

Intraductal papillary mucinous neoplasms are tumors that grow within the pancreatic ducts (the pancreatic ducts are the "tubes" within the pancreas that are used to transport fluids to the bowel to help with digestion). Intraductal papillary mucinous neoplasms are also characterized by the production of thick fluid, or "mucin", by the tumor cells.

IPMNs are important because some of them progress to invasive cancer if they are left untreated. Just as colon polyps can develop into colon cancer if left untreated, some IPMNs can progress into invasive pancreatic cancer. IPMNs therefore represent an opportunity to treat a pancreatic tumor before it develops into an aggressive, hard-to-treat invasive cancer.

On the other hand, most IPMNs will never progress to a cancer, and it can be safe to observe (rather than treat) those IPMNs that don't progress. The challenge for clinicians is to determine which IPMNs need to be removed surgically and which IPMNs can be safely observed.

For a comprehensive discussion of pancreatic cysts and IPMNs, watch the webcast by Dr. Anne Marie Lennon.

IPMN FAQs

The management of IPMNs can be complicated, so we provide answers to common questions our patients have about IPMNs. We hope you find this information helpful.

How common are IPMNs? ▼

Intraductal papillary mucinous neoplasms are surprisingly common. We completed a study here at Johns Hopkins Hospital in which we carefully studied the pancreatic findings in a large series of patients who underwent computerized tomography (CT) scanning that included their pancreas.

We found that 2.6 out of every 100 healthy individuals examined had a pancreatic cyst (IPMN). There was a strong correlation between pancreatic cysts and age. No cysts were identified among asymptomatic individuals less than 40 years of age, while 8.7 percent of the patients age 80 to 89 years had a pancreatic cyst. Thus, intraductal papillary mucinous neoplasms of the pancreas are fairly common, particularly in the elderly.

What do IPMNs look like under a microscope? ▼

The main pancreatic duct is the long branching tube-like structure that runs down the center of the pancreas. It collects the digestive enzymes made by the pancreas from branch ducts that run into it like a stream into a river, and delivers the digestive enzymes to the intestine (duodenum). Intraductal papillary mucinous neoplasms (IPMNs) arise within one of these pancreatic ducts. Grossly (using the naked eye), intraductal papillary mucinous neoplasms (IPMNs) form tumors that project into the duct (click here to compare IPMNs with other cysts). When examined using a microscope, intraductal papillary mucinous neoplasms can be seen to be composed of tall (columnar) tumor cells that make lots of mucin (thick fluid).

Pathologists classify intraductal papillary mucinous neoplasms (IPMNs) into two broad groups - those that are associated with an invasive cancer and those that are not associated with an invasive cancer. This separation has critical prognostic significance. Patients with a surgically resected intraductal papillary mucinous neoplasm without an associated invasive cancer have an excellent prognosis (>95% will be cured), while patients with a surgically resected intraductal papillary mucinous neoplasm with an associated invasive cancer have a worse prognosis.

Intraductal papillary mucinous neoplasms without an associated invasive cancer can be further subcategorized into two groups. They are IPMN with low-grade dysplasia, and IPMN with high-grade dysplasia. This categorization is less important than the separation of IPMNs with an associated cancer from IPMNs without an associated invasive cancer, but this categorization is useful as IPMNs are believed to progress from low-grade dysplasia to high-grade dysplasia to an IPMN with an associated invasive cancer.

What is the difference between main duct and branch duct IPMNs? ▼

Intraductal papillary mucinous neoplasms (IPMNs) form in the main pancreatic duct or in one of the branches off of the main pancreatic duct.

IPMNs that arise in the main pancreatic duct are called, as one might expect, "main duct type" IPMNs. Think of a tumor involving the trunk of a tree. IPMNs that arise in one of the branches of the main duct are called "branch duct type" IPMNs. Think of a tumor involving a branch of a tree.

The distinction between main duct type and branch duct type IPMNs is important because several studies have shown that, for each given size, main duct IPMNs are more aggressive than are branch duct IPMNs and branch duct IPMNs are less likely to give rise to an invasive cancer. For this reason, most main duct IPMNs are surgically resected, while some branch duct IPMNs can be safely observed.

What symptoms do IPMNs cause? ▼

Signs and symptoms include:

abdominal pain
nausea
vomiting
jaundice (a yellowing of the skin and eyes caused by obstruction of the bile duct)
weight loss
acute pancreatitis

These signs and symptoms are not specific for an IPMN, making it difficult to establish a diagnosis. Doctors will often order additional tests.

A growing number of patients are now being diagnosed by chance, before they develop symptoms (asymptomatic patients). In these cases, the lesion in the pancreas is discovered accidentally when the patient is being scanned for another reason. For example, we have seen patients who had a CAT scan because they were in a car accident; the CAT scan happened to include the pancreas and it revealed an unsuspected IPMN.

How are IPMNs diagnosed? ▼

If a doctor has reason to believe that a patient may have an IPMN, he or she can confirm that suspicion using one of a number of imaging techniques, including computerized tomography (CAT or CT scan), endoscopic ultrasound (EUS), and magnetic resonance cholangiopancreatography (MRCP). These tests will reveal enlargement (dilatation) of the pancreatic duct or one of the branches of the pancreatic duct.

In some cases a fine needle aspiration (FNA) biopsy can be obtained to confirm the diagnosis. Fine needle aspiration biopsy is most commonly performed through an endoscope at the time of endoscopic ultrasound.

How are main duct type IPMNs treated? ▼

As many as 70% of main duct type intraductal papillary mucinous neoplasms harbor high-grade dysplasia (the step right before an invasive cancer develops) or an invasive cancer. Main duct type IPMNs are therefore clinically high-risk lesions, and, in general, most main duct intraductal papillary mucinous neoplasms should be surgically resected if the patient can safely tolerate surgery. It is important that this surgery is carried out by surgeons with ample experience with pancreatic surgery.

IPMNs in the tail of the pancreas are usually resected using a procedure called a "distal pancreatectomy." Surgeons at Johns Hopkins perform some distal pancreatectomies using minimally invasive procedures (laproscopic pancreatectomy). IPMNs in the head or uncinate process of the pancreas are usually resected using a Whipple procedure (pancreaticoduodenectomy). A total pancreatectomy (removal of the entire gland) may be indicated in the rare instances in which the intraductal papillary mucinous neoplasm involves the entire length of the pancreas.

How are branch duct type IPMNs treated? ▼

The management of branch duct IPMNs is more complicated than is the management of main duct type IPMNs. Many branch duct IPMNs are harmless and the risks associated with surgery may outweigh the benefits of resecting them.

If you have a branch duct IPMN, you should consult with a physician to determine the the most suitable methodology to follow your IPMN as well as the frequency of follow-up.

International consensus guidelines for the treatment of branch duct IPMNs were updated in 2017. These guidelines balance the risks and benefits of treating patients with a branch duct type IPMN. The guidelines suggest that asymptomatic patients with a branch duct IPMN that a) is less than 3 cm in size, b) not associated with dilatation (ballooning) of the main pancreatic duct, and c) does not contain a solid mass (mural nodule), can be followed safely without surgery.

By contrast, the guidelines recommend the surgical resection of branch duct type IPMNs that cause symptoms, that are larger than 3 cm, that contain a mass (mural nodule), OR which are associated with significant dilatation of the main pancreatic duct. These guidelines have been supported by a number of recent studies. The rate of growth of an IPMN and preferences of the patient and surgeon also guide the management of IPMNs. Unfortunately, the criteria used to guide the clinical management of a patient with an IPMN are not perfect. Some IPMNs that meet criteria for surgery, when removed, will prove to be of the harmless type (they have low-grade dysplasia). Branch duct IPMNs should be surgically resected only if the patient can safely tolerate surgery. Branch duct IPMNs that are not surgically resected can be monitored clinically to make sure that they do not grow. Growth of a branch duct IPMN or the development of a mass (mural nodule) while being monitored may be an indication to surgically remove the IPMN.

Several imaging technologies can be used to monitor branch duct IPMNs for growth. These include computerized tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance cholangiopancreatography (MRCP). In general, smaller branch duct IPMNs less than 1 cm in size can be followed with an annual exam. Patients with larger IPMNs may have an examination more frequently, some as frequently as every three months.

If I had an IPMN surgically removed, am I cured? ▼

While patients who undergo resection of an IPMN not associated with an invasive cancer are "cured" of that particular lesion, IPMNs can be multiple and patients with one IPMN remain at risk for developing a second lesion in the part of the pancreas that wasn't removed.

Therefore, your doctor will recommend follow-up visits after surgery for an IPMN.

Am I at increased risk of developing tumors outside my pancreas? ▼

Patients with an IPMN have been shown to have a slightly increased risk of developing tumors of the colon and rectum. Your doctor may therefore recommend periodic follow-up examination of your colon (via colonoscopy).

How can I be evaluated and treated at Johns Hopkins for an IPMN? ▼

If you have an IPMN and would like to consult with a physician at Johns Hopkins we recommend that you contact our cyst clinic. It is extremely important that you choose a team of specialists with the most up to date knowledge, broad experience, and compassion.

We pledge to take great care of you.

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Our Cyst Clinic Treats Patients With Pancreatic Cysts

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Endoscopic Ultrasound FAQs

Endoscopic ultrasound (EUS) is a minimally invasive endoscopic technique which allows the doctor (endoscopist) to obtain detailed images of the pancreas. EUS provides the endoscopist with more information than that obtained with CT or MRI imaging. EUS can be used to evaluate solid masses and to evaluate cystic masses of the pancreas. Since EUS is often used to evaluate IPMNs, we have included information on the EUS procedure here.

Biopsies from abnormal areas of the pancreas can be taken through the endoscope, avoiding exploratory surgery. In particular, at the time of EUS the endoscopist can use a needle passed through the scope to take sample fluid from a pancreatic cyst. If you have additional questions about your EUS procedure, do not hesitate to contact the doctor performing the procedure.

How is an Endoscopic Ultrasound (EUS) performed? ▼

Watch how an EUS is performed

A thin, flexible tube (endoscope) is passed through the mouth and into the stomach and duodenum. The tip of the endoscope contains a built in miniature ultrasound probe which emits sound waves. These sound waves pass through the lining of the stomach and duodenum creating a visual image of the pancreas and surrounding tissue.

EUS can be used to obtain a needle biopsy of the pancreas or to sample fluid in a pancreatic cyst. This is done by passing a very thin needle from the endoscope into the pancreas under continuous ultrasound monitoring. This technique is called EUS-fine needle aspiration (EUS-FNA) and does not hurt.

Another, similar video, showing how EUS is performed with fine needle aspiration

Where is an EUS performed? ▼

EUS is performed as an outpatient procedure (the patient is not admitted to the hospital). Procedures are performed either in the morning or afternoon. As you will be receiving intravenous (IV) sedation you will not be allowed to drive after the procedure. It is important that you have a companion (family member or friend) to take you home and plan to have someone stay with you at home after the examination as sedatives can affect your judgement and reflexes for up to twenty four hours.

Can I eat before the procedure? ▼

EUS procedures are performed either in the morning or afternoon. Make sure you follow the directions you were given about eating and drinking before your procedure. Often, if your procedure is schedule before 12 pm, you will be asked not to eat or drink anything after midnight. Often, if your procedure is scheduled after 12 pm you may allowed to have clear liquids until 8 am on the day of the test. Again, triple check before eating or drinking!

Should I take my medications on the day of an EUS? ▼

If you are taking medication for high blood pressure, seizures, or if you are taking prednisone, you may take these medications the morning of the procedure or at least two hours before the procedure with a sip of water. Do not take any water/fluid pills until after the completion of your procedure.

Anticoagulant medications (blood thinners such as warfarin (Coumadin), heparin, or clopidogrel (Plavix)) may need to be adjusted before the procedure. You should contact your prescribing physician for instruction on when to stop taking this medication. In general aspirin and non-steroidal anti-inflammatory medications (naproxen, ibuprofen etc) can be taken before an EUS examination.

More information, including instructions for patients who are diabetic, is available at Johns Hopkins Gastroenterology and Hepatology. If you have any medical questions about the EUS, please call the nurse coordinator at (410) 502-0793 or the doctor performing the procedure.

How long does the procedure take and what happens afterwards? ▼

The actual EUS procedure usually takes approximately 45-60 minutes. Most patients are discharged 3-4 hours after they arrive. Following the procedure, you will be monitored in the recovery area until the effects of the sedation have worn off. You will be able to eat after the procedure.

Will I be admitted for the procedure? ▼

The procedure is usually performed as an outpatient. Most people are able to go home one to two hours after completion of the procedure.

When will I be given the results of the EUS? ▼

Your endoscopist will usually be able to give you the preliminary results of the EUS on the same day as the procedure. If an EUS-FNA has been performed, these results take between four to five days to return. If you attend the pancreatic cyst clinic, the EUS results will be reviewed along with any other imaging (CT or MRI) and pathology results at the weekly pancreatic cyst multidisciplinary meeting. During this meeting an individualized plan will be developed for you. You will be contacted by a member of the multidisciplinary team within twenty four hours of the meeting to discuss the plan with you.

What are the possible complications associated with EUS? ▼

EUS is a very safe procedure and complications are rare.

You may have a sore throat which usually resolves within a day or two. Sometimes people feel a little bloated due to the air inserted by the instrument.

Other potential but uncommon complications of EUS include a reaction to the sedatives used, aspiration of stomach contents into your lungs, and complications affecting the heart or lungs. One major, but very uncommon complication of EUS is where there is a tear in the lining of the stomach or duodenum, called a perforation, which may require surgery. If an EUS-FNA is performed, where a needle is passed into the pancreas to take a sample, there is a small risk of bleeding, pancreatitis or infection. To decrease the risk of infection, we routinely prescribe antibiotics for patients in whom EUS-FNA was performed on a pancreatic cyst.

An inherited genetic variation in DNA that you are born with

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Also known as a pancreatoduodenectomy, the Whipple procedure is the surgery typically performed to remove cancers of the head of the pancreas (the part of the pancreas on the right side of your body). It typically involves the surgical removal of the head of the pancreas, a portion of the duodenum and a portion of the bile ducts.

This is an experimental type of treatment. It is a medication made of killed or weakened cells, organisms or manufactured materials, which is used to boost the body's immune system. Ideally, this will allow the body to fight and kill the cancer cells more effectively. Vaccines include whole killed cancer cells or specific proteins from the cancer.

Unable to be surgically removed. This usually means that the cancer has spread beyond the areas that can be removed surgically.

The part of the pancreas that bends backwards, hooking around two very important blood vessels, the superior mesenteric artery and vein. The word "uncinate" comes from the word uncus which means "hook."

A painless procedure in which high frequency sound waves are used to generate pictures of the inside of the body. An ultrasound devise can be placed at the end of a scope, and the scope inserted into the duodenum, providing very detailed pictures of the pancreas. This is called "endoscopic ultrasound."

This term simply refers to a "mass" or neoplasm. For example, a collection of pus is a tumor. This is a general term that can refer to either benign or malignant growths.

A clot within the blood vessels. It may occlude (block) the vessel or may be attached to the wall of the vessel without blocking the blood flow.

An inflammation of the veins accompanied by thrombus formation. It is sometimes referred to as Trousseau's sign.

The long thin part of gland in the left part of abdomen, near the spleen.

A slender hollow tube inserted into the body to relieve a blockage. For example, pancreas cancers often grow into the bile duct as the bile duct passes through the pancreas. This can block the flow of bile and cause the patient to become jaundiced. In these cases the flow of bile can be reestablished by placing a stent into the bile duct, through the area of blockage.

Excessive amounts of fat in the stool. Sometimes this can appear as an oil slick on top of the toilet water after the patient has had a bowel movement. It can be a sign that the pancreas isn't functioning well.

A classification system that is used to describe the extent of disease. Clinicians use it to predict the likely survival of a patient.

A flat, scale-like cell. Although most pancreatic cancers look like ducts under the microscope, a small fraction look like squamous cells.

A maroon colored, rounded organ in the upper left part of the abdomen, near the tail of the pancreas. This organ is part of your immune system and filters the lymph and blood in your body. It is often removed during the distal pancreatectomy surgical procedure.

A long (20 foot) tube that stretches from the stomach to the large intestine. It helps absorb nutrients from food as the food is transported to the large intestine. There are three sections: the duodenum, the jejunum and the ileum. Due to its proximity to the pancreas, the duodenum is the section of the small intestine most often affected by pancreatic cancer.

An infection of the blood. This can be life-threatening and is often treated with antibiotics.

A malignant tumor that looks like connective tissues (bone, cartilage, muscle)under the microscope. Sarcomas are extremely rare in the pancreas.

Able to be removed surgically. Usually this means that the cancer is confined to areas typically removed surgically.

The use of high-energy waves similar to x-rays to treat a cancer. Radiation therapy is usually used to treat a local area of disease and often is given in combination with chemotherapy.

A thick ring of muscle (a sphincter) between the stomach and duodenum. This sphincter helps control the release of the stomach contents into the small intestine.

A forecast for the probable outcome of a disease based on the experience of large numbers of other patients with similar stage disease. Importantly, making a prognosis is not an exact science. Some patients with poor prognosis beat the odds and live longer than anyone would have predicted. Steve Dunn's Cancer Guide has an excellent article on statistics and prognoses and stories of other cancer patients.

A cancer in the organ where it started in. A primary cancer of the pancreas is one that started in the pancreas as opposed to a cancer that started somewhere else and only later spread to the pancreas.

The biochemical study of plants; concerned with the identification, biosynthesis, metabolism of chemical constituents of plants; especially in regards to natural products.

Around the ampulla of Vater in the duodenum. The peri-ampullary region is comprised of 4 structures; the ampulla, the duodenum, the bile duct and the head of the pancreas. It is sometimes difficult to tell which structure a tumor originated in. In such cases the diagnosis will be a peri-ampullary tumor.

A medical doctor specially trained to study disease processes. Pathologists make the microscopic diagnosis that is used to establish the diagnosis of cancer.

A term used to describe certain tumors which grow in finger-like projections. Pathologists use this term to describe some precancerous lesions in the pancreas (intraductal papillary mucinous neoplasm).

Any treatment that reduces the severity of a disease or its symptoms. Palliative care is often a part of the treatment plan for patients with advanced pancreatic cancer.

An oblong organ located between the stomach and the spine. The pancreas secretes enzymes needed for the digestion of food and it produces hormones such as insulin and glucagon which help control blood sugar.

A surgically created opening in an organ that can also be referred to as an anastamosis. Sometimes when surgeons remove a segment of bowel they create an ostomy to allow for the bowel contents to exit the body.

A medical doctor who specializes in the treatment of tumors. Oncologists often treat patients with pancreatic cancer with chemotherapy.

An abnormal new growth of tissue that grows more rapidly than normal cells and will continue to grow if not treated. These growths will compete with normal cells for nutrients. This is a general term that can refer to benign or malignant growths. It is a synonym for the word tumor.

Chemotherapy and radiation therapy that is given to patients before surgery. Some centers feel that the use of neoadjuvant therapy improves local and regional control of disease and that it may make more patients surgical candidates.

The thin section of the pancreas between the head and the body of the gland.

An alteration in the DNA of a cell. Think of it as a typographically error in the DNA code.

A cancer that has spread from one organ to another. Pancreas cancer most frequently metastasizes to the liver. In general, cancers that have metastasized are generally not treated surgically, but instead are treated with chemotherapy and/or radiation therapy.

A cancer that has the potential of invading nearby tissues, spreading to other organs (metastasizing) and possibly leading to the patient's death.

A painless method for visualizing internal organs. A tube-like machine with a powerful magnet generates images of the inside of the body. It does not involve the use of Xrays.

Normal, round, raisin to grape-sized collections of lymphocytes (white blood cells) found throughout the body. Lymph nodes are connected to each other by lymphatic vessels. They normally help fight infection, but also are one of the first sites to which cancers spread. In general, the spread of cancer to lymph nodes portends a worse prognosis for the patient. There are exceptions to this.

A primary pancreatic cancer that has spread to regional lymph nodes and/or resectable (removable) tissues. Removable tissues include some lymph nodes and parts of the duodenum and stomach that are routinely removed in some surgical treatments for pancreatic cancer.

The largest organ in the body, located in the right upper part of the abdomen. It performs many life-maintaining functions including the production of bile. The liver detoxifies the blood of drugs, alcohol and other harmful chemicals. It processes nutrients absorbed by the intestine and stores essential nutrients, vitamins and minerals. Bilirubin is a chemical produced when old or damaged blood cells breakdown. The liver chemically process the bilirubin so that it can dissolve in water and be excreted through the urine. When this process is disrupted, jaundice can develop.

A technique that surgeons can use to visualize and even biopsy (take tissue samples of) organs inside of the abdomen without making large incisions. Very small incisions are made in the belly and small tubes (called trocars) are then inserted. Gas is pumped in through one of the tubes to create enough space to work in. The surgeon inserts a small camera through one of the tubes and examines the lining and contents of the abdominal cavity by looking at the projected image on the television screen. With specially designed laparascopic instruments, biopsies and fluid samples can be taken for examination. Some surgeons feel that this technique can help "stage" a patient less invasively than with open surgery.

Yellowing of the skin or yellowing of the whites of the eyes caused by the accumulation of bile pigments (usually due to an obstruction of the bile ducts).

A hormone produced by the endocrine cells of the islets of Langerhans cells of the pancreas. Insulin acts to lower blood sugar levels.

A term used to indicate that cancerous cells are present in the duct but have not yet invaded deeper tissues.

The widest part of the pancreas. It is found in the right part of abdomen, nestled in the curve of the duodenum, which forms an impression in the side of the pancreas.

A hormone produced by the endocrine (islets of Langerhans) cells of the pancreas. When blood sugar levels are low, glucagon acts to raise blood sugar levels.

Gemzar is the trade name for the chemotherapy drug gemcitabine. It is frequently used to treat pancreatic cancer. It has been shown, in controlled clinical trials, to improve quality of life.

A green pear-shaped organ located on the right side of the abdomen just under the liver. The gallbladder is essentially a reservoir for holding bile.

A chemotherapeutic drug commonly used to treat pancreatic cancer.

The exocrine cells (acinar cells) of the pancreas produce and transport chemicals that will exit the body through the digestive system.

The chemicals that the exocrine cells produce are called enzymes. They are secreted in the duodenum where they assist in the digestion of food.

A test used to visualize and examine the pancreas and bile ducts. A tube is inserted through a patient's nose (or throat), down through the esophagus and stomach then into the small intestine (duodenum). There, a small probe is inserted into the ampulla of Vater. A dye is injected through the probe and into the pancreatic and bile ducts. X-rays are then taken to visualize the pancreatic and bile ducts. these ducts can be seen as white structures (this is because the injected dye is opaque). Because pancreas cancers often block the pancreatic and/or bile ducts, this technique can be useful in establishing a diagnosis of pancreas cancer.

A chemical that causes a reaction in other substances, in this case as a part of the digestive process.

A medical doctor who specializes in the treatment of hormonal abnormalities.

These are specialized cells that produce hormones released into the bloodstream. For example, the islets of Langerhans are endocrine cells in the pancreas that produce the hormone insulin. This hormone helps control blood sugar(glucose) levels.

Some rare tumors of the pancreas, the endocrine (Islet Cell) tumors, can produce these same hormones. It is very important that these rare tumors be properly diagnosed because it will determine the treatment and prognosis.

Surgical removal of a structure or part of a structure. For example, pancreatectomy is the surgical removal of the pancreas (or a portion of it).

The first portion of the small intestine. It is about 1 foot long. It is the part of the intestinal track that comes after the stomach.

A small anatomic structure. This is essentially a tube that carries various bodily fluids. The pancreatic duct runs the full length of the pancreas and drains into the duodenum.

The chemical in every cell that carries genetic information.

A dome shaped muscle that separates the lungs and heart from the abdomen. This muscle assists in breathing.

The disease in which the body is unable to appropriately control blood sugar (glucose) levels. This may be caused by failure of the pancreas to produce adequate amounts of insulin.

A fluid filled sac. Some tumors of the pancreas, including the serous cystadenomas and intraductal papillary mucinous neoplasms, form cysts. Cysts have a distinct appearance in CT scans. They are important to recognize because the treatment of cystic tumors can differ from that for solid tumors.

A dye, taken by mouth or injected, that is sometimes used during x-ray examinations to highlight areas that otherwise might not be seen.

A way to image internal organs. A series of x-ray pictures taken by a machine that encircles the body like a giant tube. Computers are then used to generate cross-sectional images of the inside of the body.

The treatment of a cancer by chemicals. For pancreatic cancer these include: Gemzar (Gemcitabine), 5-flurouracil, leukovorin, taxol, and others.

A small, flexible tube inserted into the body to inject or suck out fluids.

A cancer-causing chemical. Cigarette smoke contains a number of carcinogens.

A malignant tumor. It has the potential of invading into the adjacent tissues, spreading to other organs and may eventually lead to the patient's death.

A dramatic weight loss and general wasting that occurs during chronic disease.

A blood marker for pancreas cancer. It is not a good screening test for diagnosing possible pancreas cancers in individuals without symptoms. Instead, it can be useful in following the progress of patients known to have a cancer by measuring how their cancer is responding to treatment.

The middle part of the pancreas between the neck and the tail. The superior mesenteric blood vessels run behind this part of the gland.

The removal and microscopic examination of a small tissue sample.

A duct that carries bile from the liver to the intestine. This term may refer to the hepatic, cystic or common bile duct.

A green fluid produced by the liver that helps digest fats. It is transported from the liver to the duodenum by the bile duct. When the flow of bile is blocked, patients may become jaundiced (yellow skinned).

Tumors which are non-cancerous. These generally grow slowly and do not invade adjacent organs or spread (metastasize) beyond the pancreas.

The collection of excess amounts of fluid in the abdominal cavity (belly). It often is a sign that the cancer has spread to either the liver or to the portal vein that goes to the liver, or that the cancer involves the internal lining of the abdomen. If normal liver function is affected, a complex set of biochemical checks and balances is disrupted and abnormal amounts of fluid are retained.

The large artery that carries oxygen-rich blood from the heart. From the heart it arches backwards and descends into the abdomen where it gives off many branches to supply the organs. The superior mesenteric artery is a major branch of the aorta that can be involved by pancreatic cancer.

A radiographic technique used to visualize blood vessels. A contrast medium (a dye) is usually injected into the vessels to make them appear white on the x-rays.

A condition marked by a diminished apetite and aversion to food. Often results in physical signs of wasting.

A condition characterized by a deficiency in red blood cells. This can lead to fatigue among other symptoms.

A surgical joining of two hollow structures. It is similar to attaching two ends of a garden hose. For example, a gastrojejunostomy is a surgical procedure that connects the stomach and the jejunum (small intestine.)

This widening of the pancreatic duct as it reaches the duodenum is an landmark for physicians. It is where the bile duct and pancreatic duct join before draining into the duodenum (small intestine). Tumors in the head of the pancreas may squeeze this duct partially or completely closed. This can lead to problems with digestion and jaundice.

Chemotherapy given to patients after their cancers have been surgically removed. It is a secondary treatment given to supplement surgical treatment. (see Neoadjuvant chemotherapy which is chemotherapy given before surgery)

A benign (non-cancerous) tumor made up of cells that form glands (collections of cells surrounding an empty space).

The form of cancer that most people are talking about when they refer to "cancer of the pancreas." These tumors account for 75% of all pancreas cancers.

Microscopically, adenocarcinomas form glands. These tumors can grow large enough to invade nerves which can cause back pain. They also frequently spread (metastasize) to the liver or lymph nodes. If this happens the tumor may be considered unresectable.

A pus-filled cavity. Usually caused by an infection.

The portion of the body between the diaphragm and the pelvis.