Complex Hepatobiliary and Pancreatic Disease in Southeast Michigan

• Benign (non-cancerous) conditions are common. 
  • Cysts can develop after pancreatitis or can be pre-cancerous.
  • Pancreatitis, endocrine tumors, and other rare benign tumors may be seen incidentally (when looking at something else) on CT scans or ultrasound. 
  • Intraductal Papillary Mucinous Neoplasm (IPMN) is increasingly common and is pre-cancerous. Individuals with these tumors usually do not need to have surgery right away, but do need to be followed closely by a hepatobiliary surgeon.
• Cancerous Tumors need to be considered whenever evaluating a pancreatic mass. 
  • Pancreatic Adenocarcinoma is the most common.
  • Metastatic (spread from another organ) cancer occurs rarely.

• A detailed history and physical examination by a hepatobiliary specialist are the first steps.
• Blood work that includes basic labs and certain blood tumor markers, including CA19-9, are routine.
• A high-quality, pancreas-protocol CT scan is commonly done.
• Endoscopic Ultrasound (EUS) with needle biopsy by an experienced gastroenterologist often yields helpful information.
• Endoscopic Retrograde Cholangio Pancreatography (ERCP) can provide important anatomical detail and can be used to place a stent in the bile duct (to maintain bile drainage into the intestine).
• For established cancer, PET scans or total body CT are often done to look for any evidence of metastatic disease.

• After thorough workup, staging, and tumor board discussion, treatment might require surgery, chemotherapy, or chemotherapy followed by surgery. 
• Some intravenous chemotherapy regimens are better tolerated through an infusion port. If this is the case, your oncologist will arrange for us to place a port for you.
• We collaborate with national research organizations to enroll patients in cancer clinical trials. We may recommend a clinical trial if you are eligible.

• Jaundice (yellow skin and eyes), from bile duct blockage.
• Dark urine, from bile duct blockage.
• Abdominal and back pain, from tumor invading nerves.
• Weight loss, from appetite loss and difficulty eating.  

• Pancreaticoduodenectomy, better known as the Whipple procedure 
  • Necessary when the tumor is in the pancreatic head.
  • This is a major, approximately 6 hour long, operation.
  • Because of the shared blood supply, the duodenum, bile duct, and part of the stomach are removed along with the pancreatic head. 
  • In addition to removal of these structures, the procedure requires reconstruction with connection (anastomosis) of the jejunum (small intestine) to the pancreas (pancreato-jejunostomy), bile duct (choledocho-jejunostomy), and stomach (gastro-jejunostomy). 
• Distal Pancreatectomy 
  • Procedure to remove a tumor in the pancreatic tail.
  • This is major surgery, but not as extensive as the Whipple. 
  • Usually involves removing the spleen together with the pancreatic tail.

In some cases, this can be done laparoscopically, with or without robotic guidance.

• https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#:~:text=Pancreatic%20cancer%20is%20a%20disease,is%20difficult%20to%20diagnose%20early.
• https://www.cancer.gov/types/pancreatic
• https://www.cancer.org/cancer/pancreatic-cancer.html
• https://patient.info/cancer/pancreatic-cancer
• https://pancreasfoundation.org/patient-information/pancreatic-cancer/
• https://www.uptodate.com/contents/pancreatic-cancer-beyond-the-basics/print
• https://www.pancan.org/facing-pancreatic-cancer/patient-services/packet-order/
• https://www.pancan.org/
• https://www.cancer.org/cancer/liver-cancer.html
• https://medlineplus.gov/livercancer.html
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• https://patient.info/cancer/primary-liver-cancer-leaflet
• https://www.cancer.org/treatment/understanding-your-diagnosis/advanced-cancer/liver-metastases.html
• https://www.cancer.gov/types/liver/bile-duct-cancer/treatment
• https://medlineplus.gov/bileductcancer.html