What is Pancreatic Cancer and how is "Whipple Procedure" used in treatment of it?

Pancreatic cancer is one of the commonly seen types of cancer. What is pancreatic cancer, what are the signs of it, and what is done during treatment? Prof. Dr. Suleyman Yedibela, the General Surgeon of Anadolu Medical Center, gave important information on the matter and the details of "whipple technique", which is one of the most difficult operations of the branch of general surgery.

What is Pancreatic Cancer, what are the symptoms of it?

Pancreatic cancer is an aggressive type of cancer caused by the cells forming the channels in pancreas. Its symptoms may vary depending on where tumor is located within pancreas. In most of the patients, tumor is located in the head of pancreas and manifests with the complaints of jaundice, itching, indigestion, weight loss and pain. The weight loss here may also be resulting from the pressure applied on duodenum by cancer. And the pain progresses from the upper abdomen towards the back like an arch. However, at this point, this must be underlined: if a painless jaundice develops especially at the early stages, this first suggests a cancer in pancreas. This is because a jaundice accompanied by pain is mostly caused by the gallbladder stones.

Can pancreatic cancer develop by spreading into other organs (metastasize)?

Metastasis of pancreatic cancer means, except for local lymph node metastases, fourth stage, which is a stage where the chance of surgical treatment has been missed. The pancreatic cancer most frequently metastasizes to liver.

What are the causes?

The causes of it are not known exactly yet. However, results of scientific studies show that smoking and genetic predisposition are among the major causes.

Who are at risk?

Pancreatic cancer is more likely to develop in those who smoke tobacco products, men and those who are older than 65 years old. Although it seems as if the incidence of pancreatic cancer increase in diagnostic sense, it is not because the pancreatic cancer actually increases, rather the life expectancy of people has increased.

Can it be prevented?

There is no certain way to prevent it but avoiding tobacco products may provide protection to a certain extent. Besides, sportive activities, healthy eating and weight control are factors which can provide a stronger protection.

What are done during the treatment process?

Unfortunately, in pancreatic cancer, patients usually refer to hospital once the cancer has already progressed. However, early diagnosis is possible in those who refer to hospital in timely manner thanks to the complaint of jaundice occurring in the initiation of cancer. The best option of treatment for pancreatic cancer is surgery. In addition to it, the options such as palliative chemotherapy or immunotherapy and radiotherapy may be involved in the treatment.

 

How is "whipple procedure", which is one of the most difficult techniques of general surgery, performed?

The surgical techniques to be used will vary depending on where tumor is located. For example, in the patients where tumor is located in the head of pancreas, "whipple" technique is used. In this technique which is difficult to apply and has very complications, a third of the stomach, duodenum, the head of pancreas, biliary duct and gall bladder are removed. It is critical to remove the lymph nodes in the area as well. The procedure is completed by connecting pancreatic duct, biliary duct and stomach to small intestine, as the final step.

Is Whipple a technique suitable for every patient?

Whether this technique is to be used or not is determined taking the general condition of the patient and certain criteria into consideration. In general, certain criteria must be taken into consideration to use this technique in the patients with vein involvement. However, involvement of veins does not always pose an obstacle.

Can patients return to their social life quickly after the operation?

It is of course a big and difficult operation for both patients and surgeons. But patients can return to their daily life within two weeks after the operations performed by the teams experienced in this field. It is crucial to inform patients about diabetes since there is a risk of developing diabetes as a part of pancreas being removed. The head of pancreas is an important part where some vital enzymes are produced and medication is needed for substitution of these enzymes. Diabetes would develop and medication must be administered in patients in whom the body or tail of pancreas is removed, as insulin is produced intensively in these parts.

If any other technique than whipple is used in pancreatic cancer, different restrictions may be needed, after the operation, to be introduced in the lives of patients depending on to what extent the parts such as pancreas or intestine are affected. Chemotherapy, immunotherapy or radiotherapy may be needed as additional treatment depending on the stage of the tumor.

Prof. Dr. Suleyman Yedibela completed his medical education in Germany. He graduated from Friedrich-Alexander-University in Erlangen. He completed his residency in the Department of General Surgery at Erlangen University Hospital In 2007, he started and managed the Living-Related-Liver-Transplantation program in Leipzig University. He also served in management roles in Certificated Center for Colorectal Cancer Leipzig. In 2009, he worked as Hepato-Pancreato-Biliary Surgery and Organ Transplant Supervisor in Erlangen University. Prof. Dr. Suleyman Yedibela was as the Assistant Director of General Surgery at Medical School Hospital of Oldenburg-Groningen Hospital, Organ Transplant Manager at Istanbul Kadikoy Florence Nightingale, the Assistant Director of Surgery Department at Agaplesion Rotenburg Hospital and the Head of Esophagus and Hepato-Pancreato-Biliary Surgery at Bethel Clinic in Bielefeld University. Prof. Dr. Suleyman Yedibela has been serving as general surgeon at Anadolu Medical Center since 2022.