The Pancreas

March 5th

As many of you already know, parallel to the in vitro process, we are also in the process of getting a “shadow” in Andrés’s pancreas diagnosed. The lesion first appeared in a CT scan of the abdomen a year and a half ago and has not changed or grown since, which essentially means that if it is a tumour, it is not aggressive. The kicker is that because of its location (head of the pancreas) and small size, it is very hard to diagnose and determine what kind of tumour it is, if any. Some might argue, well, who cares what it is – just get it out. Not as easy as one would think. Unfortunately, the surgery to remove a tumour from this part of the pancreas, called the Whipple in case you want to Google it, is quite involved and has a very high risk of complications.
See, the pancreas is a gland that has both a digestive and an endocrine (hormonal) role in the body. Imagine your stomach, roughly located below the heart and sort of shaped like a letter J. It is connected at the top to the esophagus and at the bottom to a tube called “duodenum”, which is the entranceway to the small intestine. Also connected to the duodenum is the bile duct (to which the gallbladder is connected) and the head of the pancreas, a sausage shaped mass of soft tissue that lies behind the stomach and secretes digestive enzymes to help break down food, and hormones to regulate glucose. Most pancreatic tumours are rarely found early on because of where the pancreas is located (behind the stomach), and because they tend to be quite fast growing and aggressive. Andrés’s, on the other hand, hasn’t grown in a year and a half, has produced no symptoms, and is not really influencing his hormonal levels. The tests they’ve run have all come back negative. So one is tempted to say, leave it be, only there is always that chance that you don’t want to take, especially with such a “mysterious” organ as the pancreas is.

The Whipple procedure basically lops off the head of the pancreas, the duodenum, and the gallbladder and reconnects the stomach, the bile duct and the remaining bit of the pancreas directly to the small intestine. The most feared complication from the surgery is leakage in these new connections, because they are so delicate and small. If digestive juices were to ooze out, infection and inflammation could occur and that’s putting it very mildly. All this to say, you can understand why we’re so reluctant to have the surgery done. This lesion could be a benign tumour that does not cause him even one problem for the rest of his life, or it could not even be a tumour, but rather something he was born with. If he has the surgery and suffers life-threatening complications, how would we feel finding out it was nothing? On the other hand, if we assume it’s nothing and keep on imaging it every four months and it turns out to be a tumour, could it be growing under the radar and spreading? Could it become malignant and aggressive? Because of its location, it’s very hard to biopsy it, but we’re going to try in April. They will do this endoscopically and may very well not be able to get to it, or if they get to it, they could end up taking a sample that doesn’t contain any cancerous cells, even if they do exist in the tumour (because it’s so small), or worse, by messing with this delicate organ, they could cause pancreatitis.

But we’re going to think positive here and assume the gastroenterologist who will be performing it, who we happen to know is one of the best and comes highly recommended, will get to it and will get a good sample from it, that Andrés will recover from the biopsy no problem and that we will have a definitive diagnosis as a result. Then, just maybe, the decision to have the complicated surgery or to continue imaging it every four months, will be easy. I think we deserve at least one easy thing, don’t you?