Pancreas & Bile Duct Tumors

Liver, gall bladder, bile duct & pancreatic tumor surgeries can be performed by conventional open method or by laparoscopy. Laparoscopic or Keyhole cancer surgery has several advantages over conventional open surgery with same cure rate. Only surgery is curative in these tumors and cancers. Additional therapies (chemotherapy & radiotherapy) are mostly supportive. But, many patients and their relatives try to avoid surgery for the fear of the immense trauma for their loved ones, resulting in patient getting wrong or less effective treatment. With laparoscopy the trauma is much less and makes the treatment more acceptable. The Team MACS, led by some of the best oncologists in India, precisely addresses all these issues and works relentlessly for a better life.

comparing the wounds
Dr. Sandeep Nayak


MBBS, MRCSEd, DNB (Gen Surg),
MNAMS (Gen Surg), DNB (Surgical Oncology),

Fellowship in Laparoscopic and Robotic Onco-Surgery.
Dr Nayak is one of the leading senior Surgical Oncologists (cancer surgeon) of Bangalore. He is one of the pioneers of Laproscopic (laparoscopic) cancer treatment (surgery). He is the Director of Surgical Oncology at Fortis Hospital, Bangalore.

Read More

The Advantages Of Laparoscopic Cancer Surgery Over Conventional Open Surgery (Macs Advantages) Include

About Bile Duct & Pancreas

Bile duct is the tubular structure that is involved in transmitting the bile from liver to intestines. This duct passes through pancreas before entering the small intestine (duodenum). The problems associated with bile duct and pancreas tend to produce jaundice as they block the flow of bile.
Common Bile Duct (CBD) transmits the bile from liver to intestine. In doing so the duct passes through the pancreas, where the pancreatic duct joins it. The duct from gall bladder (cystic duct) also joins the CBD.
Pancreas is a gland located behind the stomach. It secretes both digestive juices and hormones like insulin. Both these functions are very important for the normal functioning of the body. Common bile duct passes through head of the pancreas and joins the duct of the pancreas before joining intestine. Pancreas also has body and tail (see below), diseases of which do not cause jaundice.

Symptoms And Diagnosis

The most common symptom of cancers bile duct & pancreas are:

  • Unexpected weight loss & loss of apatite could be one of the earliest symptoms. This occurs because of changes in digestion.
  • Jaundice is when eyes turn yellow. This occures early in case of cancers of common bile duct and head of pancreas.
  • Itching occurs because of jaundice.
  • The juices secreted by liver and pancreas are very important in digestion. Indigestion (dyspepsia) and change in color of stool (feces) very common.
  • Vague pain in the upper part of abdomen could be the only symptom in some cases.
  • The diagnosis is reached based on investigations which include various blood tests including liver functions tests and imaging tests like CT scan and MRI scan. A needle biopsy should never be performed on a suspected gallbladder cancer as this can spread the disease. Rarely a biopsy is needed. If the investigations shows a cancer far too progressed for a curative procedure, then only a needle biopsy is planned.

What Is Jaundice?

Jaundice is when eyes turn yellow. It is caused by accumulation of bile in the body. The detection of the cause of jaundice is important in its treatment. It results from interference in the normal flow of bile.

Jaundice may result from:

  • Conditions affecting the red blood cells.
  • Conditions affecting the liver cells.
  • Conditions affecting the tiny bile ducts within the liver.
  • Conditions affecting the common bile duct outside the liver.

The first three treated with medicines. However, conditions affecting the common bile duct needs to be corrected using some form of procedure. The bile from all the tiny bile ducts in the liver drains into the common bile duct. If the common bile duct becomes narrowed or blocked (obstructed) then bile which contains bilirubin can seep out into the bloodstream and cause jaundice. This is sometimes called obstructive jaundice or post-hepatic jaundice (hepatic is another word for liver). Common conditions that can cause this include:

  • Gall bladder stones. Stones can form in the gallbladder. Usually they do not cause any problem. Jaundice is an uncommon complication of gallstones. It occurs if a gallstone comes out of the gallbladder, but gets stuck in the common bile duct. Bile then cannot pass into the gut, and so seeps into the bloodstream.
  • Cancer of Pancreas. Cancer in the head of the pancreas can block the flow of bile.
  • Cancer of Bile Ductanywhere between its exit from liver to the entry into intestine.
  • Cancer of the gallbladder may grow to block the common bile duct (late).

Bile Duct Cancer & Treatment

These are called cholangiocarcinoma. They present with jaundice. Treatment depends on which portion of the duct the cancer has affected. If upper part is affected, a portion liver has to be removed with the cancer (right or left hepatectomy). If lower portion is involved, pancreas will have to be removed along with the cancer (pancreatico-duodenectomy or Whipple’s Surgery)similar to pancreatic head cancer.

Pancreatic Tumors & Treatment

Tumors of pancreas may arise in any part of pancreas. These tumors produce jaundice when the lesion is in the head. However, when the tumor is in other parts of the pancreas, patient does not develop jaundice.
Head of Pancreas: The tumors or cancers arising in and around the head of the pancreas usually cause (obstructive) jaundice as they block the bile duct.
Pancreatico-Duodenectomy or Whipple’s Surgery is the treatment that is performed for these conditions. This surgery is a complex surgery and is associated with complications. The recent advances in the technique have reduced the complications. The robotic and laparoscopy surgery combined with specialized techniques of anastomosis (Hindenburg technique) have reduced the complications for less than 3%.
Body and Tail of Pancreas: Various types of tumors and cancers arise in this region of pancreas. Tumors of this region need to undergo total or distal pancreatectomy. This procedure involves removal of both body and tail of pancreas. Laparoscopic or robotic distal pancreatectomy is a standard procedure with least morbidity.