My bile duct requires a stent in it continuously due to its collapse. It is collapsed due to a neuroendocrine tumor on my pancreas. If it does not have a stent in it, within months I will start to lose weight and have severe diarrhea. My body will eventually start taking protein from my muscles and I will get a body itch in the strangest places on my body. It does not matter what or how much I eat because my body will not be able to absorb nutrients due to the bile duct's collapse.
Will my bile duct always stay collapsed even if the tumor shrinks dramatically or is removed? SERIOUS ANSWERS ONLY PLEASE. This is an incredibly complex topic and you have supplied almost NO information to go on. Therefore you get an entirely abstract answer... which is for the best. You cannot get specific answers to questions regarding YOUR TREATMENT over the internet, unless your doctor happens to catch you posting questions online!
The reason that tumors of the head of the pancreas affect the bile duct is that the bile duct actuall PASSES THROUGH the head of the pancreas on its way into the intestine. The bile duct and the pancreatic duct join together just as they enter the intestine in the second portion of the duodenum... just a few inches after the stomach turns into tubular bowel.
When a tumor compresses the bile duct from the outside, this leads to blockage and bile cannot get out of the liver. Bile has a few jobs to do, and one of them is to rid the blood stream of oily waste products. The yellow discoloration that one suffers from bile duct blockage is called "jaundice". It represents an accumulation of bilirubin which is a waste product that comes from the normal turn-over of red blood cells.
If a patient is found to have a tumor in the head of the pancreas which blocks the bile duct, the next question that the doctor has to ask is, "is this tumor removable with surgery or not?" If it is, we call it "resectable", and if not, we call it "unresectable".
The decision to persue a surgical approach for tumors in the head of the pancreas is one that requires a huge amount of aggression on the part of the surgeon. The removal of the head of the pancreas takes with it a variety of tubular organs that are too attached to the pancreas for them to be left behind. This operation is called a "pancreaticoduodenectomy" and is reffered to as the "Whipple procedure" named after one of it's earliest proponents. This operation typically takes between 4 and 10 hours to perform and has a very high complication rate. Reconstruction of the gastrointestinal tract, the biliary flow pattern and the emptying of the pancreas into the intestine are all required. Any leaks at the points where these systems are rejoined can be disasterous, especially the pancreas-to-intestine junction. Pancreatic juice turns out to be especially nasty.
Because this operation causes so much illness, it is not undertaken lightly. If the surgeon notices anything which would indicate that the tumor is stuck to something that has to be left behind, or if it has escaped from its primary site in the pancreas and has begun to grow in the liver or in distant lymph nodes, then the operation is aborted because it's pointless to hurt the patient that much if its not going to offer a reasonable chance of increasing lifespan.
Backing up a step, the most common cancer that leads to the need for a Whipple pancreaticoduodenectomy is pancreatic adenocarcinoma. This is cancer that arises from the lining of the pancreatic ducts. The next most common cancer that would lead to this operation would be bile duct cancer that happens to grow within the head of the pancreas. Bile duct cancer is called cholangiocarcinoma.
The pancreas has two components. One component is "exocrine", which is the part that makes digestive juice and puts it into a duct system that eventually pours it into the gut to mix with food. The other part is "endocrine". Endocrine function involves hormone formation. The pancreas has little tiny clusters of cells which make hormones. These hormones are not released into the intestine to mix with food. Instead, they are released into the blood stream and circulate throughout the body, interacting with different cells as a signalling mechanism. These little nests of cells are called "Islets of Langerhans" and when they give rise to a tumor, its a completely different situation, physiologically, than adenocarcinoma arisen from pancreatic ducts.
One of the most important questions we have to ask, when it comes to the assessment of such a "neuroendocrine" tumor is whether or not it secretes hormone. Sometimes the uncontrolled release of hormone can cause problems that are in organs completely remote from the location of the tumor. For example, a gastrin secreting tumor (gastrinoma) can cause ulcers in the stomach. Insulinoma can cause dangerous hypoglycemia. VIPoma (secreting vasoactive intestinal peptide) can cause a syndrome of diarrhea and electrolyte disturbances. However, many pancreatic endocrine tumors are "nonfunctional". They may or may not be secreting some sort of hormone product, but if so, its so mutated that it has no noticeable physiologic effect.
When it comes to the assessment of resectability for a neuroendocrine tumor of the pancreas, there are a tremendous number of variables involved. First off, is there any way to get complete control of the lesion, surgically. If the tumor is stuck to something important like the superior mesenteric artery (which we're not allowed to remove since this would kill all of the absorbing intestine and kill the patient) then we call it unresectable. If it's obviously in multiple places in the body, it's unresectable. If the patient is in poor health and would not tolerate an enormous operation, then it doesn't matter how favorable the tumor's anatomy is, it's unresectable in the sense that the patient wouldn't tolerate the resection.
If there is no way to go after the lesion surgically, then we fall back on plan B. Plan B typically involves insuring that the bile duct stays open, the intestinal tract stays open, and that any medical consequences of the tumor are managed appropriately. Pancreatic cancer can be painful. There is no reason that the patient should be delivered inadequate pain control.
In some neuroendocrine tumors of the pancreas, getting less than all of it surgically is still an acceptable alternative. This is called "debulking" and is of no benefit in terms of overall survival time. However it IS of benefit in terms of symptom control. For those who are suffering the effects of cancer related hormone imbalance, this can be a real benefit.
It would seem to me that if you're being managed with a biliary stent, then you're in a sort of "plan B" mode for some reason or another. It may be related to the specifics of your tumor, or it may be that it relates to your underlying health.
I hope this answers some of your questions. I encourage you to engage your surgeon in an open conversation on the topic!
Feel free to contract me directly through yahoo answers if there is anything I can help with in terms of information interpretation. check with your doc...but yes probably that's usually is a surgery, talk to your doctor. |
