Pancreas

The pancreas sits deep in the upper abdomen, behind the stomach. It makes digestive enzymes and hormones, including insulin, that help regulate blood sugar. Pancreatic findings can behave very differently, so a useful plan starts with clear imaging, accurate pathology when needed, and a multidisciplinary review of the available options.

Pancreatic ductal adenocarcinoma

What it is: This is the most common pancreatic cancer. It usually begins in the cells lining the pancreatic ducts. A tumor in the head of the pancreas can narrow the bile duct and lead to jaundice.

Risk factors: Age, smoking, obesity, long-standing diabetes, chronic pancreatitis, and some inherited cancer syndromes can increase risk. Having a risk factor does not mean that someone will develop pancreatic cancer.

Possible symptoms: Painless jaundice, dark urine, pale stools, persistent upper-abdominal or back pain, unintentional weight loss, poor appetite, and new or worsening diabetes. These symptoms have many possible causes, but should be assessed promptly.

Tests and treatment: Pancreas-protocol CT or MRI/MRCP helps define the tumor and its relationship to blood vessels. Endoscopic ultrasound with biopsy is used when tissue confirmation will guide treatment. Surgery may be appropriate for localized disease; the operation depends on location and can include a Whipple procedure or distal pancreatectomy. Chemotherapy before or after surgery, symptom relief, and bile-duct drainage are chosen according to stage and individual fitness.

Pancreatic cysts — IPMN and MCN

What they are: Pancreatic cysts are often found incidentally. Some are harmless, while mucin-producing cysts such as intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) carry different levels of future cancer risk.

Risk factors and symptoms: Many cysts have no known cause and cause no symptoms. Age, smoking, a family history of pancreatic cancer, and certain inherited conditions can influence risk. Pain, pancreatitis, jaundice, or a changing cyst deserve closer assessment.

Tests and treatment: MRI/MRCP or CT is used to assess cyst size, duct changes, wall nodules, and growth over time. Endoscopic ultrasound and cyst-fluid testing are sometimes useful. Many cysts are monitored safely with scheduled scans. Surgery is considered when there are high-risk features, concerning cytology, symptoms, or clear progression.

Pancreatic neuroendocrine tumors

What they are: These uncommon tumors arise from hormone-producing neuroendocrine cells. Some release hormones and cause specific symptoms; others do not and are found during imaging for another reason.

Risk factors and symptoms: Most occur sporadically. A small proportion are associated with inherited conditions such as MEN1, von Hippel–Lindau disease, neurofibromatosis type 1, or tuberous sclerosis. Depending on hormone production, symptoms may include repeated low blood sugar, ulcer symptoms, diarrhea, or flushing. Non-functioning tumors may cause no symptoms.

Tests and treatment: Assessment may include hormone blood tests, CT or MRI, endoscopic ultrasound, pathology, and specialized functional imaging. Size, grade, growth rate, hormone activity, and spread determine treatment. Options can include observation of selected small lesions, enucleation or pancreatic resection, and medical or radionuclide treatment for advanced disease.

Chronic pancreatitis and its complications

What it is: Repeated or persistent inflammation can scar the pancreas, narrow or block the pancreatic duct, and gradually reduce digestive and endocrine function.

Risk factors and symptoms: Alcohol, smoking, recurrent acute pancreatitis, inherited forms of pancreatitis, autoimmune pancreatitis, and some metabolic disorders may contribute. Symptoms can include recurring pain, weight loss, greasy stools, poor nutrition, and diabetes. Complications may include fluid collections, bile-duct or duodenal narrowing, bleeding, or vascular clots.

Tests and treatment: CT, MRI/MRCP, and endoscopic ultrasound help show ductal changes, stones, and complications. Treatment focuses on smoking and alcohol cessation where relevant, pain control, pancreatic enzyme replacement, nutritional support, and diabetes care. Endoscopic or surgical treatment may be considered for persistent pain, obstruction, or a correctable structural complication.

Solid pseudopapillary neoplasm and other rare tumors

What it is: A solid pseudopapillary neoplasm is an uncommon tumor with low to intermediate malignant potential, seen more often in younger women. Other rare pancreatic tumors require precise pathology because their treatment and expected behavior differ.

Risk factors and symptoms: No modifiable risk factors are established for solid pseudopapillary neoplasm. It may cause no symptoms until it grows; some people notice abdominal fullness, discomfort, or an incidental mass on imaging.

Tests and treatment: CT and MRI assess the mass, nearby organs, blood vessels, and pancreatic duct. Biopsy is considered when it will change management. Complete surgical removal is commonly the main treatment for a localized solid pseudopapillary neoplasm, with the extent of surgery tailored to its site and size.

Periampullary lesions

What they are: These lesions occur around the ampulla of Vater, where the bile duct and pancreatic duct meet the duodenum. They can arise from the ampulla, bile duct, duodenum, or pancreatic head, and these different origins matter for treatment.

Risk factors and symptoms: Risk varies by the exact tissue of origin. Age, smoking, chronic inflammation, and some inherited syndromes can play a role. Jaundice, itching, cholangitis, pancreatitis, anemia, or weight loss may occur, but early lesions can be silent.

Tests and treatment: CT/MRCP, endoscopy, endoscopic ultrasound, ERCP, and biopsy can help define the lesion. Small superficial adenomas may be removed endoscopically in selected cases. Invasive or concerning lesions often require a Whipple procedure; the final plan depends on staging, pathology, symptoms, and overall health.

Acute pancreatitis

What it is: Sudden inflammation of the pancreas. Most attacks are mild and settle with hospital care, but some cause severe illness, fluid collections, or damaged pancreatic tissue.

Risk factors and symptoms: Gallstones and alcohol are the most common causes; very high triglycerides, some medicines, and ERCP can also trigger an attack. Typical symptoms are severe upper-abdominal pain spreading to the back, nausea, and vomiting.

Tests and treatment: Blood tests (lipase or amylase) confirm the diagnosis and ultrasound looks for gallstones; CT is used when the course is severe or unclear. Treatment includes fluids, pain relief, and nutrition. When gallstones are the cause, removing the gallbladder, usually laparoscopically, helps prevent further attacks. Collections or necrosis occasionally need endoscopic, radiological, or surgical drainage.

Pancreas divisum

What it is: A common congenital variant in which the two ducts of the developing pancreas do not join, so most pancreatic juice drains through the smaller minor papilla.

Risk factors and symptoms: It is present from birth and most people never have symptoms. In a small number of people it may be associated with recurrent acute pancreatitis or pain, and other causes are excluded first.

Tests and treatment: MRCP, ideally with secretin, or endoscopic ultrasound shows the duct anatomy. No treatment is needed without symptoms. In selected patients with recurrent pancreatitis, endoscopic treatment of the minor papilla may be considered; surgery is rarely required.

Annular pancreas

What it is: A rare congenital condition in which a ring of pancreatic tissue partly or completely surrounds the duodenum.

Risk factors and symptoms: It can narrow the duodenum in newborns, or appear in adults with vomiting, fullness after meals, ulcer-like pain, or pancreatitis. Many adults have no symptoms.

Tests and treatment: CT or MRI/MRCP and upper endoscopy help confirm the diagnosis. People without symptoms need no treatment. When the duodenum is obstructed, the usual operation bypasses the narrowed segment rather than dividing the pancreatic ring.

How an assessment is organized

The first appointment reviews symptoms, scans, pathology reports, medicines, and general health. Further tests are arranged only when they will clarify the decision. The aim is a personalized plan that explains what is known, what remains uncertain, the benefits and limits of each option, and the expected follow-up.

This information is general and does not replace an individualized medical assessment.