Diagnosing a disease of the pancreas requires a lot of experience and expertise. Depending on the symptoms and previous findings, the appropriate examinations have to be chosen to be able to make a correct diagnosis and start suitable treatment as soon as possible.

Examination methods
The examination methods in the case of a suspected disease of the pancreas include blood tests (including tumour marker CA 19-9) and contrast-enhanced CT scans, complemented by MRI if necessary.

Diagnosis of pancreatic carcinomas

Frequently, patients come to see me because of a suddenly occurring yellowness of the skin and the whites of the eyes (jaundice, icterus). In addition, significant weight loss in connection with dull upper abdominal pain or a sudden onset of diabetes are frequent but unspecific symptoms of a pancreatic carcinoma. In some cases a slightly increased concentration of pancreatic enzymes (amylase, lipase) in the blood can be detected due to the obstruction of the pancreatic duct.

If the following symptoms occur, the pancreas should be examined:

•     Yellowness of the skin and the whites of the eyes
•     (Unintentional) weight loss
•     Pain in the abdominal area and/or belt-like pain radiating to the back
•     Loss of appetite and nausea over several weeks
•     Onset of diabetes mellitus

The following risk factors encourage the occurrence of a disease of the pancreas and require a particularly thorough clarification of the symptoms:

•     First-degree relatives (parents, siblings) have developed pancreatic cancer
•     Smoking
•     Alcohol (pancreatitis)
•     Overweight
•     Diabetes mellitus

There are no standardised preventive check-ups available yet that might help detect pancreatic cancer at an early stage. Although an ultrasound examination (sonography) of the abdomen and the determination of the tumour marker CA 19-9 are of some significance, they are only suitable for detecting the disease at an early phase in some cases. They are therefore not recommended as preventive check-ups or screening methods.

Diagnosis of pancreatic cysts
Pancreatic cysts are often detected simply by chance. Here, the same as above applies: proper clarification is important to obtain accurate medical evidence and to be able to plan suitable treatment. This is particularly essential, as half of all pancreatic cysts may become malignant.

The following methods are suitable for the assessment of pancreatic cysts:

•     Computed tomography (CT)
•     Magnetic resonance imaging (MRI)
•     Endosonography including puncturing and analysis of the cyst content

Diagnosis of pancreatitis
The existence of pancreatitis can, in many cases, be presumed based on a person’s medical history and current health problems. To be able to diagnose the extent of the disease and decide on appropriate treatment measures, blood tests, a CT scan and/or an MRI are necessary.

Pancreatic cancer, which in medical terms is called pancreatic carcinoma or ductal adenocarcinoma of the pancreas, is relatively rare compared to other types of cancer. In Austria, approximately 1300 to 1500 persons are affected per year. Unfortunately, this is an extremely dangerous disease that requires fast and proper treatment. The causes of pancreatic cancer could not be clearly explained until now. However, there are several known risk factors which encourage the development of this form of cancer: smoking, diabetes mellitus, pancreatitis and genetic factors.

Identifying pancreatic cancer
At first, pancreatic cancer rarely causes symptoms in the early phase and is often diagnosed late, at an advanced stage. Take certain alarm signals of your body seriously and have a check-up carried out in the case of:

•     Pain of the upper abdomen radiating in a belt-like way to the back
•     Loss of appetite, nausea, vomiting and weight loss
•     Onset of diabetes
•     Yellowness of the skin and the whites of the eyes (jaundice, icterus)

If you have noticed one or more of these signals, further examinations become necessary. In the case of suspected pancreatic cancer, blood tests (including tumour marker) and a contrast-enhanced CT scan, sometimes complemented by magnetic resonance imaging (MRI), are the examination methods of choice.

These examinations are helpful to determine whether there actually is a tumour, whether it is benign or malignant, where it is located precisely, the proximity to the surrounding tissue and how far the disease has progressed.

Expert knowledge needed
As soon as all the test results are available, I will suggest the treatment which promises the best chances of success. For many years I have been dealing with the issue of the treatment of diseases of the pancreas and am specialised in surgery on this organ. Regarding diagnostics and therapy, I cooperate with a number of medical experts from various specialist fields. I can thus offer you a wide range of diagnostics and methods of treatment in connection with your disease.

Even though it is possible to perform minimally invasive surgery (keyhole surgery) in selected cases, modern pancreas surgery is always precise and radical. In order to identify those patients whose potentially malignant part of the organ can be removed completely, the surgeon needs correct evidence prior to the operation regarding the correct diagnosis, extent of the tumour, its resectability and any evidence of metastases. The fewer additional interventions before planned radical surgery are carried out, the more favourable the whole course of the treatment will be.

A cyst is a cell-lined, enclosed tissue cavity containing liquid. Cysts of the pancreas may have various causes and the cells lining the cavity may in some circumstances degenerate into malignant tumours. By analysing the cysts’ structure, their contents and the cells lining them, their potential risk of becoming cancer can be assessed.

Cystic neoplasia
Significant progress in diagnosis and risk-adapted treatment has been achieved in the field of pancreatic cystic neoplasia. This positive trend has substantially affected how pancreatic cysts are dealt with in medicine and broadened the range of indications for pancreas surgery considerably.

Some cysts of the pancreas are prone to be or become malignant with a probability of 50 percent. Therefore, a clear diagnosis of the type of cyst is important for suitable treatment. Depending on their origin and/or composition a distinction is made between more or less dangerous cysts:

•     Pseudocyst (PC): harmless
•     Serous cystic neoplasm (SCN): harmless
•     Intraductal papillary mucinous neoplasm (IPMN): potentially dangerous
•     Mucinous cystic neoplasm (MCN): dangerous
•     Solid pseudopapillary neoplasm (SPN): dangerous

In particular, the presence of symptoms, a cyst size of more than three centimetres, an irregular, thickened cyst wall or an enlarged pancreatic duct are an indication of dangerous pancreatic cysts (so-called worrisome features).

By means of modern, high-resolution MRI and endosonography, various types of cystic neoplasms can be differentiated and, depending on how worrisome they are, be treated individually. This allows timely surgery and a permanent cure of preliminary stages or early forms of certain types of pancreatic cancer.

If one or more pancreatic cysts have been detected, I will be pleased to advise you on further examinations and the necessary treatment on the basis of the existing images and test results.

Acute pancreatitis
The surgical treatment of acute pancreatitis has undergone a complete change over the past decade. In the past, patients who showed symptoms such as inflammation, infection and organic dysfunction were operated on immediately. Nowadays, the socalled step-up approach (delay – drain – debride) is applied in the treatment of acute pancreatitis: this consists of late intervention (only in the case of proven infection of the necrosis), percutaneous or transgastric drainage and finally removal of the necrosis – generally with endoscopic instruments via the stomach or a minimal opening in the lateral abdominal wall (minimally invasive necrosectomy).

Chronic pancreatitis
In the treatment of chronic pancreatitis, a step-up approach has also been established: conservative – endoscopic – surgical. However, surgery is and will remain an effective and permanent form of treatment for pain induced by pancreatitis. Surgical drainage can preserve the remaining pancreatic function without the necessity for further “maintenance” interventions. The narrowing of the bile duct and the stomach, which are not endoscopically accessible, are also treated most effectively by appropriate surgical intervention.

The pancreas is an organ that plays an essential role in digestion. On the one hand, it produces substances, the so-called digestive enzymes (protease, lipase and amylase), for breaking down proteins, fats and carbohydrates. On the other, hormones controlling the glucose metabolism are produced in the pancreas. The best known of these hormones is insulin. Due to diseases of the pancreas, tumours and inflammation, but also as a result of surgery, the function of the pancreas may be reduced, thus leading to disorders of the entire digestive process. This malfunction may show itself in flatulence, malodorous intestinal gases, fatty deposits in stools, malnourishment and an increased blood sugar level.

If these symptoms are recognised and read correctly, the reduced function of the digestive system can be improved by the use of medication, diet can be adjusted and digestion can return to normal again.