Precancerous conditions of the pancreas

Precancerous conditions of the pancreas are changes to pancreas cells that make them more likely to develop into cancer. These conditions are not yet cancer. But if they aren’t treated, there is a chance that these abnormal changes may become pancreatic cancer.

The most common precancerous conditions of the pancreas are:

Mucinous cystic neoplasm (MCN) is found in the body and tail of the pancreas. It occurs most often in women between 40 and 50 years of age.

Intraductal papillary mucinous neoplasm (IPMN) usually occurs in the head of the pancreas. It is found in both men and women, usually when they are in their 60s and 70s.

Solid pseudopapillary neoplasm (SPN) occurs most often in the tail of the pancreas. It is also known as a Hamoudi tumour. They are most common in women in their 20s and 30s.

Neuroendocrine tumours can be either precancerous or cancerous. Doctors will look at a sample of the tumour under a microscope to find out if it is cancerous or not. Tumours that are more than 5 cm in diameter are usually cancerous. Occasionally, neuroendocrine tumours make extra hormones, particularly insulin.

The signs and symptoms of precancerous conditions of the pancreas include:

• vague abdominal pain or discomfort
• a firm, but not tender, lump in the abdomen
• yellowing of the skin and the whites of the eyes (called jaundice)
• weight loss
• diabetic symptoms, which include unusual thirst, frequent urination, extreme fatigue or lack of energy, nervousness and sweating

If you have symptoms or your doctor thinks you might have a precancerous condition of the pancreas, you will be sent for tests. Tests used to diagnose precancerous conditions of the pancreas may include:

• ultrasound, which could include endoscopic ultrasound (EUS)
• fine needle aspiration (FNA) guided by EUS
• CT scan
• endoscopic retrograde cholangiopancreatography (ERCP)
• MRI

Surgery is usually done to treat precancerous conditions of the pancreas. Most precancerous conditions can be completely removed. The type of surgery done depends on where the tumour is in the pancreas.

Distal pancreatectomy is used for tumours in the body or tail of the pancreas. It removes the tail of the pancreas, or the tail and part of the body of the pancreas, and nearby lymph nodes. The spleen is only removed if the tumour has grown into the spleen or the blood vessels supplying the spleen.

The Whipple procedure( also called pancreaticoduodenectomy) is used for tumours in the head of the pancreas. It removes the head of the pancreas along with part of the duodenum (the first part of the small intestine), the gallbladder, part of the common bile duct, the pylorus (bottom part of the stomach that attaches to the duodenum) and lymph nodes near the head of the pancreas.