What are the normal roles of the pancreas and bile ducts in health ? The pancreas is a gland located in the abdomen which produces pancreatic juices that help to digest food after a meal. It also makes insulin and other hormones. Insulin helps control the amount of sugar in the blood. Bile ducts form the drainage system which convey bile from the liver, where it is formed, to the upper part of the small intestine, duodenum. Bile is a yellowish-green coloured fluid which helps to digest the fat content in our meals. Cancer of the Pancreas and cancer of the bile ducts Most pancreatic cancers begin in the ducts that carry pancreatic juices. Cancer of the bile ducts originates from cells lining the bile ducts. Symptoms or what the patient feels Cancers of the pancreas or bile ducts may be silent when early, however as the cancer grows it may cause one or more of the following symptoms : Yellow discoloration of the skin and eyes dark urine Pain in the upper abdomen or back Loss of appetite, nausea or vomiting Weight loss, lethargy and general weakness None of the above are sure signs of cancer and may also be caused by obstruction by gallstones or by infection of the bile ducts or other diseases. A doctor will be able to advise on the cause or on any tests that may be needed. Anyone with these symptoms should see a doctor for advice as soon as possible so that early treatment can be given. Diagnosis and Investigations If a doctor suspects that a patient has symptoms and signs that suggest pancreatic cancer, the doctor may arrange for investigations to help confirm the diagnosis. They may include one or more of the following: Blood tests - Bilirubin and liver enzymes which may indicate obstruction of the bile ducts. Other tests may be needed. CT scan (Computed tomography) or Ultrasonography (U/S) – Images of the pancreas, liver, bile ducts and other organs in the abdomen can be obtained by high frequency sound waves transmitted through an ultrasound device plcaed on the surface of the abdomen (U/S), or by taking multiple Xrays which are compiled by a computer (CT scan) to reconsitute images of the organs in the abdomen. ERCP (endoscopic retrograde cholangiopancreatography) -- The doctor passes a scope through the patient's mouth into the stomach and the small intestine. A thin tube is passed through the scope into the bile ducts and pancreatic ducts, and Xray pictures are taken. EUS (Endoscopic ultrasound): The doctor passes a special scope through the patient's mouth into the stomach and the small intestine. The scope carries an internal ultrasound device that scans the pancreas, liver, bile ducts and surrounding tissues. Biopsy -- The doctor may obtain tissue by inserting a needle to remove cells or by doing an operation. The removed tissue is examined under a microscope to look for cancer cells. Treatment methods Treatment depends on the site (position) of the cancer, its size and whether it has spread to surrounding or distant organs. Determination of the size of the cancer and its extent is called staging. When planning treatment, the doctor also considers other factors, including the patient's age, overall health and fitness, and his/her preferences. There may be several treatment options available. Depending on the type and stage, the cancer may be treated with surgery, radiotherapy or chemotherapy, or a combination of the above. The surgeon may remove all or part of the cancer in pancreas or bile ducts. The extent of surgery depends on the location and size of the tumor, the stage of the disease, and the patient's overall health and fitness. Sometimes the cancer cannot be completely removed because of safety considerations or technical reasons. However if the tumor is blocking the bile duct or small intestine, the surgeon can perform a bypass surgery to relieve jaundice and itch caused by obstruction. An important part of treatment is pain control, to relieve any pain which the patient may experience.