What is pancreatic divisum?
Pancreatic divisum is a congenital (present at birth) anomaly of the pancreas characterised by the presence of two pancreatic ducts instead of one. The pancreas is an organ that produces digestive fluids containing enzymes to digest food. The fluids are then drained into the duodenum, the first part of the small intestine, through the pancreatic duct.
The correct functioning of the pancreas is important in digestion, as well as neutralising the stomach acid. During foetal development, there are two pancreatic ducts (dorsal and ventral), which fuse into one. When pancreatic divisum occurs, the majority of the pancreas is drained by the dorsal duct [1, 2, 3, 4].
This condition is the most common variant of pancreatic ductal fusion and drainage anomalies [2]. Approximately 4%-14% of the general population have pancreatic divisum [1]. Most individuals with pancreatic divisum do not exhibit any signs or symptoms, and the condition does not cause any other issues. In some cases, some signs of pancreatitis (inflammation of the pancreas) may be present [1].
Pancreatic divisum is mostly diagnosed as an incidental finding during abdominal ultrasound, or upon investigating pancreatic trauma. For example, in a study of 500 pancreatic imaging examinations, pancreas divisum was detected in 21 cases (4.3%) [5].
It is worth noting that other conditions such as previous pancreatic trauma, partial pancreatectomy, or pancreatitis with irreversible damage to the duct, pseudocyst, and pancreatic carcinoma can simulate the appearance of pancreas divisum [2]. Therefore, a careful and comprehensive evaluation is necessary for an accurate diagnosis.
Therefore, more advanced pancreatic studies are indicated, such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) [1, 6]. These techniques can reveal the characteristic features of pancreas divisum, such as a short (1-6 cm) and thin (2 mm diameter) pancreatic duct (known as duct of Wirsung) that branches off into regular arborization (a tree-like structure of the ducts) and drains only the posterior part of the head of the pancreas [2].
Does having pancreatic divisum lead to higher risk of cancer?
While pancreatic divisum is often asymptomatic and does not cause any harm, some studies do suggest a potential link between pancreatic divisum and an increased risk of pancreatic cancer. In a study of 32 cases of pancreatic divisum, 12.5% were associated with pancreatic tumours [7]. Another study found association between pancreatic divisum and cancer in up to 12.5% of cases [8].
While these studies suggest a link between pancreatic divisum and cancer, it is important to note that both studies are based on small sample sizes. Given that the number of patients with both pancreatic divisum and pancreatic cancer in the general population is low, the absolute risk remains small. Additionally, more research is needed to understand the connection between pancreatic divisum and cancer, with larger sample sizes and diverse population of patients from multiple ethnicities and socioeconomic backgrounds.
If you have pancreatic divisum, it is important to discuss your overall health and other individual risk factors with your doctor. Your doctor will then recommend a surveillance plan and potential healthcare interventions you might need.
Pancreatic cancer: Diagnosis, Prognosis and Treatment
Pancreatic cancer is a term encompassing tumours of the pancreas. These are usually highly lethal, one of the fastest-growing solid tumours worldwide [9]. In Europe, pancreatic cancer is the tenth most frequently-diagnosed cancer, accounting for about 3% of malignancies in both men and women [10]. The high mortality of pancreatic cancer is particularly dangerous due to the ability of the disease to remain asymptomatic until an advanced stage, making early detection challenging [11].
Diagnosis of pancreatic cancer is performed using imaging methods including ultrasound, CT scan, magnetic resonance imaging, and positron emission tomography [9]. The diagnosis can also be made using endoscopy. If a biopsy (a small sample of the tumour) is taken, histopathology (cutting the sample into very thin slices, then staining with dyes allowing to visualise various tissues and molecules under the microscope) is performed to determine the stage of cancer, as well as expression of certain molecules to to guide therapeutic decisions [9]. However, despite the improvement in diagnostic techniques, the early diagnosis of pancreatic cancer remains unsatisfactory [12].
The treatment for pancreatic cancer depends on the stage of the disease. For patients with early-stage disease, mainly stage I and partially II, radical surgery is the mainstay treatment [10]. Surgery is the only potentially curative option, however this is possible in only 20% of patients at the time of diagnosis [13]. For the patients with locally advanced, unresectable (impossible to operate on without risking damage to neighbouring anatomy) or metastatic (spreading to other parts of the body) pancreatic cancer, chemotherapy or radiotherapy are the treatment options. However, these aim to slow down the spread of cancer and provide some comfort of the patient as a means of palliative care. Additionally, surgery to improve the digestive functions can be performed, however this does not treat the cancer, only improves the patient's comfort during radical treatment or palliative care [14].
The prognosis of pancreatic cancer is generally poor. The 5-year survival rate for all stages of pancreatic ductal adenocarcinoma is only 7% [15]. Even with chemotherapeutic treatment, the 5-year overall survival rate is less than 10% [16]. The prognosis depends mainly on radical surgery and the presence of negative resection margins (parts of normal tissue surrounding the tumour which are also taken out to ensure that no cancer cells are left behind, as well as on the biological tumor stage, which also influences the treatment strategy [10].
In conclusion, while there is some evidence of an increased cancer risk in patients with pancreatic divisum, the matter requires further research. However, as pancreatic cancer is very deadly, it is important to seek medical attention if you suspect pancreatic cancer. Regular check-ups are also important if you have been diagnosed with pancreatic divisum.
