The pancreas is a gland located deep within the upper abdomen, situated behind the stomach. It performs two major functions: producing digestive enzymes to break down food and releasing hormones, such as insulin and glucagon, to regulate blood sugar levels. Because of its deep location and dual function, problems with the pancreas can present with vague symptoms, making specialized medical expertise necessary for accurate diagnosis and treatment. This guide details the different medical professionals involved in pancreatic care, from the first point of contact to advanced specialized treatment.
Starting the Journey: Primary Care Physicians
The first doctor an individual typically sees for new or unexplained symptoms, such as persistent abdominal pain or sudden weight loss, is the Primary Care Physician (PCP). The PCP initiates the assessment process by taking a detailed patient history and performing a physical examination. Initial screening tests are often ordered, which may include blood work to check for elevated levels of pancreatic enzymes like amylase and lipase, or to look for signs of liver involvement like jaundice.
The PCP’s role is triage, determining if symptoms warrant a specialist referral or if they can be managed generally. If initial findings suggest a pancreatic issue, such as inflammation (pancreatitis) or a mass, the PCP coordinates the next steps. They act as the gateway to specialized care, ensuring the patient is directed to the most appropriate expert for further investigation.
The Specialist for Diagnosis and Medical Management
The primary specialist for the non-surgical diagnosis and medical management of pancreatic diseases is the Gastroenterologist (GI), who focuses on the entire digestive tract, including the pancreas. Within this field, some physicians specialize further as medical pancreatologists, concentrating solely on conditions like acute and chronic pancreatitis, exocrine pancreatic insufficiency, and pancreatic cysts.
Gastroenterologists use a range of advanced, non-surgical techniques for diagnosis and treatment. Endoscopic Ultrasound (EUS) is a procedure where an endoscope with an ultrasound probe is passed through the digestive tract to create detailed images of the pancreas and surrounding structures. This allows for the precise sampling of tissue through a needle biopsy to confirm a diagnosis.
Another specialized procedure is Endoscopic Retrograde Cholangiopancreatography (ERCP), which uses an endoscope and X-rays to visualize the ducts of the pancreas and bile system. ERCP allows the GI specialist to perform minor interventions, such as removing gallstones blocking the pancreatic duct or placing a stent to open a stricture caused by inflammation or a mass. For patients with chronic pancreatitis, the GI specialist also manages exocrine insufficiency by prescribing pancreatic enzyme replacement therapy to aid digestion.
When Surgical Intervention is Required
Structural issues, such as tumors, large fluid-filled cysts, or severe complications from chronic pancreatitis, often necessitate intervention by a surgical specialist. These specialized surgeons are referred to as Hepatopancreatobiliary (HPB) surgeons, indicating their expertise in the liver, bile ducts, and pancreas. HPB surgeons are trained in complex operations that require a high degree of precision and experience.
One of the most complex procedures is the Whipple procedure (pancreaticoduodenectomy), typically performed for tumors in the head of the pancreas. This operation involves removing the head of the pancreas, the duodenum, the gallbladder, and part of the bile duct, followed by reattaching the remaining organs to restore digestive function.
For tumors located in the body or tail of the pancreas, a distal pancreatectomy is performed, which often includes the removal of the spleen due to its close proximity. In rare cases, a total pancreatectomy may be performed, removing the entire pancreas. Due to the high complexity and associated risk, patients are encouraged to seek treatment at high-volume medical centers where surgeons perform these procedures frequently.
Collaborative Treatment for Pancreatic Cancer
When pancreatic cancer is diagnosed, a single physician cannot manage the entire care journey; instead, a coordinated approach by a Multidisciplinary Team (MDT) is adopted. The MDT brings together multiple specialists who meet regularly to review the patient’s case and formulate a unified treatment plan. This collaborative model ensures that all aspects of the disease are addressed, from tumor treatment to symptom management.
Key Specialists in the MDT
The team includes several specialists:
- The Medical Oncologist manages systemic treatments, primarily administering chemotherapy, targeted therapy, or immunotherapy, to kill cancer cells throughout the body.
- The Radiation Oncologist plans and delivers high-energy X-rays to target the tumor directly, often combined with chemotherapy, a process known as chemoradiation.
- The Palliative Care specialist is integrated into the MDT from the time of diagnosis, focusing on managing pain, controlling symptoms, and maintaining the patient’s quality of life.
- The HPB surgeon, GI specialist, and oncologists work together to sequence surgery, chemotherapy, and radiation therapy, ensuring the patient receives the most comprehensive and individualized strategy.
These systemic and localized treatments are often used to shrink tumors before surgery or to treat cancer that has spread.