Pancreatic Exocrine Neoplasia in Dogs

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Pancreatic Exocrine Neoplasia in Dogs

By: Dr. Nicholas Trout

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Section: Veterinary Care In-depth

Diagnosis In-depth

Your pet's problems may have been of short (acute) or long (chronic) duration. Going off food and losing a significant amount of weight can be difficult to appreciate for many animals unless weight is actually measured on a regular basis.

On physical examination your pet may show discomfort when palpated in the upper right quadrant of the abdomen. In some cases the abdomen will be tense and painful all over. Occasionally a mass in the region of the pancreas will be palpable.

Jaundice or yellowing of the skin and mucous membranes may be the first clinical sign noted. In the case of pancreatic exocrine neoplasia this is usually associated with the tumor obstructing the outflow of bile.

There are no specific laboratory abnormalities for pancreatic cancer. The white blood cell count may reflect inflammation. The red blood cell count and total protein may suggest dehydration.

Elevations in liver enzymes and bile products in the blood would confirm the bile obstruction.

Abdominal X-rays may confirm the presence of a mass in the right upper quadrant. A mass may displace other organs in that area such as the duodenum, stomach and liver. Inflammation in the vicinity of the pancreatic tumor can produce a non-bacterial accumulation of fluid, which tends to decrease the detail of the X-ray, creating a so-called "ground glass" appearance to the image.

Abdominal ultrasound is sensitive in detecting not only a mass within the pancreas, but the presence of metastasis to local lymph nodes or other organs such as the spleen or liver. The effect of a pancreatic tumor on the bile outflow tract can also be appreciated.

Ultrasound-guided fine needle aspiration of the tumor is a minimally invasive technique that in many cases can produce a diagnosis without the need for surgery. Under sedation or general anesthesia, the mass is located using ultrasound. If it can be isolated and deemed to be safe relative to other important and often vascular structures nearby, a needle is guided into its core and cells aspirated to be evaluated by a pathologist.

In some cases where there is an effusion, a sample of fluid from the abdomen may contain neoplastic cells originating from the pancreatic tumor.

When ultrasound is not available, diagnosis may be made at the time of surgery. Pancreatic exocrine neoplasia can grossly resemble some variants of acute or chronic pancreatitis and so definitive diagnosis should be made by biopsy and histopathologic evaluation. Fresh frozen samples taken at the time of surgery may be evaluated and a diagnosis obtained in about twenty minutes in certain referral and university hospitals.

Treatment In-depth

Treatment for exocrine pancreatic neoplasia is almost always unrewarding using either a medical or a surgical approach. The most common reason for this negative outlook is that the cancer has usually spread by the time the veterinarian has made the diagnosis.

The tumor does not respond well to chemotherapy and therefore this approach alone has no merit.

In most cases, at the time of surgery, the mass is large, invasive and has spread to other abdominal organs. The pancreas is an important organ in the body. Not only does it have a role in the digestion of food but it is also responsible for producing insulin and regulating levels of blood glucose (sugar). If the pancreas were completely removed, the pet would be a diabetic and would need enzyme supplementation to assist with digestion. He would also need the stomach rerouted to the small intestine to allow outflow of food from the stomach and require rerouting of bile from the gall bladder to the small intestine. When all of these procedures are considered, together with the poor outlook and rapid spread for this tumor, it is not surprising that, sadly, in most cases, the most humane option is euthanasia, once the diagnosis has been made.

In the rare case that the tumor has not spread and can be removed, tumor removal would often be followed by placement of a jejunal feeding tube, to allow your pet to receive nutrition directly into the small intestine at a level below the pancreas.

After pancreatic surgery food is not offered by mouth for 2 to 5 days. Hydration and electrolytes are maintained by intravenous fluids. Nutrition will be provided either intravenously or via a feeding tube.

Small amounts of low fat bland food such as scrambled egg or boiled chicken and boiled rice may be offered after a few days. If vomiting does not occur then your pet may be discharged from the veterinary hospital.

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