A Patient's Guide to Pancreatic Cysts

Home , Cyst, Pancreatic duct, Pseudocyst

A Patient’s Guide to Pancreatic Cysts

University of Michigan Comprehensive Cancer Center

Staff of the Comprehensive Cancer Center’s Multidisciplinary Pancreatic Cancer Program provided information for this handbook GI Oncology Program, Patient Education Program, Hepatopancreatobillary Surgery, Medical Oncology, Radiation Oncology Programs

Note: We will refer to this booklet during many of your visits. Please bring it with you to all appointments. Digestive System Anatomy

Esophagus

Liver Stomach Gallbladder

Duodenum

Colon

Pancreas (behind the stomach)

Pancreas and the Surrounding Organs

Liver

Stomach Gallbladder

Spleen

Portal Vein

Pancreas Common Bile Duct

Duodenum Superior Mesenteric Artery and Vein

I. Overview: Understanding pancreatic cysts A. Where is the pancreas located?...... 1 B. What does the pancreas do? ...... 2 C. What are pancreatic cysts?...... 2 D. What are the symptoms of a pancreatic cyst? ...... 3 E. How are pancreatic cysts diagnosed?...... 3 F. What are the types of pancreatic cysts?...... 7

II. Treatment A. What are the treatment options?...... 11 B. How does a patient decide on treatment?...... 11 C. Surgery ...... 13 1. When is surgery recommended? ...... 13 2. Will I take Insulin after?...... 16 C. Surveillance...... 17 1. What is surveillance? ...... 17

III. After Surgery A. Life after the Whipple procedure ...... 19 B. Dietary Changes after Whipple Procedure...... 19 C. What are pancreatic enzymes?...... 19 D. Special Considerations for distal pancreatectomy...... 21

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©2012 University of Michigan Comprehensive Cancer Center A Patient’s Guide to Pancreatic Cysts IV. Resources A. Support and Coping Resources ...... 23 B. Note Pages...... 24 C. Appointments & Calendar...... 26 D. Important Phone Numbers ...... 29 E. Maps & Other Information...... provided in back pocket

Illustrations

Figure 1: Anatomy of Pancreas ...... 1 Figure 2: Endoscopic Procedure ...... 5 Figure 3: Pseudocyst...... 7 Figure 4: Serous Cystadenoma...... 7 Figure 5: Mucinous Cystic Neoplasm...... 8 Figure 6: Intraductal Papillary Mucinous Neoplasm...... 8 Figure 7: Solid Pseudopapillary Neoplasm...... 9 Figure 8: Whipple Procedure...... 14 Figure 9: Distal Pancreatectomy procedure...... 15

The medical team at the University of Michigan Multi-disciplinary Pancreas Clinic at the Comprehensive Cancer Center created this booklet to provide information on pancreatic cysts and the treatment options available to you. Your medical team is available to help answer questions about this material and to help answer any questions you may have. Do not hesitate to contact us as you make your treatment decisions. Resource phone numbers are listed in the back of this booklet.

All of this information is available at the Patient Education Resource Center located on level B1 of the Cancer Center Building.

The information in this booklet will be reviewed and discussed throughout your treatment.

Please bring this booklet with you to all appointments.

You will find blank pages at the back of the book to use for questions, appointments or other notes.

©2012 University of Michigan Comprehensive Cancer Center A Patient’s Guide to Pancreatic Cysts vi A Patient’s Guide to Pancreatic Cysts ©2012 University of Michigan Comprehensive Cancer Center OVERVIEW Pancreatic Duct Pancreas A Patient’s Guide to Pancreatic Cysts Head Body Tail Celiac Plexus 1

Figure1. Anatomy of the Pancreas Figure1. Overview of Pancreatic Cysts of Pancreatic Overview Sphincter of Oddi Common Bile Duct ©2012 University of Michigan Comprehensive Cancer Center that drains bile from the gallbladder and runs through the head of the pancreas and runs through the head of the pancreas that drains bile from the gallbladder duct to form the Ampulla of Vater. connecting with the pancreatic body. It lies close to the liver and the section of the small bowel called the of the small bowel called to the liver and the section body. It lies close abdomen. on the left side of the tail is close to the stomach ‘duodenum’. The that runs through the pancreas and empties The pancreatic duct is a channel bowel. The common bile duct is another channel digestive juices into the small The pancreas is pear-shaped and approximately 6-8 inches long. It has a wider 6-8 inches long. It is pear-shaped and approximately The pancreas end called the body and a tapered head, the middle part called end called the side of your pancreas is on the right to Figure 1. The head of the the tail. Refer Where is the pancreas located? is the pancreas Where OVERVIEW A Patient’s GuidetoPancreatic Cysts disease. Lindau diseaseandare seeninabout10%ofpatientswithpolycystic kidney Pancreas cystscanbeassociatedwithunderlying disorderssuchasvonHippel- appropriate managementisstillbeingunderstood. reasons. Thecausesofothertypespancreatic cysts,thediagnosisand cysts isincreasingandoftenfoundon CTorMRIscansdoneforother “pancreatitis”. Pseudocystsarenevercancerous. Theidentificationofpancreas found intruecysts.Theycanarisefrominflammationthepancreascalled called apseudocyst.Thesepocketsoffluidsaren’tlinedwiththetypecells In factmostpancreaticcystsaren’ttechnicallyatall.Onetypeofcystis symptoms. is thatmostpancreaticcystsaren’tcancerousandmanydon’tevencause Though itmaybealarmingtolearnyouhaveapancreaticcyst,thegoodnews Pancreatic cystsareabnormal,sac-likepocketsoffluidwithinyourpancreas. What arepancreaticcysts? endocrine pancreas. exocrine pancreasandtheotherpartthatproduceshormonesiscalled The partofthepancreasthatproducesdigestivejuicesiscalled The pancreashas2mainfunctionsinthebody: What doesthepancreasdo? tosecretehormones,likeinsulin,thataffect howthebodyusesand • tomakedigestivejuices(calledenzymes) that flowthroughthe • digestive system,and pancreatic ductsandhelpbreakdownfatssugarsinthe stores nutrients.

©2012 University of Michigan Comprehensive Cancer Center challenge and other conditions such as pancreatic cancer should be ruled out. challenge and other conditions such as pancreatic cancer to determine whether it Your doctor may want to take a sample of the cyst fluid or can become cancerous, has potential to be malignant or not. If your cysts is, Most often pancreatic cysts are found when a scan is done for another reason Most often pancreatic cysts are found when a scan is with symptoms such such as to evaluate for kidney stones. However, patients will undergo tests to as abdominal pain, weight loss, or nausea and vomiting pancreatic cyst can be a determine the cause of these symptoms. Diagnosing a and last for days or years. How are pancreatic cysts diagnosed? Pancreatic cysts can be associated with persistent upper abdominal pain which Pancreatic cysts can be associated and shoulders. Abdominal pain can be related to may also radiate to the back of the pancreas. This can occur suddenly pancreatitis which is inflammation have a loss of appetite and nausea that leads to weight loss. have a loss of appetite and Abdominal Pain Nausea and Vomiting when the duodenum is compressed. This causes Stomach emptying is delayed lead to nausea and vomiting. Patients sometimes a feeling of fullness and may may grow in the head of the pancreas bowel) so cysts located duodenum (small of the skin to jaundice (yellow color structures, which can lead and block these and/or eyes) or blood abnormalities. of the cyst in the pancreas. Below are symptoms that may occur: the pancreas. Below are symptoms of the cyst in Jaundice and to the common bile duct pancreas is located close The head of the What are the symptoms of a pancreatic cyst? of a pancreatic the symptoms What are at all. In those no symptoms cyst have a pancreatic patients with Very often and the location disease of the extent to vary and are related symptoms that do, OVERVIEW A Patient’s GuidetoPancreatic Cysts with intravenoussedation. sampled andsentfor analysistothelaboratory.Thisprocedure isperformed cells forcytologytohelpdiagnosistheabnormality. Pancreaticcystfluidcanbe needle (FNA)ofthecystmayalsobeperformed duringanEUStoexaminethe (arteries andveinsnexttothepancreas). Anaspiratewithasmallor‘fine’ CT scan.Itcanalsoidentifytumorsthat mayinvolveimportantbloodvessels, (<2 cm)pancreatictumors,includingcysts, thatmaynotbewellvisualizedbya detecting pancreasabnormalities.EUSis particularlyusefulfordetectingsmall are obtainedthroughthestomachorinternalwall.Itishighlysensitivefor placed intothestomachandsmallintestine.Ultrasoundimagesofpancreas An EUSisperformedwithalightedtubethatinsertedthroughthemouthand Endoscopic Ultrasonography(EUS) hindered byunderlyingbowelgas. abnormalities canthenleadtoCTorMRIs.Visualizationofthepancreasis An ultrasoundcansometimesidentifyacystinthepancreasorbileduct.These Trans AbdominalUltrasound: other featuresthatcouldhelpinadiagnosisandtreatmentplanning. location ofthecyst,findingsforsolidcomponentsassociatedwithcystand the careteamtoseecystingreatdetail.Thisincludessizeofcyst, risk ofthecystbecomingmalignantorcancerous.Manythesetestsallow can providevaluableinformationtoyouandyourphysiciandeterminethe some ofthetestsandproceduresusedtodiagnosepancreaticcysts.These a thoughtfulmannerwithanexperiencedmulti-disciplinaryteam.Beloware however, itisimportanttoapproachthework-upofthesepancreascystsin who wanttomoveaheadquicklyinmakingadiagnosisandbegintreatment; if itiscancerorabenigncyst.It adequate biopsythatallowsthepathologisttodecidewithcompletecertainty treatment usuallyinvolvessurgicalremoval.Itisoftendifficulttogetan

frustrating 4 forthepatientanddoctor ©2012 University ofMichiganComprehensive Cancer Center OVERVIEW A Patient’s Guide to Pancreatic Cysts Refer to Figure 2. Refer to Figure 5 Endoscope Monitor Video X-Ray Machine

Figure 2. Patient undergoing endoscopic procedure ©2012 University of Michigan Comprehensive Cancer Center naturally present in the ducts serves as a contrast substance. MRCP produces naturally present in the ducts serves as a contrast substance. visualizing blockages in images similar to an ERCP and is an excellent tool for the ducts and pancreatic cysts. Magnetic Resonance Cholangiopancreatography (MRCP) that specifically MRCP is a special type of MRI. It uses computer software site of tumors. Fluid images pancreatic and bile ducts, which are often the blockage. It can also be used to place a stent or tube to open a blocked bile duct or tube to open a blocked also be used to place a stent blockage. It can commonly used for this procedure. General anesthesia is most for drainage. not awake during the test. The patient is ERCP (endoscopic retrograde cholangiopancreatography) retrograde (endoscopic ERCP look at the bile to called an endoscope a lighted tube is done with An ERCP is causing a what helps determine This procedure pancreas ducts. and/or OVERVIEW A Patient’s GuidetoPancreatic Cysts in 1-2days. The CTwillbereviewedbytheradiologistandconsultingdoctor catheter) willbeplacedpriortothescan. additional informationtotheradiologist;thereforeatemporaryIV(intravenous examines thepancreasingreatdetail.AspecialdyeisusedforCT,togive and organs.ThisisaspecialCTscandoneattheUniversityofMichiganthat assess thecystforsize,locationandinvolvementofsurroundingvessels ‘pancreatic protocol’CTtobedoneattheUMforyourfirstclinicvisitbetter that thecystmightbegrowingintooraround.Thedoctormaysuggesta The CTscancanshowsmallcystsortumorsaswellimportantbloodvessels Computed Tomography(CT) used tobiopsyorsamplelesionsinthewaydoneusingEUSERCP. required, ERCPratherthanMRCPwillbeused.Inaddition,MRI/MRCPcannot If therapeuticinterventions,suchasstentplacementtoalleviatejaundice,are ERCP procedure.MRCPmaybeusedinplaceoffordiagnosticpurposes. MRCP providesasimilarpictureasERCP,butwithouttherisksofaninvasive

OVERVIEW A Patient’s Guide to Pancreatic Cysts 7 Figure 3. Pseudocyst

Figure 4. Serous Cystadenomas symptoms • malignant Does not become • include abdominal pain and fullness Symptoms can • Twice as likely to be found in women • there are multiple small cysts called microcysts Suspected when • without observation for patients treatment is Recommended • Cannot become malignant • common type Most • level and elevated blood amylase history of pancreatitis Recent ©2012 University of Michigan Comprehensive Cancer Center Serous Cystadenomas What are the types of pancreatic cysts? of pancreatic the types What are cysts: are 5 types of There Pseudocysts OVERVIEW A Patient’s GuidetoPancreatic Cysts Intraductal PapillaryMucinousNeoplasm Mucinous CysticNeoplasm Inthebranchducts-observeoroperateiflargeassociatedwith • Inthemainduct–operateifmedicallyfit • Moreofteninmenthanwomen • Pancreatitiscanbefoundatthesametime • Cancausesymptomsorbeasymptomatic • Surgeryisrecommended • Mostcommonlylocatedinthetailof pancreas • Mostpresentwithvagueepigastricsymptoms • Mostlyinwomenwithanaverageageof 40-50years • Havepotentialtobecomemalignant • symptoms orotherconcerningfeatures Figure 6.IntraductalPapillary MucinousNeoplasm

Figure 7. Solid Pseudopapillary Neoplasm • abdominal pain common symptom is Most • recommended Surgery • cyst pancreatic Most uncommon • age 27 median in young women Mostly ©2012 University of Michigan Comprehensive Cancer Center Solid Pseudopapillary Neoplasm Pseudopapillary Solid OVERVIEW A Patient’s GuidetoPancreatic Cysts

Treatment of Pancreatic Cysts of Pancreatic Treatment Surgery to remove cyst Further testing often with imaging and/or clinical follow up Monitoring the cyst with imaging 1. 2. 3. 4. No further evaluation or treatment • Malignant potential • Other medical conditions you may have • of cyst to operate and location Ability • weight loss or jaundice Presence of symptoms such as pain or • Surgical risks • size and type of cyst Cyst ©2012 University of Michigan Comprehensive Cancer Center the cyst with a needle or surgically treat it. This surgery can also be done the cyst with a needle or surgically treat it. This surgery endoscopically in some cases. How does a patient decide on treatment? is not causing you Even a large pseudocyst can be left alone as long as it may elect to analyze symptoms. If it is causing you symptoms your doctor Depending on the type of cyst and your symptoms you have your doctor may Depending on the type of cyst treatments: recommend one of several Your physician will discuss your individual circumstances and discuss circumstances and discuss will discuss your individual Your physician depending on: treatment options What are the treatment options? the treatment What are TREATMENT A Patient’s GuidetoPancreatic Cysts be recommended. doctor isunabletotellforsurewhatkindofcystyouhave…surgerymay Cystic Neoplams,IntraductalPapillaryMucinousNeoplasm(IPMN),orifyour For theotherthreetypesofcysts:SolidPseudopapillaryneoplasms,Mucinous doctor maywanttofollowitssizebyrepeatimagingtests. left alone,unlesstheyarecausingsymptomsorgettinglargerovertime.Your Serous cystadenomasalmostneverevolveintocancer,sotheyalsomaybe

TREATMENT A Patient’s Guide to Pancreatic Cysts 13 Surgery

Refer to Figure 8. ©2012 University of Michigan Comprehensive Cancer Center Although the Whipple procedure can successfully remove the cyst from your Although the Whipple procedure can successfully remove that should be body, there are some serious complications that are possible part of the stomach. Surgery includes re-connecting the remainder of the part of the stomach. Surgery includes re-connecting the structures can drain bile duct, pancreas and stomach to bowel so that these properly. If the cyst is found to be in the head of the pancreas and is operable, the If the cyst is found to be in the head of the pancreas also called a surgical procedure performed is a pancreaticoduodenectomy, head of the pancreas, Whipple procedure. This surgery involves removing the intestine and sometimes the gallbladder, part of the bile duct, part of the small with a peri-operative mortality rate of < 1%. pancreatectomies annually, Whipple Procedure When considering undergoing pancreatic surgery, it is important to identify When considering undergoing and an experienced pancreatic surgeon. a high volume pancreatic center University of Michigan perform over 100 The pancreas surgeons at the other surrounding tissues and vessels. These tests help the surgeon determine other surrounding tissues or resectable. In addition, a surgeon will evaluate whether the cyst is operable to determine if he or she can tolerate the surgical the patient’s overall health procedure. containing the cyst. The extent of the abnormality will also determine how will also determine cyst. The extent of the abnormality containing the surgically. will need to be removed much of the pancreas about the size, location and involvement of Diagnostic tests give information The location of the pancreas adds to the technical difficulties of a surgical technical difficulties of a the pancreas adds to the The location of and are located near the pancreas veins and arteries operation. Important pancreas remove the portion of the with the surgeons ability to may interfere When is surgery recommended for pancreas cysts? for pancreas is surgery recommended When TREATMENT Liver Gallbladder A Patient’s GuidetoPancreatic Cysts Pancreas Head of can asktospeakadieticianforhelpmanagingsymptoms. foods orotherwisemodifyyourdietafteryouhaveaWhippleprocedure.You are unabletoproperlyabsorbfatsoyoumayhaveavoidlargemealsorfatty carefully consideredwhendecidingtogoaheadwiththesurgery.Somepatients Duodenum Liver Reconstruction and Bowel Bile Duct

Figure 8.Whipplesurgical procedure 14 Reconstruction and Bowel Pancreas REMOVED ©2012 University ofMichiganComprehensive Cancer Center Pancreas Stomach Reconstruction and Bowel Stomach PRESERVED TREATMENT Spleen Removed 50% removed Cut for resection (removed) Head and Neck of Pancreas preserved A Patient’s Guide to Pancreatic Cysts 15

Figure 9. Distal pancreatectomy surgical procedure Pancreas Duodenum ©2012 University of Michigan Comprehensive Cancer Center pancreatectomy. pancreatectomy. techniques using minimally invasive surgery can be performed In some cases (laparoscopy or robotic surgery). incisions in the abdomen through small Distal pancreatectomy Distal by can be removed the pancreas body or tail of are in the Cysts that is called a distal spleen. This and the part of the pancreas the distal removing TREATMENT A Patient’s GuidetoPancreatic Cysts management followingremovaloftheentirepancreas. that youwillunderstandwhattoexpectwithrespectlifestylechangesand a consultationwithanendocrinologistwillbearrangedpre-operativelyso pancreatectomy (completeremovalofthepancreas)isrecommendedthen of pancreasremovedandthehealthremainingpancreas.Ifatotal There isapotentialthatyoumaybecomediabeticdependingontheamount After surgerywillIneedtotakeinsulin?

©2012 University of Michigan Comprehensive Cancer Center imaging is indicated. for first year. Surveillance for rest of life based on EUS or MRI every 6 months above findings. pancreas cysts over time. EUS and MRI should be done every 6 months for the pancreas cysts over time. EUS surveillance. In some cases the interval will be first year, then annually for may be more often. Patients will be instructed to yearly and in other cases it any change in symptoms that might suggest earlier contact their physician with using radiographic imaging, typically MRI and/or endoscopic ultrasound. and/or endoscopic ultrasound. imaging, typically MRI using radiographic pancreas for becoming cancer the are not considered high risk For cysts that will work closely together to follow surgeon and medical gastroenterologist cysts and benign (non- cancerous) to distinguish between Our present ability being is limited. Studies are potential to grow into cancer those that have cyst by on how to follow a pancreas guide physicians and patients conducted to What is surveillance? What is TREATMENT A Patient’s GuidetoPancreatic Cysts

A Patient’s Guide to Pancreatic Cysts 19

After Pancreatic Cyst Surgery Pancreatic After ©2012 University of Michigan Comprehensive Cancer Center pancreas is removed what is left of the pancreas can often not produce enough pancreas is removed what is left of the pancreas can in order to resume normal of these enzymes to break down food. If this occurs, fat absorption it is necessary to take pancreatic enzymes. What are pancreatic enzymes and why do I need to take them? What are pancreatic enzymes and why do I need which help break Pancreatic enzymes are chemicals secreted by the pancreas you eat. When part of the down the fats, proteins and carbohydrates in the food In the long term, you may need to continue to avoid or limit fatty foods and may fatty foods limit or to avoid may need to continue In the long term, you enzymes right below. require pancreatic enzymes daily. Refer to section pancreatic goal is to maintain weight, have regular bowel movements and restore adequate have regular bowel movements and restore adequate goal is to maintain weight, an individualized plan by a dietitian or your doctor nutrition. You will be given to meet with a dietitian after surgery. and will have the opportunity after surgery. Small frequent meals (5-6 meals foods may be recommended spacing of 2 to 3 hours apart. daily) are easier to digest with each person has individual dietary needs. Your You should understand that Dietary Changes after a Whipple Procedure Dietary Changes after a diet and advances to solid foods. After a Whipple, Your diet begins with a liquid and absorb fats and avoidance of fatty digest you may not be able adequately to may have a drain in place when discharged, and you will be taught how to care and you will be taught in place when discharged, may have a drain for recovery from Surgery. discharge. Expect 6-12 weeks for it prior to Recovering from Surgery Recovering from than 5 restrictions of no greater restrictions will include lifting Post-operative You taking narcotic pain medication. weeks and no driving while pounds for 6 Life after the Whipple Procedure Procedure the Whipple Life after AFTER SURGERY A Patient’s GuidetoPancreatic Cysts enzyme supplement. (add genericnames)toimprovetheeffectivenessofyourpancreatic recommend anacid-reducingmedicationsuchasPrevacid,Nexium,orZantac Talk toyourdoctoraboutwhatthebestplanisforyou.Yourmayalso and dosageofpancreaticenzymesmustbeindividualizedforeachperson. Your doctorcanprescribeenzymesupplementstohelpwiththis.Thetype The symptomsofinsufficientpancreaticenzymesinclude: Weightloss • Frequentorloosestools • Floatingorgreasy/fattystools • Foulsmellinggasorstools • Largeamountsofgas • Crampingaftermeals • Indigestion •

AFTER SURGERY

A Patient’s Guide to Pancreatic Cysts 21

as though it is rare, a person without a spleen can develop as though it is rare, a person sepsis quickly. and if traveling out of the country Carry a medical alert card, you leave to obtain a prescription for contact your doctor before that you fill the prescription and antibiotics. It is recommended and take carry the antibiotics with you for international travel, or higher. them if you develop a fever of 101 degrees Fahrenheit five years. sign of infections such as fever, Call your doctor at the FIRST or severe sore throat. chills, cough, abdominal pain, to an Emergency room immediately Contact your physician or go 102 degrees Fahrenheit or higher, if you have a temperature of Repeat your Pneumovax, Hib, and Meningococcal vaccines every Repeat your Pneumovax, Hib, 4. 2. 3. 1. ©2012 University of Michigan Comprehensive Cancer Center following: preventive care for the rest of their life, though the risk of severe overwhelming though the risk of severe overwhelming for the rest of their life, preventive care about is < 1%. Talk to your doctor following splenectomy infection in adults dentist, and Always alert your doctors, yourself from infections. how to protect the no spleen. We also recommend workers that you have other health care Special considerations for patients having a distal pancreatectomy a distal pancreatectomy having for patients considerations Special a splenectomy) (including and attention to infections to pay more spleen have who have no Patients AFTER SURGERY A Patient’s GuidetoPancreatic Cysts

Maps, Important phone numbers and websites Chapels and Pastoral Care Cafeteria and Coffee shops ATM and Cashier’s Office Social Work Nutrition Services Pain Services Physical Therapy Discounted lodging, parking meals, and other expenses Assistance with transportation, Financial counseling • Resources General Health • Resources to Enhance Treatment: • The UMHS website • Assistance Program (GAP) To assist with Practical Matters at the Guest • (PERC) Education Resource Center Cancer Center Patient The • (HERC) The Health Education Resource Center ©2012 University of Michigan Comprehensive Cancer Center of Michigan in the back pocket of this book. Patient resources are described in Patient resources are described the back pocket of this book. of Michigan in www.mhealthy.org. of Michigan website: detail on the University may find helpful include: Resources you There are many resources available to patients and families at the University of at the University and families to patients available many resources There are University a Map and Guide to the System. We have included Michigan Health RESOURCES A Patient’s GuidetoPancreatic Cysts ______

Other Date Date Date Date Date Date Date ______Time Time Time Time Time Time Time Time

Friday

A Patient’s Guide to Pancreatic Cysts Thursday

27 Wednesday

Tuesday

Monday

Sunday

Monday

Tuesday

Wednesday 28

Friday

Saturday RESOURCES 615-8839 615-1600 936-7944 936-7944 936-5781 936-7944 877-334-2943 A Patient’s Guide to Pancreatic Cysts Dr. Cyrus Piraka Dr. Erik Wamsteker 29 ......

...... Important Phone Numbers Phone Important ...... noted) code unless are 734 area (all numbers ...... Dr. Richard Kwon Dr. Michelle Anderson Dr. James Scheiman Dr. Joseph Elmunzer patient of Drs. Simeone, Minter, Nguyen, or Mulholland Contact for the following doctors • (HPB) resident on call, if you are a The Hepatopancreatobiliary ©2012 University of Michigan Comprehensive Cancer Center Call the UM Page Operator @ 936-6267 and ask them to page: Call the UM Page Operator @ 936-6267 and ask them To Reach a Doctor For Medical Problems Monday-Friday after 5pm, To Reach a Doctor For Medical Problems Monday-Friday Weekends & Holidays: Jan Hampton while making treatment decisions and for follow-up issues) (for questions during the diagnosis, Pancreatic Biliary Nursing Office University of Michigan Pancreas Destination Program Physician Assistant University of Michigan Pancreas Colleen Debeauclair Pancreatic Clinic Nurse Coordinator Dr. Michael Mulholland Nurses and Physician Assistants: Dr. Diane Simeone Dr. Rebecca Minter Dr. Kevin Nguyen Surgical Doctors: Surgical RESOURCES A Patient’s GuidetoPancreatic Cysts Support andCoping Health EducationResourceCenter Cancer PatientEducationResourceCenter Nutrition Services Resources To ScheduleanAppointment Appointments Social WorkandGuestAssistanceProgram physician orotherprofessionalmedicalservices.Our aimistopromoteactiveparticipation This documentisnotintendedtotaketheplaceof careandattentionofyour Questions aboutindividualhealthconcernsorspecific treatmentoptions in yourcareandtreatmentbyprovidinginformation education. . Reviewers: J.Hampton,RN andK.Hammelef,RN ©2012 The RegentsoftheUniversityMichigan Authors: D.Simeone,MDandR.Minter, MD

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