A Multidisciplinary Clinic At Lehigh Valley Topper Cancer Institute
Lehigh Valley Topper Cancer Institute offers cancer patients consultations with multiple cancer specialists through multidisciplinary clinics . For pancreatic cancer patients, the gastrointestinal cancer MDC brings together specialists from surgical oncology, radiation oncology, medical oncology, nursing, radiology, pathology clinical trials, nutrition and social services. This collaborative, interdisciplinary group explains the patients diagnosis and offers recommendations for treatment. As part of the MDC meeting, the patient and his or her loved ones are encouraged to ask questions. A nurse navigator also attends the MDC and coordinates care for the patient afterward.
What Are The Types Of Pancreatic Cancer
The pancreas is an oblong organ that lies deep in the abdomen and is an integral part of both the digestive and endocrine system. It secretes hormones to regulate the body and digestive enzymes to break down food.
There are two types of pancreatic cancer: exocrine tumors and endocrine tumors.
Exocrine tumors are the majority of pancreatic cancers, and the most common form is called adenocarcinoma, which begins in gland cells, usually in the ducts of the pancreas. These tumors tend to be more aggressive than neuroendocrine tumors, the kind that Apple Inc. co-founder Steve Jobs had, but if caught early enough, they can be treated effectively with surgery.
Pancreatic neuroendocrine tumors constitute only 1% of all pancreatic cancers. They can be benign or malignant, but the distinction is often unclear and sometimes apparent only when the cancer has spread beyond the pancreas.
The five-year survival rate for neuroendocrine tumors can range from 50% to 80%, compared with less than 5% for adenocarcinoma.
More advanced tumors have a higher risk of recurrence and can spread to the liver, said Dr. Steven Libutti, pancreatic cancer expert and director of the Montefiore-Einstein Center for Cancer Care in the Bronx.
Our Approach To Pancreatic Cancer
Johns Hopkins pancreatic surgeons perform a variety of innovative techniques to treat pancreatic cancer, including operations using both traditional open methods and minimally invasive methods. During one appointment at our multidisciplinary clinic, patients will meet with experienced specialists who will care for them at every stage of the journey.
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The Challenge Of Early Diagnosis: Vague Symptoms
There is no single red flag that alerts patients and/or their doctors to the possibility that someone has pancreatic cancer. Typically, patients who will eventually be diagnosed with this cancer first head to the doctor for vague abdominal pain. Because this is such a general and not specific symptom, doctors appropriately believe that the patient is dealing with something common, such as an ulcer, irritable bowel syndrome, or gallbladder problems. The doctor then often recommends treatments that include dietary changes, the use of an antacid, or even an endoscopy, but they dont immediately test for pancreatic cancer.
Only after the patient derives no relief and visits the doctor multiple times over the course of several months, is a CT scan ordered. By that time, the symptoms may have progressed to include jaundice, back pain, and weight loss, which means that the cancer is already in the later stages and may have spread to other parts of the body.
For the patient who is eventually being diagnosed with pancreatic cancer, the months that were spent ruling out other diagnoses could mean the difference between life and death.
It is not realistic, or even medically sound, to expect that doctors will approach every patient who complains of abdominal symptoms as if they may have pancreatic cancer.
Pancreatic Cancer: The Silent Killer
From time to time, we address most unpleasant topics in this forum. Pancreatic Cancer is one of these topics. There has been a modest increase in the incidence of this dreaded cancer such that nearly 50,000 Americans will be diagnosed with a cancer of the pancreas this year. Slightly more people are being diagnosed and slightly fewer are dying each year from it, but the 5 year survival after diagnosis is still only 8 percent which is scary bad.
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Why Is Pancreatic Cancer A Concern
All cancers are important to detect and treat, and this is especially true of cancer of the pancreas. Even though it is relatively uncommon it is the twelfth most common new cancer each year, but importantly it is the fourth most common cause of cancer death, trailing only lung, colon, and breast cancers. In other words, even though only 48,000 people a year will be diagnosed nearly that many will die from it. Early detection gives the best hope of successful treatment.
Alex Trebek Rbg John Lewis: Why Pancreatic Cancer Is So Deadly
- Pancreatic cancer, which took the life of TV personality Alex Trebek, is one of the deadliest cancers.
- Experts say thats because it spreads quickly and usually isnt detected until its in later stages.
- Treatments such as chemotherapy, radiation, and surgery usually only prolong the life for a person with the disease for a short period of time.
- Right now, there are no effective methods to screen for pancreatic cancer.
Alex Trebek, the popular host of the television show Jeopardy, died on Sunday, more than 2 years after he had been diagnosed with stage 4 pancreatic cancer.
Trebeks death from the disease follows the deaths earlier this year of Supreme Court Justice Ruth Bader Ginsberg, who was diagnosed with the same condition in 2009, and Rep. John Lewis, who died at age 80, 6 months after being diagnosed.
They are just three of the estimated 47,000 people in the United States who will die this year from a cancer that, although rare, is one of the most lethal.
Pancreatic cancer is one of the most deadly forms of cancers and the fourth leading cause of cancer deaths in the United States, said Dr. Anton Bilchik, a surgical oncologist, professor of surgery, chief of gastrointestinal research, and chief of medicine at John Wayne Cancer Institute at Providence Saint Johns Health Center in Santa Monica, California.
Pancreatic adenocarcinoma is the most common type, while pancreatic neuroendocrine tumors are less common.
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Pancreatic Cancer Treatment Is Evolving
Aside from the fact that it is hard to catch early, pancreatic cancer is also deadly because it can be tough to treat. This is because pancreatic cancer tumors dont respond as well to commonly used cancer therapies as other, less lethal types of cancer.
But there are treatment options, including surgery, chemotherapy and radiation. Depending on the specific type of pancreatic cancer and when its diagnosed, treatment generally involves some combination of these three therapies.
Recently, a new combination of chemotherapy drugs collectively known as FOLFIRINOX has shown promise for patients with pancreatic cancer that has metastasized, or spread to other parts of the body.
When To See A Doctor
If you find yourself experiencing symptoms like unexplained weight loss, loss of appetite, abdominal discomfort or back pain, check in with your doctor. The sooner you can rule out or catch pancreatic cancer, the better off youll be.
Anyone with a family history of pancreatic cancer or a genetic mutation that may make them more susceptible to the disease should contact a cancer specialist or make an appointment with a doctor who can make a referral. There may be ways you can catch this disease early.
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What Is The Treatment
Surgery to remove part or all of the pancreas is an option for the minority of people whose pancreatic cancer was detected in its early stages.
Most people with pancreatic cancer receive chemotherapy, according to the Hirshberg Foundation for Pancreatic Cancer Research.
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But chemotherapy and radiation can be hit or miss.
“Something that makes pancreatic cancer difficult is the tumor itself is surrounded by a dense microenvironment, so it makes getting the drug delivery difficult,” Julie Fleshman, president and CEO of the patient advocacy organization Pancreatic Cancer Action Network in California, told NBC News.
Researchers are investigating targeted therapies based on the molecular makeup of a patients tumor.
Certain types of immunotherapy, which stimulates a persons own immune system to recognize and destroy cancer cells more effectively, can also be used to treat pancreatic cancer, the American Cancer Society noted.
Risk Factors For Pancreatic Cancer
Although anyone can get pancreatic cancer, there are certain factors that can increase a persons risk. Some of these are:
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Family history of pancreatic cancer
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Inherited genetic syndromes
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High-calorie diet
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Eating a lot of processed foods
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High protein diet
People with these risk factors particularly those with a family history of or genetic predisposition to pancreatic cancer should consider speaking with a specialist about strategies for potentially preventing pancreatic cancer and scheduling regular tests.
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How Is Pancreatic Cancer Diagnosed
There are currently no approved early detection methods, but researchers hope tests that can pick up biomarkers for the cancer will become available in the next few years.
When patients complain of symptoms, the cancer can be found with imaging tests such as a CT scan, MRI and ultrasound. Certain blood tests, procedures and a biopsy can also help doctors diagnose the disease.
Signs And Symptoms Of Pancreatic Cancer
Much like ovarian cancer, pancreatic cancer is often caught at a later stage than other types of cancer. “There is no standard early detection test for pancreatic cancer, and the presenting symptoms may be vague. As a result, most cases are diagnosed once the disease has reached an advanced stage, making it more difficult to treat,” explained Dr. Victoria Manax Rutson, then chief medical officer with the Pancreatic Cancer Action Network, in an email interview.
Typical symptoms of pancreatic cancer, which are often mistaken for other ailments, include:
- recent-onset diabetes
- sudden pain, typically in the back or abdomen
If pancreatic cancer is suspected, the disease is diagnosed by taking tissue samples of the tumor, as well as imaging tests.
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Access To Clinical Trials
There is so much new pancreatic cancer research taking place every day, including trials for new chemotherapy drugs, targeted therapies, immunotherapies and other drug combinations. Patients at the Cancer Institute can participate in clinical trials through NCI Community Oncology Research Program , as well as clinical trials available at Memorial Sloan Kettering through the Memorial Sloan Kettering Cancer Alliance. We also offer many other pharmaceutical and investigator-initiated trials.
At Lehigh Valley Topper Cancer Institute, we check tumor molecular profiling to look for actionable mutations. This helps us recommend the most appropriate clinical trials for each of our eligible patients, Khalil explains. Theres more happening now than ever before.
Patient Population And Diagnosis
Pancreatic ductal adenocarcinoma is largely a disease of old age, with an average age of diagnosis of 71 years. Yet the presenting symptoms are nonspecific such as weight loss and abdominal pain . This population of patients is accustomed to aches and pains, and so in most cases, the earliest signs of malignancy go unnoticed a high level of perception is required to avoid delays in diagnostic workup. Furthermore, in contrast to breast, prostate, melanoma and testicular cancers, there are no simple examinations that can elevate the level of suspicion: the pancreas is too deep to palpate and there is no specific blood test available for PDA. Other symptoms at diagnosis can include new onset of diabetes , unexplained jaundice and unprovoked thrombosis the most specific of these is unexplained painless jaundice, but many other explanations are possible. Thus, by the time that a patient seeks medical advice and their GP successfully navigates the diagnostic maze, often many months have passed and the patients condition has further deteriorated.
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What Are The Risk Factors For Pancreatic Cancer
There are some risk factors that a person cant change, including age with most patients over 65 and having a family history of pancreatic cancer. Men and African Americans are slightly more likely to develop pancreatic cancer than women and whites.
The National Cancer Institute and the American Cancer Society also list risk factors that people do have influence over. They include:
- Workplace exposure to certain chemicals used in the dry cleaning and metal working industries.
Who Has The Greatest Risk
- People with two or more relatives who have had pancreatic cancer
- Have inherited the BRCA2, p16, STK11 gene mutation or chronic pancreatitis
- Are over the age of 50
- People who are overweight
Third Degree Relatives – First cousins, great-aunts and uncles
An inherited genetic variation in DNA that you are born with
Second Degree Relatives – Aunts, uncles, grandparents, nieces and nephews
First Degree relatives – Blood relatives in your immediate family: parents, children, and siblings
This is an experimental type of treatment. It is a medication made of killed or weakened cells, organisms or manufactured materials, which is used to boost the body’s immune system. Ideally, this will allow the body to fight and kill the cancer cells more effectively. Vaccines include whole killed cancer cells or specific proteins from the cancer.
Also known as a pancreatoduodenectomy, the Whipple procedure is the surgery typically performed to remove cancers of the head of the pancreas . It typically involves the surgical removal of the head of the pancreas, a portion of the duodenum and a portion of the bile ducts.
The part of the pancreas that bends backwards, hooking around two very important blood vessels, the superior mesenteric artery and vein. The word “uncinate” comes from the word uncus which means “hook.”
Unable to be surgically removed. This usually means that the cancer has spread beyond the areas that can be removed surgically.
A benign tumor made up of cells that form glands .
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Why Is Pancreatic Cancer So Deadly Looking For New Answers
Medical Oncologist/Hematologist,Whittingham Cancer Center,Norwalk Hospital, Connecticut,Director of Clinical Cancer Research for Western Connecticut Health NetworkConsultant in Gastrointestinal Oncology,Memorial Sloan Kettering Cancer Center
Pancreatic cancer has the potential to become the second leading cause of cancer deaths in the United States by 2020, but it is already wreaking havoc on the lives of thousands today. According to the National Cancer Institute, in 2019, an estimated 56,770 people will be diagnosed with pancreatic cancer, and an estimated 45,750 people will die of the disease.1
A recent high-profile diagnosis that has drawn international attention is that of Alex Trebek, host of Jeopardy, who announced in early May 2019 that he had stage IV pancreatic cancer . Trebek is the latest in a long line of celebrities who have faced this type of cancer, including Patrick Swayze, Michael Landon, and Dizzy Gillespie, all of whom died of metastatic pancreatic cancer within a few months to years after diagnosis .
Although Trebek recently shared the good news that his tumors were shrinking with treatment, the reality surrounding pancreatic cancer is often grim.
Obviously, the key to successfully fighting pancreatic cancer is diagnosing it as early as possible, but how to do this is not so obvious.
What Is Pancreatic Cancer
The pancreas is a 6-inch long gland that lies between the stomach and the spine, the National Cancer Institute noted. It helps the body break down food and regulate blood sugar.
About 95% of pancreatic cancers begin in exocrine cells, which produce the digestive juices.
Pancreatic cancers that begin in endocrine cells which make hormones like insulin are far less common, but also less aggressive.
Trebek hadnt specified which kind of tumor he had, but it was likely the first type.
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Mayo Clinic Minute: Pancreatic Cancer Is The Most Lethal
Pancreatic cancer can be a frightening diagnosis. Compared to most other cancers, survival rates are much lower and death often occurs at a more rapid pace. In this Mayo Clinic Minute, a leading expert in pancreatic cancer at Mayo Clinic explains more about the disease and potential future improvements in treating and screening for it.
Journalists: Broadcast-quality video pkg is in the downloads at the end of the post.Please courtesy: “Mayo Clinic News Network.” Read the script.
Pancreatic cancer is the most lethal cancer in the human body with overall five-year survival rates at just about 7 percent, despite all the advances over the past decades, says Dr. Santhi Swaroop Vege, director of the pancreatic diseases group at Mayo Clinic.
There are no telltale signs for pancreatic cancer, and symptoms like weight loss, abdominal pain, jaundice and appetite loss are nonspecific.
“That’s one of the biggest problems we face,” says Dr. Vege. “Usually, these people will have indigestion, acid reflux … before finally somebody thinks of doing a CT scan. And by that time, it’s already late.”
He says treatments can be any combination of surgery, chemotherapy, radiation and endoscopic procedures.
“If it is localized to the pancreas and if it is not involving the major structures, then the best treatment, of course, is resection a big surgery,” says Dr. Vege.
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Survival Rates: What To Know
Because doctors rarely find pancreatic cancer in its early stages when its easiest to treat, its one of the most deadly cancers. About 9% of people with pancreatic cancer live at least 5 years after diagnosis. But the 5-year survival rate is much better — 34% — if it hasnt spread past the pancreas. Know that survival rates cant predict what will happen to any single person and may not reflect newer types of treatment.
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Potentially Curable If Caught Very Early
Despite the overall poor prognosis and the fact that the disease is mostly incurable, pancreatic cancer has the potential to be curable if caught very early. Up to 10 percent of patients who receive an early diagnosis become disease-free after treatment. For patients who are diagnosed before the tumor grows much or spreads, the average pancreatic cancer survival time is 3 to 3.5 years.
