Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s Focus On Pancreatic Cancer Conference. In this blog, she recaps the conference. You can view the conference in its entirety, including presentations here.
Anyone who has been affected by pancreatic cancer, either as a patient, caregiver or member of the treatment team, knows pancreatic cancer is difficult to detect in its early stages and to treat effectively. Pancreatic cancer often grows silently, and the symptoms pancreatic tumors cause are similar to those resulting from other gastrointestinal conditions. In fact, many patients experience months of symptoms and are treated for a variety of other problems before pancreatic cancer is diagnosed.
There are no screening tests or biomarkers available for pancreatic cancer, and even standard CT scans often do not detect these tumors. The result is that many patients are diagnosed with pancreatic cancer at such a late stage that it cannot be surgically removed and therefore is not potentially curable. Patients who do undergo surgery often experience recurrences.
The future of pancreatic cancer treatment depends on new understanding of the biology and genetics of this disease, and there is real hope on the horizon, but what can be done for today's patients?
Greater awareness of pancreatic cancer among primary physicians and patients
It's very important that both doctors and their patients be attuned to the possibility of pancreatic cancer and take appropriate steps to detect these tumors early. Patients at risk include those who experience unexplained weight loss or persistent GI symptoms, a sudden onset of type 2 diabetes or a sudden worsening of existing diabetes, or repeated episodes of pancreatitis.
Patients with a family history of pancreatic cancer should be seen by a certified genetic counselor.
Appropriate diagnostic interventions for suspected pancreatic tumors.
A standard abdominal CT scan does not detect many pancreatic tumors, so a special pancreatic scan is required. Using the wrong imaging technique can lead to extensive delays in diagnosis. It is also important that pancreatic cysts, which can range from harmless to premalignant, be evaluated and managed appropriately.
Penn offers a comprehensive pancreatic cyst program headed by Nuzhat Ahmad, MD.
Careful evaluation of patients to select those who are candidates for surgery
Evaluating newly diagnosed pancreatic cancer patients for surgery is one of the most difficult and critical steps in the treatment process. Surgery offers the only possible cure, but the surgery itself is a major procedure that can lead to significant complications.
Michael Kochman, MD, co-director at the GI Cancer Evaluation Center explained at the Focus on Pancreatic Cancer conference the importance of using the appropriate imaging to determine who is and isn't a candidate for surgery. Endoscopic ultrasound has become the most widely used and an effective means of making this determination, but it needs to be done in a facility that has experience and expertise in pancreatic cancer.
Surgery done by an experienced, expert team
Jeffrey Drebin, MD, PhD, chair of Penn's department of surgery, stressed the critical importance of having a highly experienced surgical team , skilled in performing a complicated surgery called the Whipple procedure, for pancreatic cancer. He noted that proper selection of patients for the surgery and the combination of high surgical volume and expertise markedly affects outcomes.
Penn's long-term survival results for surgically resected pancreatic cancer patients are close to double the national average with significantly reduced complication rates.
Availability of radiation therapy options for all stages of pancreatic cancer
James Metz, MD, clinical director of radiation oncology at Penn, stressed the new options and innovative approaches that are being developed at Penn for pancreatic cancer patients. These include the use of proton therapy to minimize the dose of radiation to normal tissues. Proton therapy, available at only eight centers in the United States, also has the potential to be used for "retreatment" of areas that have already received doses of radiation therapy for metastatic disease. Metz also pointed to the integration of radiation therapy with other modes of treatment, including new drugs that make tissue more sensitive to the effects of the radiation.
Aggressive chemotherapy approaches
Chemotherapy is used for almost all stages of pancreatic cancer.
For patients whose tumors can be surgically removed, or resected, chemotherapy is given either before or after surgery. Patients with borderline resectable tumors receive chemotherapy to help shrink their tumors and those with advanced or metastatic disease get chemotherapy to help control their tumors.
Weijing Sun, MD, director of GI medical oncology, discussed the efforts that are under way to improve the results of chemotherapy by developing new targeted agents and combining existing drugs in new ways or with other approaches such as immunotherapy. The results are slow, but are showing steady improvements in survival.
For most patients with pancreatic cancer, clinical trials are an important option and should be a part of the treatment planning discussion from the day of diagnosis.
Comprehensive management of the whole patient and the problems pancreatic cancer can cause
Patients with pancreatic cancer frequently face multiple physical and psychosocial challenges. Understanding these issues and managing them requires a full team of well-trained, experienced professionals.
At the Abramson Cancer Center’s Integrative Oncology Program, led by Jun Mao, MD, MSCE, patients learn the value of mindfulness, yoga, reiki and physical therapy in conjunction with standard medical treatment. For patients with pancreatic cancer, proactive management of physical and psychosocial issues is an essential part of treatment.
View the Focus On Pancreatic Cancer Conference to learn more about treatment options at the Abramson Cancer Center for patients with pancreatic cancer.