Several large, dilated pancreatic ducts.
“There’s a lot of effort being put into changing the direction we’re going. There is interest in the medical community to begin to explore new
technology, new clinical approaches and new treatment of pancreatic cancer.” Another symptom may manifest itself as a psychological condition but actually is physically based. Pancreatic cancer produces a factor that also can make a patient depressed. “You can become depressed six months before you find out that you have pancreatic cancer, then you find out that you have this advanced cancer, and, of course, you are really going to be depressed,” explained Hedy Kindler, MD, director of Medical Oncology at the Center for Gastrointestinal Oncology. Unfortunately, usually by the time a patient has enough symptoms to see a doctor, the cancer already has spread.
Patients have treatment options Pancreatic cancer patients at the Medical Center are treated at the Center for Gastrointestinal Oncology where a team of specialists, including medical, radiation and surgical oncologists diagnose and determine whether a patient can have surgery, chemotherapy, radiation or a combination. Through the use of minimally invasive procedures, like MRIs and endoscopic ultrasounds—in which a long flexible tube with a sensor at the end is inserted into the digestive tract—doctors can diagnose the stage of a cancer without having to perform surgery. The technology of endoscopic imaging has improved so that doctors now can obtain clear images of the interior of organs, take small biopsies, and even inject pain medications in the nerves surrounding the pancreas without a large incision. The number of pancreatic cancer patients seeking treatment at the Center for Gastrointestinal Oncology has nearly tripled in the last three years, said Posner. Because treatment and surgery for pancreatic cancer are so complicated, studies have shown that patients have better outcomes when treated at an institution that handles a high volume of pancreatic cases. But the dire statistics can sometimes discourage patients from seeking treatment. Occasionally even family doctors don’t know the extent to which the disease can be treated and don’t refer patients. “Doctors have a bias about pancreatic cancer because they don’t understand that the surgery can be done safely and it can be effective,” said Posner. “Recent published evidence suggests they’re not sending patients for surgery, even patients with early stages of the disease.” Oncology surgeons at the Medical Center are expanding the circumstances under which they will perform surgery, even operating for precancerous lesions. “That has had a significant impact,” Posner said. “We’re identifying patients with early stage disease and in some instances preventing their cancer from either occurring or recurring.” That doesn’t mean the operations are simple. To access a pancreatic tumor, surgeons must displace several major organs while working around major blood vessels. “It’s a small space with complicated real estate,” Irving Waxman, MD, director for the Center for Endoscopic Research and Therapeutics, explained.
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Age is not a factor in determining who can have surgery. “I’ve operated on people in their thirties and people in their eighties and even in their nineties,” Posner said. There also are positive developments for those whose tumors are inoperable – the majority of patients. The Medical Center is part of a national study based on laboratory research by Ralph Weichselbaum, head of the Medical Center’s Department of Radiation and Cellular Oncology, and funded by the biopharmaceutical company GenVec that involves injecting genetically modified viruses loaded with the cancer-killing protein TNF into pancreatic tumors. TNFerade, a GenVec product, has received fast-track product designation by the U.S. Food and Drug Administration, and targets tumors in patients with advanced inoperable pancreatic cancer that has not spread. Interim results reported in June showed that patients were living eight months longer using TNFerade. TNFerade also is being evaluated for potential use in the treatment of other cancers, including esophageal, rectal, and head and neck cancers. “It’s a dramatic improvement,” said Waxman. “Fortunately, the time of blasting cancer and disintegrating everything is gone.” Located deep in the abdomen, the pancreas is an oblong flattened gland, sandwiched between the stomach and the spine.