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When Congressman John Lewis and "Jeopardy" host Alex Trebek announced they're fighting pancreatic cancer, the disease was already at an advanced stage in both men. Stage 4 means the cancer has spread from its original site, in this case the pancreas, to other areas of the body.
Pancreatic cancer’s tendency to hide until it’s at a dangerously advanced stage is part of the reason the disease is on track to become the No. 2 cancer killer in the U.S. within the next decade, says MUSC Health cancer surgeon Katherine Morgan. She serves as medical director of the National Pancreas Foundation’s South Carolina chapter.
In this Q&A, she answers some key questions about the cancer sometimes called a silent killer.
Morgan: Pancreatic cancer often presents late in its course as it spreads throughout the system very early. That’s why it is such a difficult disease to cure and has such a poor prognosis. Most people present with advanced disease — stage 4, which is metastatic, and has spread beyond the pancreas.
Morgan: There aren’t good screening tests that can consistently detect pancreatic cancer in its early stages, and the symptoms don’t usually show up until later in the disease. Pancreatic cancer tends to spread systemically earlier than other gastrointestinal malignancies.
Morgan: The most common symptom is painless jaundice, which is when a patient’s eyes turn yellow, their urine turns dark and they may develop clay-colored stools. Other symptoms include abdominal pain, fatigue, weight loss, diarrhea and new-onset diabetes.
Morgan: Risk factors for pancreatic cancer include smoking, obesity, new-onset diabetes and a family history of having this type of cancer. In the past several years, the role of genetics in the development of some cases of pancreatic cancer has become clearer.
Morgan: In all stages of pancreatic cancer, chemotherapy is the primary treatment. It uses drugs to try to kill the cancer cells.
In patients whose cancer is just in the pancreas and has not spread, surgery to remove the cancer may be the best chance for cure.
If the cancer is in the head of the pancreas, which means the widest part of the organ, we do a Whipple procedure. That means we remove the head of the pancreas along with the end of the bile duct, the first part of the small bowel (the duodenum) and the surrounding lymph nodes. We may also remove and reconstruct portions of the nearby major blood vessels if they’re involved with the tumor.
In patients who have cancer in the body or tail of the pancreas, which are the narrower parts of the organ, we remove the affected parts but leave the head of the pancreas.
Chemoradiation is also often part of the treatment of cancer that hasn’t spread beyond the pancreas. It combines chemotherapy with radiation.
There are several newer ablation therapies for people with localized cancers that can’t be removed surgically, typically due to extensive blood vessel involvement. Ablation means we use extreme heat or cold to destroy tumors.
There are also many clinical trials available to patients who aren’t candidates for standard therapies.
While we still have a long way to go — pancreatic cancer still is a difficult disease with a poor prognosis — there is certainly optimism in terms of the new treatment options that have come across in the last few years. There have been major advances in chemotherapy over the past decade. We’ve become much more adept with new surgical approaches and techniques for pancreatic cancer. There are multiple new therapies. And we are so close to clinical translation with several important research initiatives, focusing on personalized treatment options. I am hopeful we will see a real difference in survival rates for this difficult disease in the next decade.
We are fortunate at MUSC Health to have a multidisciplinary team with experts in oncology, surgery, pathology, gastroenterology and radiology who specialize in treating pancreatic cancer, with many on the national forefront of new treatment options for this cancer.
Morgan: Lynparza is chemotherapy agent historically used in ovarian cancer patients and has recently been shown to help people with advanced pancreatic cancer go longer without the disease getting worse.
While its benefit has been shown only in people with advanced disease, it’s exciting because it’s a good example of a targeted therapy, a type of personalized medicine.
Four researchers at MUSC have been awarded a patent for their idea of a nanoparticle that delivers anti-rejection drugs directly to an organ pre-transplant.
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