pancreatic cancer

Treating Pancreatic Cancer

pancreatic cancer imagePancreatic cancer is a very aggressive disease that is prone to metastasizing or spreading. Unfortunately, it has been rising in incidence in the United States with approximately 50,000 new cases per year. Treatment for pancreatic cancer varies depending on the individual patient, but when determining surgical treatment options we consider these questions: Has the tumor spread? Is it removable? And is the patient in good enough shape to have surgery?

If surgery is an option, the approach for pancreatic cancer is dictated by where the tumor is located, and the surgeon may remove parts or, in rare circumstances, the entire pancreas. Most tumors are diagnosed in the head of the pancreas, and these can be removed with a pancreaticoduodenectomy, also known as the Whipple procedure. The Whipple procedure, an aggressive operation that typically takes between three to six hours to complete, involves removing a third of the pancreas and part of the intestines called the duodenum. However, if the tumor is on the other side of the pancreas then it can be removed with something called a distal pancreatectomy, which involves less reconstruction than the Whipple procedure.

In addition to the standard surgical options, we also utilize technologically advanced, minimally invasive surgical approaches using laparoscopy and robotic surgery. Laparoscopic surgery involves placing medical instruments in the belly through tubes, which results in smaller incisions. This approach can get patients out of the hospital a little faster because of less blood loss and fewer complications than standard surgery. We are also using cutting-edge robotic surgery for pancreatic cancer. This technology can be used in the Whipple procedure and the distal pancreatectomy, and the robot provides the surgeon with incredible dexterity. While traditional laparoscopic instruments do rotate and open and close, the robot has wrists and 3D visualization. This allows the surgeon to see things with good depth perception instead of looking at a flat screen, which can be especially helpful for complex surgeries in confined areas. The surgical robot is a valuable, minimally invasive tool for selective circumstances, although it is not necessary for all pancreatic procedures.

About Dr. Kooby

koobyDavid A. Kooby, MD, FACS, is a board certified surgical oncologist specializing in laparoscopic and open surgical treatment of pancreas, bile ducts, stomach, and colon cancers. Dr. Kooby is a pioneer in minimally invasive and robotic pancreatic surgery, and serves as Professor of Surgical Oncology in the Department of Surgery at Emory University School of Medicine. Dr. Kooby also is the Director of Surgical Oncology at Winship at Emory Saint Joseph’s Hospital and the Director of Minimally Invasive GI Surgical Oncology at Emory University School of Medicine. Dr. Kooby will be co-directing the International Hepato-Pancreato-Biliary Association State of the Art Conference

 

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Pancreatic Cancer Surgery Options

There are a variety of treatment options for pancreatic cancer depending on the size and location of the tumor, whether the cancer has spread and the overall health of the patient.   Dr. David Kooby, surgical oncologist at Winship Cancer Institute of Emory University, describes the surgical treatment options available to patients diagnosed with pancreatic cancer.

Procedures include:

Whipple Procedure or Pancreaticoduodenectomy: this method is used when the tumor is in the head of the pancreas. The surgeon removes the head of the pancreas and parts of the bile ducts, small intestines and stomach.

Distal Pancreatectomy: in this procedure, the body and tail of the pancreas are removed in addition to the spleen.

Total Pancreatectomy: the entire pancreas is removed along with part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

Learn more about Winship Cancer Institute of Emory University

Pancreatic Cancer: Incidence and Outlook

Pancreatic cancer increases with age and most people are between 60 to 80 years old when diagnosed. Early pancreatic cancer often does not cause symptoms. Pancreatic cancer can affect anyone. People with a family history of pancreatic cancer in first degree relatives have an increased risk.

Pancreatic cancer specialist, Dr. David Kooby from Winship Cancer Institute of Emory University talks about why the disease is so prevalent and why it is so difficult to treat.

Learn more about Winship Cancer Institute of Emory University.

Risk Factors and Symptoms of Pancreatic Cancer

The pancreas is a flat, banana-shaped organ that is located behind the stomach. Functionally, it can be regarded as two separate organs based on the chemicals each produces. The exocrine pancreas makes up the largest part of the gland and is responsible for creating enzymes that help break down foods we eat so that they can be used by the body. The endocrine pancreas is composed of groupings of cells that make up a much smaller part of the gland. These cell clusters, called islets, are responsible for producing hormones, such as insulin, that help regulate the amount of sugar in the blood.

What are the risk factors and symptoms of pancreatic cancer? Winship surgical oncologist, Dr. David Kooby answers those questions.

Learn more about Winship Cancer Institute of Emory University.

Takeaways from the Pancreatic Cancer Live Chat at Winship

Pancreatic Cancer Chat

Thanks to everyone who joined us Tuesday, May 12th for the live online pancreatic cancer program chat at Winship Cancer Institute of Emory University hosted by Drs. El-Rayes & Kooby.

Drs. El-Rayes & Kooby answered several of your questions about pancreatic cancer risk factors, symptoms and therapy. There are a variety of treatment options for pancreatic cancer; for some patients, a combination of treatment methods may be used. Check out the conversation by viewing the chat transcript! Here are just a few highlights from the chat:

Question: Who is at the most risk for pancreatic cancer?

David Kooby, MDDr. Kooby: Pancreatic cancer can affect anyone. People with a family history of pancreatic cancer in first degree relatives have an increased risk. Smokers are at risk, as tobacco appears to be a causative factor. Other groups who have an elevated risk of getting pancreatic cancer are those with new onset or long-standing diabetes mellitus and those with one of several uncommon genetic syndromes: BRAC2, HPSS, FMS, Peutz Jegher. Other associations include age over 60, chronic pancreatitis, and obesity. Many of the symptoms for pancreatic cancer are vague, which makes this a difficult disease to diagnose.

Question: When surgery is not an option, are there any treatments beyond chemo and radiation?

Bassel El-Rayes, MDDr. El-Rayes: A number of novel therapies are currently on clinical trials and those include drugs that stimulate the immune system or drugs that target specific molecular abnormalities in cancer (targeted therapies). In addition, in certain situations there are options to use therapies that ablate (physically destroy the tumor). These include nano knife.

 

Question: Are qualifying patients given the option to participate in these trials Dr. El-Rayes?

Bassel El-Rayes, MDDr. El-Rayes: When we evaluate patients in the clinic, we always discuss with them the different options of therapy, including, standard therapy vs. clinical trials. For patients to participate in clinical trials, they have to meet predefined criteria. If patients are interested in clinical trials, we will screen them to determine whether or not the meet these criteria.

 

Question: My sister and brother have both been diagnosed with pancreatic cancer within months of each other. There are three remaining siblings. Can you address how we can be tested?

Bassel El-Rayes, MDDr. El-Rayes: The first step would be to see a genetic counselor to look for a possible genetic link. There, they can test for specific genes that might indicate a higher risk in the family.
David Kooby, MDDr. Kooby: If the genetic testing doesn’t yield any abnormality, the second step would be to consult with a pancreatic cancer specialist. These specialists are either gastroenterologists or medical oncologists. Currently, there are no set guidelines on how frequently family members of current patients should be tested. Your specialist can outline a plan that works best for you and your family. Researchers at institutions like Winship are actively working on better methods for screening for pancreatic cancer.

If you missed this chat, be sure to check out the full list of questions and answers on the web transcript. For more information go to the Pancreatic Cancer at Winship Cancer Institute website or 404-778-7777 to learn more from a registered nurse.

If you have additional questions for Drs. El-Rayes & Kooby, feel free to leave a comment in our comments area below.

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