pancreatic cancer

Pancreatic Cancer and Your Digestive Health

Pancreatic CancerWhen you think of digestion you probably don’t think about the pancreas, but it sits right behind the stomach and works to provide essential digestive functions. The pancreas, only about 4-6 inches long, is widely known for producing insulin, an important hormone that regulates blood sugar levels, but it also assists the body in the absorption of nutrients into the small intestine.

Pancreatic cancer risk increases with age and most people are between 60 to 80 years old when diagnosed. Early pancreatic cancer often does not cause symptoms; however, there are five early warning signs that we can all be aware of to better advocate for our health.

Five Early Distress Warnings of Digestive Cancer

  1. Yellow eyes or skin. The pancreas uses a greenish-brown fluid made in the gallbladder, called bile, to help the small intestine in digestion. If a tumor starts in the head of the pancreas, it can block or press on the bile duct and cause bile to build up. This back-up causes yellow discoloration, called jaundice.
  2. Belly pain. Pain has been described as distressing, as compared to a sharp cramp or ache. Pain may go away when you lean forward because it and spreads toward the back.
  3. Change in stool. Pale, floating, smelly stools. Or dark stools. Let your stool be a guide. If a pancreatic tumor prevents digestive fluids from reaching the intestine, the result is an inability to digest fatty foods. Anytime there is a change with digestion then check in with your doctor. It may not be a sign of digestive cancer, but you do need to be aware of your own body function to determine what is or is not “normal.”
  4. Lack of appetite. Or sudden, unexplained weight loss. A drop in appetite and a tendency to feel full after eating very little is something to be aware of. Again, it may not be alarming but you do need to be aware of your own body function to determine what is or is not “normal.”
  5. Diabetes, especially if unexpected from regular checkups. Most diabetes diagnoses are not due to pancreatic cancer; however, research studies show that pancreatic cancer patients have a higher rate of diabetes diagnosis than the general populace. Knowing your family history of pancreatic cancer and having a baseline of regular screening will help your doctor evaluate if additional tests should be done.

Schedule Annual Screenings

Being an advocate for your health starts with healthy behaviors; tobacco use, particularly cigarette smoking, accounts for 20-30 percent of pancreatic cancer. Knowing risk factors you should avoid (such as smoking) and being aware of what your body is signaling will help you in early detection as well as potential outcome.

Annual screenings to check for chronic health conditions, such as high blood pressure, heart disease, diabetes and cancer, are an important part of staying healthy. Scheduling a regular exam with your primary care provider also gives you the opportunity to discuss any health concerns you may have. Find a doctor near you and schedule a well visit today.

Emory Healthcare

At Emory Healthcare we’re here to help you find the care you need, when you need it. With more than 2,800 doctors and 300 locations, including 11 hospitals, and hundreds of primary care offices, urgent cares and MinuteClinics, we’re delivering specialized care across the region, find a doctor near you to help you get and stay healthy.

Winship Cancer Institute of Emory University

If you or a loved one has been diagnosed with cancer, you need a multidisciplinary team of health care specialists. Winship’s pancreas cancer team includes surgeons, medical oncologists, radiation oncologists, gastroenterologists, pathologists as well as pain specialists, nutritionists and social workers. For patients with early stage pancreatic cancer, the Whipple surgical procedure is the best option for long-term survival.

Winship Cancer Institute of Emory University surgeons perform a large number of Whipple procedures every year; a high volume of these procedures directly translates into the expertise needed to perform the procedure safely. Some patients may be candidates for laparoscopic or robotic surgery, which may improve both recovery and cosmetic appearance after surgery. Winship at Emory surgeons are leading the world in this area as well. If diagnosed with cancer, it’s important to get to Winship first.

Winship Cancer Institute of Emory University is the National Cancer Institute (NCI) Comprehensive Cancer Center for Georgia – the highest designation given by the NCI to cancer centers in the nation. Winship offers expertise in cancer research, prevention, detection and treatment with the most advanced therapies. Winship is where you get treatments years before others can. Our expert team coordinates every detail of your visit to meet your individualized treatment plan. Visit emoryhealthcare.org/cancer or call 1-888-WINSHIP for an appointment.

 

About Dr. El-Rayes

bassel el rayes mdBassel El-Rayes, MD, is the Director of the GI Oncology Clinical and Translational Research Program, Associate Cancer Research Director for Clinical Research at Winship Cancer Institute of Emory University and Professor of Hematology and Oncology at Emory University School of Medicine. Dr. El-Rayes earned his bachelor’s degree in biology and doctoral degree from the American University of Beirut. He then completed his residency in internal medicine and fellowship in hematology and medical oncology at Wayne State University, Detroit. He was on faculty at Wayne State University Karmanos Cancer Institute from 2003-2009. Dr. El-Rayes clinical interests include gastrointestinal malignancies specifically pancreatobiliary and neuroendocrine cancers. He is principle investigator on multiple investigator initiated trials. He has served on the gastrointestinal committee for Southwest Oncology Group (SWOG) and Radiation Oncology Cooperative Group (RTOG). He currently serves on the National Cancer Institute Neuroendocrine Tumor (NET) Task Force. He also serves as Co-chair of Hoosier Oncology Group (HOG) Cancer Research Network – Gastrointestinal Clinical Trials Working Group. Dr. El-Rayes is a Georgia Cancer Coalition Distinguished Clinical Scholar. He has published over 90 peer reviewed articles in elite journals including Journal of Clinical Oncology and Cancer Research.

About Dr. Kooby

david kooby mdDavid A. Kooby, MD, FACS, specializes in laparoscopic/robotic and open surgical treatment of liver, bile duct, pancreas, stomach, and colon tumors/cancers. He also has expertise with tumors and diseases of the spleen, adrenal glands, and retroperitoneum. He has taught many national courses on laparoscopic resection of the liver, pancreas, and colon, and is frequently invited to speak at national conferences. He received his MD at the State University of New York, Downstate Medical College, Brooklyn, NY, in 1994; completed his surgical residency at Vanderbilt University, where he won medical student and resident teaching awards. He completed both bench research and clinical fellowships at Memorial Sloan-Kettering Cancer Center, New York, NY. He was recruited by Emory in 2003, and is currently an Associate Professor of Surgery in the Division of Surgical Oncology, Director of Surgical Oncology at Emory/Saint Joseph’s Hospital, and Director of Minimally Invasive GI Surgical Oncology. He serves on several national committees including the task force charged with updating the staging of hepatobiliary malignancies for the American Joint Committee on Cancer’s Cancer Staging Manual, the research and education committee for the American Hepato-Pancreato-Biliary Association, and the Hepatobiliary Working Group for the Society of Surgical Oncology. He is leader in multicenter clinical research and is a national leader in minimally invasive pancreatic surgery.

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

 

RELATED RESOURCES:
Pancreatic cancer at Winship
Steve Jobs, pancreatic cancer & the Whipple Procedure 
Intro to Pancreatic Cancer Part I: Stats, Types, & Risk Factors
An Intro to Pancreatic Cancer Part II: Prevention, Diagnosis & Treatment
5 Early-Distress Warnings of Digestive Cancer

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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