GRACE :: Pancreatic Cancer

What is resectable pancreatic cancer?

Published March 5, 2012 | By Dr. Katz | Leave a comment

Both the National Comprehensive Cancer Network (NCCN) and the American Joint Commission on Cancer (AJCC) staging systems suggest that the definition of “resectable” pancreatic cancer is straightforward. However, determining whether a patient is eligible for surgical resection actually requires some fairly complex medical decision-making.

According to the cancer staging systems, “resectable” pancreatic cancers are, first and foremost, those that are not associated with disease outside the pancreas. The reason for this is that the outcome following surgery—even if all disease can be removed—is not associated with a longer lifespan or better quality of life than that associated with chemotherapy alone when there is disease in sites such as the liver or lung. Simply put: patients with any amount of disease outside the pancreas live longer and better without surgery. This is a fact that neither I, nor any other pancreatic oncologist, would dispute. However, the anatomic extent of disease that constitutes “resectable” cancer among patients with cancers localized to the pancreas is more controversial.

Continue reading →

Posted in General, Surgery | Tagged CA 19-9, CA19-9, pancreatic, resectable, surgery, Whipple | Leave a comment

Advanced Pancreatic Cancer: Changing Landscape Signals Hope

Published February 20, 2012 | By Dr. Javle | 1 Comment

Pancreatic cancer, though relatively uncommon, is the fourth most common of cancer-related deaths. In the United States, 44,030 new cases of pancreatic cancer were diagnosed with 37,660 deaths in 2011. The average estimated five-year survival of a pancreatic cancer patient with advanced stage of the cancer is 5% or less. Despite these grim figures, a number of recent developments in basic and clinical research offer hope for the future.

Patients with advanced pancreatic cancer include those with cancer spread to liver or other distant organs. In these cases, surgery or radiations are not feasible and chemotherapy remains the sole treatment option. For the past ten years, gemcitabine chemotherapy has been the mainstay for patients with advanced, stage IV pancreatic cancer. The approval of gemcitabine by the F.D.A. was based on an improved survival over the previous standard, 5-fluorouracil chemotherapy. Gemcitabine also led to a ‘clinical benefit response’, or an improvement in pain, appetite, weight and quality of life. In the past decade, there have been several clinical trials, which combined gemcitabine chemotherapy with other chemotherapy agents used in pancreatic cancer. All of these trials indicated that when gemcitabine was combined with another chemotherapy agent (gemcitabine + drug X), the resultant survival was no better than with gemcitabine alone.

Continue reading →

Posted in Advanced Pancreatic Carcinoma, Chemotherapy for Pancreatic Cancer, Targeted Therapies for Pancreatic Cancer | 1 Comment

Surgery: the only chance for cure for pancreas cancer?

Published February 9, 2012 | By Dr. Katz | 4 Comments

Most patients have read, on the internet and elsewhere, that surgery is “the only chance for cure” for patients with pancreatic cancer. If you were to review the scientific literature on pancreatic cancer written over the past 30 years, you would find that almost every paper written for a surgical audience begins with this statement somewhere in the introductory paragraph.

So, is it true?

First, let me start by way of introduction. I am a surgical oncologist who treats—exclusively—patients with tumors in the pancreas. That is, I am a physician who uses surgical resection as my primary therapeutic modality for patients with pancreatic cancer and similar diseases. With that, it may perhaps come as some surprise that although I agree that surgery is an important treatment option for patients with pancreatic cancer, it is not the whole story.

The problem with pancreatic cancer is that it is a systemic disease. In all patients. Even patients who have disease which appears localized to the pancreas on the most advanced imaging studies available. All patients with pancreatic cancer, to some degree, have cancer cells floating around somewhere outside the pancreas. For this reason, surgery cannot possibly be the whole story.

Continue reading →

Posted in Surgery | 4 Comments

Dedicating the New Pancreatic Cancer Section, and Welcoming Our New Faculty

Published February 3, 2012 | By Dr West | 1 Comment

It is a big step for GRACE to grow from a community focused all but exclusively on lung cancer to a broader community of people affected by many different cancers. It took years to have GRACE transition from being a site fueled almost exclusively by one person to a resource with a group of specialists all participating together. It’s a richer experience for that, and now GRACE faces the challenge of overcoming the hurdle of reaching and integrating more patients and caregivers. Many people note that “there’s nothing out there like GRACE”, which I agree is true, but it would be unfortunate to have such a valuable source of current knowledge and vibrant support be limited to only or primarily lung cancer.

And one cancer that faces all too many difficulties is pancreatic cancer, which is understudied, has statistics that can be demoralizing, and overwhelms the tens of thousands of people affected by it. The opportunities for the latest information and a sense of community are limited, and this has led to the development of the GRACE Pancreatic Cancer section from the generous contributions in support of two special individuals.

The first is Ruth Elkes, who fought a valiant battle with pancreatic cancer. She was the mother to three sons, including one of my college friends, Daniel Elkes, who currently dedicates his career to cancer research and developing new medicines. His mother Ruth was born and raised in Chicago, IL and received her BA Degree from the University of Michigan. In addition to dedicating her time to motherhood, she volunteered at many institutions. Her generosity of spirit, combined with the lack of educational and support resources about pancreatic cancer, left her family committed to changing and improving that for others. The Elkes Foundation provided a significant contribution to enable the new section of the GRACE website in hopes of serving this unmet need for the pancreatic cancer community.

The second gift comes from the parents of Dr. Weiss, who provided the following message in memory of their good friend, Andrea Braunstein:

The new pancreatic section of GRACE has been funded in memorial to our recently departed friend, as well as beloved wife, mother and grandmother, Andrea Braunstein. Andrea spent the last three years of her life valiantly battling pancreatic cancer in the only way that she knew how–with dignity, determination, and perseverance. She empowered herself with as much information about this disease as was possible and thereby enabled herself to play an active role in her treatment. Andrea was born on October 3, 1948 in Brooklyn, NY and graduated from Brooklyn College with a BA in education. She and her husband, Kenny, brought up their children, Joshua and Heather in Rockland County, NY. Her granddaughters, Shayna and Aubrey lit up her life and despite her illness, provided her with the will to keep living. Until her very last days, she lead a fulfilling life, emotionally supporting her children, traveling with her grandchildren, maintaining an active social life and involving herself in others’ lives as much as possible. As a former educator, Andrea embodied everything that GRACE is about and would have been proud and honored to have her name associated with such a worthwhile project. Andrea’s passing leaves an enormous hole in our lives, but she will live forever in our hearts and memories. – Sheila and Bruce Weiss