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November 17 is World Pancreatic Cancer Day, but the entire month of November is meant to bring awareness to this disease. Pancreatic cancer is the third most common cause of cancer death in the U.S., recently surpassing breast cancer. In 2018, 55,000 new cases of pancreatic cancer are expected and an estimated 44,000 deaths, according to the National Cancer Institute.
“Although we have made great advances in many cancers, pancreas cancer remains one of the most difficult to treat ― often because patients are diagnosed at a late stage,” says Dr. Michael Wallace, a Mayo Clinic gastroenterologist. “But I am optimistic about the future, as we are seeing major areas of progress.”
Advances in screening and early detection for high-risk individuals, minimally invasive surgical innovations and new genetic classifications are changing the outlook for pancreatic cancer, he says.
Historically, individuals have been screened for colorectal, breast, cervical and several other cancers, but not pancreatic cancer. Until recently, there were no effective methods for screening, since the pancreas sits deep inside the abdomen ─ out of reach of many imaging and endoscopic procedures.
The International Cancer of the Pancreas Screening Consortium issued guidelines on who should be considered for proactive screening. These include individuals who have one or more family members affected by pancreatic cancer, especially at a young age, and those with known genetic alterations that put them at increased risk. Such alterations include genes like BRCA (the “breast cancer gene," which also can cause ovarian and pancreatic cancers) and other genes that cause colon polyps (familial polyposis).
“This broad group of people may represent up to 20 percent of individuals who are at increased risk, but it is important that we follow them closely, especially since we do have effective screening tests now, including MRI and endoscopic ultrasound,” he notes.
"Advances in early detection, minimally invasive surgery and precise genetic classification are leading to improvements for treating pancreatic cancer." ─ Dr. Michael Wallace
Cysts and risk
Thanks to advances in MRI technology, doctors today can identify pancreatic cysts, small saclike pockets of fluid that may increase the risk for cancer. “We find cysts in about 40 percent of the population. While most are inconsequential, it is important to distinguish which of them are benign and which we need to either watch, biopsy or even surgically remove,” Dr. Wallace explains.
In 2015, Dr. Wallace and a team of colleagues developed a profile of the patient who would be most at risk of these lesions developing into cancer. Their analysis was published in Pancreas.
Journalists: Sound bites with Dr. Wallace are in the downloads at the end of the post.
Please ‘Courtesy: Mayo Clinic News Network.’
“We have now identified a common precursor lesion, like a mole for melanoma or a polyp for colon cancer, that we can follow carefully to detect cancer at its earliest stage. Studies such as these allow us to further stratify people into a low-, medium- or high-risk category for their cyst becoming cancerous, based on characteristics, including size and shape. This will hopefully enable us to help diagnose cancer earlier and, in turn, positively impact survival,” he says.
Surgical and genetic advances
“Traditionally, only about 5 percent of all patients are diagnosed at an early stage where we can resect their tumor completely with surgery,” Dr. Wallace says. “Now we are pushing the boundary of who we can get to surgery, including patients who were told they were not candidates in the past.”
Dr. Wallace explains that patients with large tumors can now take advantage of improved chemotherapy to shrink the tumors prior to surgery. “Our goal is to get the tumor out. Because if we can get the tumor out, we can cure these individuals,” he says.
In addition, robust research related to the genetic classification of tumors is helping to evolve treatment for many patients.
In the past, genetic information was usually available from surgical specimens only. Today, thanks to fine needle biopsies, “we’re able to get enough material and look at genetic sequences to see if there is a better medication available when our current options are exhausted,” Dr. Wallace explains.
“Precision medicine is very exciting, but we’re seeing major areas of progress on many fronts for pancreatic cancers,” says Dr. Wallace. “There is hope for this cancer.”
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