This is Roswell. Rookie by Roswell Park Cancer Institute. European opinion or your total options. You're -- him when welcome back to -- this comprehensive look at all aspects of cancer care treatment and diagnosis and research. From a comprehensive source we're hearing from Roswell Park Cancer Institute in buffalo. Until my anger and today we're talking about pancreatic cancer. We'll find out what it is how it's treated and does some of the new research options. That it that are out there. And they are somewhat hopeful too as well and in studio today we have. Doctor -- -- a year she is an associate professor of oncology and co director of the liver and pancreas tumor center here at Roswell park. Doctor you're thank you for being here thank you -- for having me appreciate it and by your side today we have doctor Boris -- should not. Associate professor of oncology and also co director of the liver and pancreas tumor center here Roswell doctor groups not thank you. Thank you for having me back -- pancreas. Let's start with weird isn't in in what it is before we even get to the cancer doctor -- should. All the -- is. Very important organ in digest a function it's located behind the stomach. It's about seven to ten inches in length and runs across the upper part of the the abdomen. On and is more towards the back of the abdomen so win patients have symptoms from. Pancreas problems that's often associated not only with with pain in the upper abdomen but also back pain. And it's a very important organ I think it's most two most vital functions are. To help with digestion and makes enzymes which are very critical for digesting the food and it also makes insulin which. Obviously is very critical for. -- the blood sugar control. We don't think about much either you know we you know we think of our style like we know our lungs that you know we are colon and all the different things that we talk about all the time. You know on this program and in in our general health conversations we don't talk about the pancreas that much so if it is it's they don't -- -- or it's the brains of the intestinal system it's a very very critical or again. That regulates. All of -- function of the GI tract makes a lot of hormones and it also is very important and digestion system very critical. Critical work that being said it's a tough cancer it is a a tough one to diagnose a tough one to treat. On the tough one to to deal with is really no simpler way way way to say it. You -- tell me you know generally what leads to. Pancreatic cancer what can cause. As a doctor a year you probably it's you know some. Thoughts on -- glad. Absolutely I'm not unfortunately to cancer and aging the average age that which patients are diagnosed is about 72. We've seen young patients in in their thirties diagnosed we're gonna manage the youngest patient is in their forties. Kris African Americans a little more than caucasians. Meals a little more than females and they -- not sure whether it's just surveys that are. Their other risk factors obesity. Smoking risks that seem to be higher than some of these stations as well. Obesity is a big on linked to the risk of developing pancreatic cancer are. As a -- chronic pancreatitis. Which is a condition where patients develop inflammation. In the bank and yes. And sometimes we don't know why they had it sometimes is secondary to alcohol use or some storms like gallstones that gun and and caused obstruction on the bank candy dots. There are also some from the union conditions risk factors families that have increased risk of getting pancreatic cancer. And down some studies have shown an increased risk with the -- their consumption of red meats. And and reduced risk with the consumption of fruits and vegetables and some of those are yet to be proven. You a lot of cancers are attributed to tobacco. And an -- diet in is it sounds like this is well maybe not a controllable cancer it seems like those two are huge factors. Tobacco use and diet seemed to be something at least we can take into account. And in help stave off prevent. Developing. Pancreatic cancer -- correct there. I think -- system proved those. That eliminating some of these things prevents the cancer because of the number of different factors involved it is a little difficult. To tease out the individual risk of these different elements but certainly sting of it from tobacco would be good. -- -- -- the doctor cushion off if you could you talk to me a little bit about symptoms. You know we always are and are looking you know -- humvee you know within ourselves you know we we we feel pain we you know we still we detect something wrong. And immediately start to think you know what could it be. Are their symptoms of pancreatic cancer and you know and definitive symptoms and I think that's probably. Conversation we need to have. And hand their lies the problem. Did. -- cancer does have a very common set of symptoms and basically. Such as weight loss. Loss of appetite. Abdominal discomfort. In more advanced stages you'll get back pain in and and more severe pain but in the earlier stages they're very nondescript. Symptoms there may be some fatigue again loss of appetite. One of the more prominent symptoms that patients will have this very sudden. Is jaundice. If you. Because the the bile -- -- the the yellow vial that comes from the gallbladder goes through the pancreas tumors and head of the -- will block off the bile duct. And patients will turn yellow the and that's obviously very noticeable and that's often times what. Gets the attention and have them you know has and seek medical. Care come in are very stressful world. -- loss of appetite and losing weight and these these other sort of ill defined symptoms are very common. Among all of us. And so but in retrospect when patients do finally get the diagnosis of cancer. They can often times look back about six months and realize that. You know something was up but it's those sort of -- defined nature of the symptoms and and the fact that this that the pancreas cancer. Tens of percent at a at a later stage because they're very early symptoms or pretend to be overlooked. And it's only when the symptoms become very dramatic. That it is really gets worked up at that point and often times unfortunately. It's at a more advanced stage so that's that's a problem we deal with is that there's no there's no good screening tests there's no good. Very consistent blood tests like there are without PSA and prostate cancer. Mammograms and breast cancer colonoscopy in colon cancer we have very good screening tests. For -- cancer not so good there's the screening testers on development. And really I would have to say right now we don't have a good screening test for -- is similar nature to lung cancer and mean there really is that he agreed to screen for lung cancer it's something that did that. Present itself in -- off -- else's look like cancer right there there are some spiral CT scans seeing at these high resolution CT scans can pick up one cancers earlier. Com and and you know but for tankers cancer really of it you know you can. -- very good quality CT scan will pick up a pancreas cancer. But not in the earliest stages when it might be the most curable. It really is it's a delicate issue because you know the you know anyone out there listening it has a stomach pain right now. Is -- you know in his listen to this program. In has some of the symptoms it that you that you laid out here. Is probably you know has red flags going off you know Mike. Goodness could this be something serious. What is it that you know I are in alerts in an -- Patient or primary care physician doctor a -- should be looking for. Or alert to with a regard to pancreatic cancer. I think below have tried at one point or another to lose weight but if you have had any. Perhaps more successful weight loss program man wants a -- -- friends or colleagues. I have -- that could be a red flag pin on that could be something else going on. Patience of pancreatic cancer also might have had. Episodes of pancreatitis you know people who have had to repeat visits to do my agency at home with inflammation in their bank this. That is at risk factor in these are patients as well who should get a good quality scans and be seeing their primary care physicians getting some labs. And the tour does a family history. If if families and have had an increased risk of pancreas cancer breast and colon cancer. I think these are families that one should be a little more attention to be seen symptoms. You both mentioned pancreatitis was pancreatitis and you know is it is it something that's common. You know I've not heard much about it doctor could not. Yeah pancreatitis is is actually very common and that's an inflammation of the pancreas. Common causes of pancreatitis might be. -- gall stones can caused pancreatitis -- difficult storms pass the call -- through the pancreas. Use of alcohol. In excess can lead anchor -- and their whole host of immune -- you can have something called auto immune pancreatitis. And there's other medications and other environmental factors -- caused pancreatitis that. Usually in the end we're able to distinguish. Sometimes it's difficult but with the current technologies we can generally distinguished pancreatitis from. From a cancer but there is an association because. Bankers cancers can cause pancreatitis. And you can and so did that to co exist but in general were able to tease them apart critic is that the key takeaways there with pancreatitis would be that if you have experienced that have been diagnosed with -- that are no councilman in your family has. That that's something that should be communicated to a position down the line if if symptoms are present and correct yeah outlaw status chronic pancreatitis is say one of the risk factors for develop a pancreas cancer we think that that's from. A chronic irritation or chronic inflammation. That can lead to the development of pancreas cancer so there there is there is some associate so often is the case we don't. -- about a disease until someone else note. Hasn't Patrick Swayze. It's succumb to to pay increase. I can't for the pancreas. Not not that long ago. The young guy you know over a revered did a young gentleman. You know who who succumb to this disease comments about. His battle with cancer of the tankers doctor here. Com yes I think -- and patience of the are famous. There's -- -- he and and Patrick -- people are little more apt to notice and think about this disease. Unfortunately no matter who you are and down watch your status you know the symptoms are. Still kind of -- Collison Hart it's an -- cancer are diagnosed. And at this time of diagnosis often it's not operable. And end up having to be treated with chemotherapy and radiation to try and control it prevented from growing and spreading as was the case. And these famous individuals. So again. And Patrick Swayze and an old guy either you said that you know age is certainly a factor in this cancer and and others as well. But you know he was relatively young guys and and that before him Michael Landon. -- little house in the very same he surely also succumbed to paint his cancer but on the other side of the spectrum we have justice Ginsburg. Who had you know had pancreas cancer in and had a successfully respected and as far as I know she's still. You know active. And the other famous one that -- do it's it's is Steve Jobs but that is Steve Jobs didn't have. Pancreas cancer -- and I think that's an important point is that not all. Tumors of the pancreas are all pancreas cancer pursue a Steve Jobs for example have a neuro -- tumor which is a very different kind of tumor in the pancreas. On we also see sis in the pancreas and we on this the other -- nine lower grade tumors I think their message there is is that. I'm just because there's a mass in the pancreas there's a lot of other things it can be other -- tankers cancer can be benign he can be inflammatory can be. Much more in the one type of tumor. So I think just not to get confused -- all -- cancers are not the same. This is Russ Wallace you're hearing about pancreas cancer today cancer of the pancreas that is doctor Boris -- ocean off. Associate professor of oncology co director of the liver and pancreas tumor center. Along with his colleague doctor -- guy here is also an associate professor of oncology co director of that. -- center. We've talked about what it is where it is what it does. How it's diagnosed. Let's get into. Treatment and let's get into where we're going as far as. Treatment and research. What is the key treatment for. Cancer of the pancreas. Well it just just just. As a -- to treatment that in terms of the diagnostic studies -- think we just need to mention that briefly -- Eighty we have some very good imaging. These days the equality of the cat scans we now have high resolution cat scans they can give -- much better pictures we have a new modality that we have here is -- Roswell. And this topic ultrasound which has become very popular. It's a procedure where they put a -- down and there's ultrasound on the end of the -- you can actually look inside this pancreas with a very high a resolution ultrasound. And see if -- any abnormalities and then -- even nicer about that as you can actually do a biopsy. Of any suspicious. Master cyst that really gives us a lot more information. I am in the old days I think you know twenty years ago for example a lot of patience would -- have been explored. But now with the very good diagnostic imaging we have we can have a pretty good idea what's going on before we make a decision to to to operate. As far as treatment I'll I'll. Just touch upon these surgical treat now what doctor writer who's you know before you move I'm dreaming and -- -- -- -- there as they brought it up with those that the diagnostic imaging you do spoke of the -- gothic. Dying. Domestic that is something that's done after there's a suspicion that that this is not something that. You know he's done in cash it's not a screening test I think that it it. It can sometimes we can pick these up when patients have CT scans for other reasons -- We've seen both doctor and iron fire have -- have seen patients who had some sort of trauma war. I kidney stone or any kind of event that took them to the emergency room and they get a cat scan and we find some of them -- nine tankers and then -- and then we work enough so they can be incidentally found. The -- vast majority of these are found because of symptoms. -- and and that's only come to the attention there. You know medical doctors usually through their family doctor and then in the GI doctor and then ultimately. Make their way to us focus on to the truth now. So come on the surgical side. And then the majority of patients present with -- cancer unfortunately. Aren't going to be. Patience and I'm going to deal to take care as a surgeon. However that's the most important initial assessment as to determine whether the tumor and Pincus is surgically respectable because. By and large surgical -- section is still the best therapy and provides the longest. Survival. And and that's often stage dependent so if if if you get a good quality cat scanned. And the and a and a pancreas surgeon -- who is experienced in in -- neck surgery. Feels that the tumor is operable can be removed generally now will be the next the next step now in cases what we we have this term. In our in our lingo called borderline respectable meaning that this little bit larger tumors. That are that are not quite on respectable but or in that borderline that gray area. Those are the ones that. We've made a very strong effort to employ something called. -- management therapy where we able shrink the tumor with chemotherapy and radiation. In order to make it. More operable. And give us a better chance of removing the tumor these are the kind of tumors are really half the entire tumor has to be removed if we leave tumor behind -- cells behind. These tumors will likely recur so our job as a surgeon at the end of the day. My role is to remove the entire tumor to get it out completely with good margins anything that can help me do that. Chemotherapy radiation to shrink the tumor to allow me to completely respected in my colleagues. That's at the end of the day I think what's gonna provide the patients with the most opportunity. Now unfortunately for those other group of patients. That are not. Amenable to surgical recession. Those are the ones of my colleagues on doctor right ear doctor when mine and others in the medical oncology side there the whole world be the primary caregivers for back. If we should you know before we move on to that what would -- the tumor. Into what puts a tumor in today gray area is it it would need to win it's you know in. You know involved in another organ or too far into the pancreas in general we we we have four stages and and surgeons will generally operate on stage one and two. There's the gray area which is almost like stage 2.5. Is win it's it's close to being. What we call locally advanced or wrapping around. The critical blood vessels is and we mention a few moments ago earlier in the air in in in this program. The -- sits in the back of the abdomen unfortunately it's it's right over top some very major vascular. Structures that does give all the blood flow to all of the intestinal track when the tankers tumor wraps around those blood vessels unfortunately it becomes inoperable. If it's. Partially going around those blood vessels are pushing up against those blood vessels those -- the kind of tumors that we can shrink. With chemotherapy and radiation therapy and make them more operable and make it more likely that I can completely. Were there are surgeons here can completely remove it. And so that would be the first couple stages now doctor -- we'll talk about stages three and four. Which are basically outside of the realm of of what we can do on the surgical site. So unfortunately not many patients I was -- Over 80% of patients diagnosed with pancreatic cancer. Come to the doctors at the stage and and doctor -- and often his surgically colleagues have not able to successfully intersected. And then those patients we call them locally advanced or incomparable. -- metastatic. And environmental study remained too -- has originated in the pancreas and then travelers. Through the bloodstream and spread to deliver -- to the baby don't you which is the lining of the abdomen. Or other distant locations like the balloons of the lungs. These stations benefit most from chemotherapy. Think you look -- -- -- options have evolved over the last 1015 years and in fact. Even though this check this cancer remains very challenging to treat. The fact that we have had a pretty successful big phase three clinical trials -- these stations that. Advanced metastatic pancreatic cancer tells us that a lot of the work. That remains to be done progress is being made in that direction and we are getting into and we need to be but we still remain far much work remains to be done. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- We've been using this since the early 1990s. Because in addition to helping these patients and controlling their counselors. It had a big impact on their quality of life and -- number one reason and still remains the number one reason why we use this -- even today. Other drugs can be nations like targeted therapies such as this oral medication -- -- sealock showed improved survival of an advantage inside of being. And that means in our parliamentarian. Very recently just this past week in fact a new clinical study phase three randomized trial adding a new -- quite a bit -- seems. Which is already in the market being used since 2005 for the treatment of breast cancer. What she'll want to add an improved survival. In patients with pancreatic cancer when given with -- cited being. Compared to patients receiving just inside of being alone. And these data on these results are expected to be presented at a big national meeting in January 2013. In addition to this just this last year our doctor push enough alluded to patients needing to have their two most shrunk or mean a little bit smaller so that they can have sergeant. Have a surgeon. Going to take them out. And a combination of drugs colorful and feeding -- an acronym for a bunch of different chemotherapy to agents. That can shrink these tumors a third of the time. So there are now options that we didn't have before these are all new things that have come up in just the last 56 years. And down not much progress remains to be mean. Yeah Raza one of my colleagues doctor Mok has a lot of water -- where he is trying to develop new combinations and new -- appease. Targeting cancer cells especially in the pancreas and a new study going on here right now bank. Far -- cancer patients involves genocide of being an oral chemotherapy tentacles of low down. And a targeted drug -- to Vietnam and new studies are constantly. Being developed an open -- here at Roswell park. Well that is. You know that there are so many cancers where you know research is moving as quickly and it seems like the you know the research is is moving pretty rapidly with with regard to. Cancer of the pancreas is is is you've laid out here. Speaking of repeat you know -- Canadian how how quickly. This disease moves you know some some cancers are slow you know we talked. You know in this studio lot about prostate cancer very slow. Developing disease over time this is not one of those great contribution. Count on unfortunately not this is. Like other cancers of the similar Lee is soft -- cancer gastric cancer -- lung cancer. You know these cancers tend to be in more aggressive types of cancers. And the prostate cancer that you mentioned. And but that's why it's I think. It is important that we do the research because we really need to come up with tomorrow's best therapy today who offer for patients. But it is a very challenging. Cancer to treat. It's also challenging for other reasons and that it affects -- your nutrition and and that's very important because when we're treating patients we have to maintain good nutrition. We have to control and more advanced disease we have to control pain so we're thinking about a lot of other things. In terms of quality of life even for patients with more advanced disease there's a great opportunity we have a palliative care team that works with us. This is. -- cancer is one of those cancers are really lends itself well to the concept of multi disciplinary care. And that's. I mean multi just -- care sort of built into the Russell DNA that's really how are -- institute is. Set up and then the pancreas cancer we have a weekly conference on all the patients with -- cancer presented at the conference we have radiation doctors surgeons. We have medical colleges are nurses are there. As well as other groups that we work with the -- team the palliative care team nutritionist dietitians social worker. He really is if you had to pick a cancer that takes a team effort this is certainly. Would be my poster child for that. The only a few moments remaining -- carrier but you know it's really the take away here is to me today is that this cancer can be treated. You know surgically as doctor -- if not his his pointed out here in him some in many cases. And you know with with chemotherapy in in others but that take away to me is that there's there's hope there's progress right. Absolutely the challenges remain but the opportunities. To improve outcomes are also many. My two messages to patients water unfortunately dealing that this is this. Would be to consider getting a second opinion consider exploring clinical trials. Such as the child I was so successful in just this past week that was offered him an atrocity and many patients either -- crew are to that study. One actually able to -- us this option even before. It hopefully will become an option. Internationally and nationally for patients and the second day call message for all of these. Patients would be. You need a team approach you need a team that will focus on your quantity on pain control on making sure the bile duct and your nutrition. Are good as you fight this illness and I think having access to all of that is. Very very important -- conclusion often you know final point you know we need to be aware right I mean. You should we mention the symptoms here in the symptoms can be confusing they can be somewhat common in in our lifestyle and our in our lives but. You know if if we are presented with a you know a bunch of symptoms we should take him seriously and make sure that we follow. Very true -- I would add one other thing I think it's important especially with. Eight a relatively. More rare canceling -- cancer but one that requires a lot of sophisticated technical. Issues. In terms of the surgery for example these are very complex surgeries and really. -- really should be to be done by a surgeons of them was high level of training and also high level of experience these are not the types of surgeries that. As a surgeon you wanna be doing a couple of years you really need to be doing. The the Whipple procedure for example which is the common surgery we do for the tumors of the head of the pancreas or. Removing the -- the pancreas such isn't just -- paint protect me. Those are complex surgeries and clearly like many other complex surgeries outcomes are really dictated by the experience. The that the surgeon -- the team you know I think -- mention I'm positive that there is a new technology called the nano knife. And the -- night is is a it's a probe that actually passes electricity across the tumor. And can actually kill the tumor in place and we are the only senator in Western New York it has an and a knife and we have been applying it both for liver tumors and for for pancreas. Tumors pancreas cancers in fact. So -- -- night is something it's a very new technology. But we are now beginning to it to use it for I'm respectable pancreas cancers so those. Pincus cancers that can't be surgically removed or could be -- surgically removed if we could add an additional margin. With this man and -- technology. We are we are offering that two patients -- doctor Boris cushion off is an associate professor of oncology co director of the liver and pancreas tumor center. Thank you for being here and doctor in new guy here. Associate professor as well of oncology here at Roswell park and also the co director. The liver and pancreas tumor center here at Roswell park if you'd like to hear the show in its entirety or others you can do so at Roswell park dot org. Wanna ask a question you can call them told free anytime at 877 ask our PCI. That is 8772757. Settle. Listen to Roswell this Sunday mornings at 630 young WB yeah. -- by Roswell Park Cancer Institute your team opinion for your total options on line at Roswell this god of war. And and do you. Then.