According to the American Cancer Society, about 43,000 people are diagnosed with pancreatic cancer in the U.S. each year, and fewer than 1 in 5 of these cancers are caught early enough to be surgically removed.
Kevin T. Watkins, MD, chief of upper gastrointestinal and general oncologic surgery, is a nationally renowned expert on pancreatic cancer and its treatment. Here, he provides answers to frequently asked questions about this condition and how Stony Brook offers the leading-edge care for it.
Q: What is pancreatic cancer?
A: Made up of abnormal cells or tumors, most pancreatic cancers begin in the ducts that carry pancreatic juices — the enzymes that aid digestion and the hormones that help regulate the metabolism of sugars.
Even when diagnosed early, pancreatic cancer typically spreads rapidly, and is seldom detected in its early stages. Signs and symptoms may not appear until the cancer is quite advanced. Signs to watch for include upper abdominal pain that may radiate to your back, yellowing of your skin and the whites of your eyes (jaundice), loss of appetite, weight loss, depression, and blood clots.
According to the American Cancer Society, for all stages of pancreatic cancer combined, the one-year relative survival rate is 20%, and the five-year rate is 4%. Survival rates are low because fewer than 10% of patients’ tumors are confined to the pancreas at the time of the diagnosis; in most cases, the malignancy has already progressed to the point where surgical removal is impossible.
Q: What are the causes and risk factors for pancreatic cancer?
A: No one really knows what causes pancreatic cancer, but factors that may increase your risk include:
- Age. Increasing age, especially over age 60
- Gender. Men have slightly higher rates than women
- Race. African-Americans typically have higher rates
- Weight. Being overweight or obese
- Other medical conditions. These include chronic inflammation of the pancreas (pancreatitis) or diabetes
- Family/personal history. A family history of genetic syndromes such as BRCA2 gene mutation, Peutz-Jeghers syndrome, Lynch syndrome, and familial atypical mole-malignant melanoma. Also a personal or family history of pancreatic cancer.
Q: Is there any good news about pancreatic cancer?
A: Yes. Although survival rates are low compared with other cancers, they have slowly increased over the years. This is mostly due to new tests that have been developed that can help identify cancer earlier in people with a family history of pancreatic cancer, and improved treatments.
At Stony Brook, we offer state-of-the-art diagnosis and treatment of pancreatic cancer, including new surgical options. In December 2009, we pioneered a new procedure never before used for pancreatic cancer, called irreversible electroporation (IRE).
IRE is a surgical technique that kills the cancer by using electrical fields to generate pores in the tumor cells. It kills tumor cells without causing collateral damage to adjacent tissue. The NanoKnife, a computerized system used for the procedure, uses brief and controlled electrical impulses to open microscopic pores in a targeted area.
By increasing the number, strength, and duration of the electrical pulses, pores in the cells remain open permanently, causing microscopic damage. The cells then die, and the body rids itself of these dead cells.
Q: What are the benefits of IRE?
A: IRE does not generate heat or cold, which could damage normal, adjacent tissues. The main benefit of IRE is that it gives us the potential to offer treatment to some patients who previously had no options.
This breakthrough technology, however, is not viable for those patients where the cancer has metastasized, or spread elsewhere in the body. But, for those patients who are candidates, the procedure may result in a major improvement in quality of life and extended time beyond the anticipated few months associated with the advanced level of disease.
Q: Is IRE widely available?
A: IRE is not widely available for the treatment of pancreatic cancer. As of now, it is most commonly used in the treatment of liver tumors. Currently, Stony Brook University Hospital is one of the few facilities using IRE for pancreatic cancer, and to date has treated the most patients worldwide.
