All About Pancreatic Cancer, Pt. II with Dr. Paul Hansen and Dr. Ron Wolf

I’m Dr.Paul Hanson, I’m a Liver &
Pancreas Surgeon with The Oregon Clinic and I’m Dr. Ron Wolf, I’m a Liver & Pancreas Surgeon with The Oregon Clinic. Unfortunately pancreatic cancer in
general is fairly sporadic and by that we mean the
whole population is susceptible to getting it
but its heavily correlated with age, so people who are over 45 have a much higher risk getting pancreatic cancer than the younger population. The second thing is, the subsets of
patients that smoke tobacco or people who have pancreatitis have major
risk factors for pancreas cancer so for whatever reason
whether it’s alcohol related or gallstone related or another cause
those patients in the future are high-risk. Patients that have a direct family
history of pancreas cancer, especially a first degree relative or a mother or father – they’re at higher
risk and then there are some genetic syndromes that patients can have
and those are highly correlated with getting pancreas cancer – sometimes as high as a risk of like a factor of 10
higher. Most commonly, patients present to
their physicians with either
abdominal pain or occasionally with jaundice – which is yellowness in
the skin and eyes or with weight loss. If a patient
presents to their physician with complaints where there’s a concern
about this then probably one of the first things they’re gonna
get is an abdominal cat-scan. There are some other tests that we will then follow up with and and they
may include something called an endoscopic ultrasound which is where the gastrointestinal physician puts the scope down into the patient’s
stomach and can actually ultrasound directly through the wall of
the stomach into the pancreas and if they see a
mass or something of concern then they can actually biopsy that. Pancreatic surgery is major abdominal
surgery. There two types of pancreatic surgery that we can perform. The surgery on the pancreatic head is
something called a Whipple procedure and if there’s a cancer
in the body or tail of the pancreas, the procedure we
perform would be called a distal pancreatectomy Both of them are major procedures, but the Whipple – the cancer in the pancreatic
head – is the bigger of the two procedures. The
operation can take anywhere from 4 to 10 hours. A typical surgery maybe takes about six hours. We go in and we actually free up all the
attachments to the pancreas and the pancreatic head and we have to take out a small piece of the small bowel as well as a portion of the
bile duct in the gallbladder. I’ve found that patients recover fairly well from pancreatic cancer
surgery. Typically they’re in the hospital for a
week – sometimes longer if they have issues with their
recovery, but in general about 7 to 10 days
is a typical hospitalization. When they leave, it’s usually
kinda hard week or two – in terms of getting around, being a little
bit sore – sometimes using pain medication still and sometimes not eating really robustly,
but I’ve found that between about six and 12
weeks after surgery patient start to feel a lot better. And people report at about three months
that they feel pretty well. They may have gained most of their weight back and by about six months, more than half the patients say that they feel pretty normal. And, if you interview
people years later the most common answer is that I feel
normal – like I can’t tell I had surgery and that’s really comforting to hear
actually. There’s actually a lot of enthusiasm around treating pancreatic cancer now, that has probably been
lacking for the last forty years and it has to do with the discovery of better medication along with better, safer surgery. So it seems like the
combination is allowing patients to live longer,
especially with respect to selecting the the right patients for surgery, but also, the drugs themselves are
more effective so I think that’s very exciting – their combinations now that even in patients that can’t have surgery can prolong their survival quite significantly. I’m nearly doubling
the survival in that setting. The second thing is the
immune system is a new area of research – maybe not totally new – but there’s a lot more exciting things in the lab. Our own
laboratories looking at the way that the the person’s
immune system reacts to the pancreatic cancer and specifically the way that the
pancreas itself reacts to the nearby pancreatic cancer. The cells in the blood and
the cells that are in the pancreas or both being analyzed by people in our
lab and and we’re trying to change the cellular
dynamic so that that the cancer cells are being targeted better by the
patient’s immune system.

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