Liver and Pancreas Institute for Quality at George Washington University Hospital


Pancreatic Cancer is one of the most
difficult diagnosis and challenging
clinical diseases that we face. Most times patients will develop symptoms
that occur fairly advanced in the disease. And those symptoms could include a
darkening of the urine, a lightening of the stools, and yellowing
of the eyes called jaundice. Typically, if those symptoms occur, the
patients should seek medical care right
away and ultimately get to specialty care for
the treatment of the underlying tumor. Patients who have cancers or tumors in
the body or tail of the pancreas, which
is the end of the pancreas, typically don’t present with those
symptoms, but will present with symptoms of
abdominal or back pain much later in the
course of their disease and, again, should seek medical attention
or specialty care to treat the underlying
condition. Pancreatic Cancer occurs in 40 to 50
thousand patients each year in the United
States and is the 4th leading cause of
cancer deaths. The treatments for pancreatic cancer
include surgery, chemotherapy, and
radiation. However, the only cure for pancreatic
cancer is surgery, actual removal of the tumor and then
reconnection of the remainder of the
pancreas and organs to the intestinal
track. Oftentimes, patients will have a
combination of surgery, plus chemotherapy and radiation in order
to prevent the tumor from coming back in
the future. Other patients, who present with more
advanced disease, can only receive
chemotherapy and radiation alone and
typically that is not curative. So, here at George Washington University
Hospital, we have two unique treatments
for pancreatic cancer; one, is minimally invasive surgery, and
two, is advanced vascular reconstruction, or blood vessel reconstruction for tumors
that are more advanced. The first technique involves using small
incisions and using the camera in the
operating room and long instruments in order to mobilize
the tumor and do a resection. The benefit of that is that there is less
pain and a faster recovery after surgery for patients who undergo minimally
invasive surgery. Therefore, they can go on to get the
second stage of their treatment in a
much better condition and much faster than they would if they
had undergone traditional open operations. And as our chemotherapy improves, which
it will, then those patients, more likely,
will have a better outcome over time. Second treatment involves patients who
have more advanced disease. One of the unique features about
pancreatic cancer is that as it grows, it can oftentimes involve the blood
vessels that carry blood to and from the
remainder of the small intestines. And, traditionally, patients who had
those tumors that involved the blood
vessels were not considered candidates
for surgery and therefore would get chemotherapy and
radiation alone, which we know is not
curative. Now, we are able to offer patients up
front radiation treatment to those blood
vessels as well as chemotherapy, and as long as their cancers remain
stable, then they are eligible to have a
total pancreatectomy, that is removal of the entire pancreas
and also removal of segments of the blood
vessels in reconstruction. And we’ve seen that those patients do the
same as patients who had no blood vessel
involvement. And so, we are able to offer surgery to a
much larger proportion of patients and hopefully end up with a better
outcome for a larger pool of patients
than would otherwise been offered in the
past. So, one of the more exciting areas of
cancer therapy right now are techniques
and treatments that utilize our own immune system to
attack cancer cells and we think that
this is the future for cancer treatments. By figuring out why your immune system
does not attack cancer like it attacks a
bacteria or a virus, we now have drugs that allow the immune
system to recognize cancer cells and
therefore go and attack those cancer cells cells just like they attack a common cold
or a common virus. We think the combination of those
therapies along with the new surgical treatments
that we offer here at George Washington
University Hospital will provide better outcomes for patients
with pancreatic cancer and will provide a longer survival for
patients with this dismal disease.

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