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In 2014, Dr. Paul Silverstein had just finished surgery, which he has performed thousands of times over a six-decade career as a board-certified surgeon. But this day was different. Her nurse from INTEGRIS Health noticed that his eyes were yellowing, which she knew could be a telltale sign of pancreatic cancer.
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Pancreatic cancer is one of the deadliest forms of cancer. About 47,050 people will die of pancreatic cancer this year, according to the American Cancer Society. This includes Alex Trebek, the beloved “Jeopardy!” guest, who died last Sunday, about 20 months after announcing that he had been diagnosed with stage 4 pancreatic cancer. Since July, also civil rights icon Rep. John Lewis and US Supreme Court Justice Ruth Bader Ginsburg died of pancreatic cancer. Other famous people who have died from pancreatic cancer in the past include Patrick Swayze, Steve Jobs, Aretha Franklin, Joan Crawford, Luciano Pavarotti, and astronaut Sally Ride.
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Subsequent medical examinations confirmed Dr. Silverstein’s fears. He had a type of pancreatic cancer known as adenocarcinoma that had spread to his lymph nodes. This type of cancer has a five-year survival rate of 12%. To his credit, Dr. Silverstein continues to beat the odds as he is in the sixth year of his battle with the disease.
Since November is Pancreatic Cancer Awareness Month, we recently consulted with Dr. Silverstein, who is now retired, and Dr. Brian Geister, oncologist and certified in-house physician treating Dr. Silverstein, to learn more about the cancer. to the pancreas, why it’s so deadly and what the future holds.
“Symptoms typically don’t occur until the disease is more advanced and tends to be more resistant to treatment than other cancers,” says Dr. Geister.
Unlike mammograms for breast cancer, colonoscopies for colon and rectal cancers, or pap smears for cervical cancer, there is no standardized screening for pancreatic cancer. Typically, you only notice when symptoms appear and you have a reason to have blood tests or pictures. By that time, the cancer growth can be considerable and has likely spread to another area, further complicating treatment.
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The American Cancer Society relies on information from the SEER database, run by the National Cancer Institute, to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for pancreatic cancer in the United States, based on how far the cancer has spread. The SEER database groups tumors into localized, regional and distant stages:
There is a 9% five-year survival rate for all SEER stages combined. That figure jumps to 37% if it’s found early and contained in the pancreas. If it spreads to lymph nodes or another nearby structure, there is a 12% five-year survival rate. The survival rate drops to only 3% if it metastasizes and spreads to a distant part of the body or organ, such as the liver or lungs. Liver failure is the cause of death for many patients with metastatic cancer.
The overall figure of 9% is the lowest survival rate among the most common types of cancer. In comparison, prostate cancer has a five-year survival rate of 98%, stomach cancer has a five-year survival rate of 32%, and liver cancer has a five-year survival rate of 18%. .
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Many people are unaware of how deadly pancreatic cancer can be. Dr. Silverstein also learned something new after his diagnosis. Initially, he believed that there was a cure for pancreatic adenocarcinoma, which begins in the pancreatic ducts. While some treatments can reduce and control cancer, the traces will never leave your body.
“I also recently learned that pancreatic cancer is now the third leading cause of cancer death in the United States,” says Dr. Silverstein, whose distinguished career at INTEGRIS Health includes being instrumental in the creation of the INTEGRIS Paul Silverstein Burn Center. “Because it is the third leading cause of cancer deaths, the diagnosis is still too late.”
Dr Geister says pancreatic cancer is projected to be the leading cause of cancer deaths by 2030, making it vital to pay attention to early warning signs.
The pancreas acts as a kind of factory, as it helps produce digestive juices to help break down food and creates hormones that are important to regulate blood sugar. The exocrine cells produce the digestive juices, while the endocrine cells produce the hormones, such as insulin.
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About 95% of pancreatic cancers start in exocrine cells, so many of the early symptoms involve digestive problems. For example, pancreatic cancer can prevent enzymes from reaching the intestines to process the fats you consume, leading to greasy or light-colored stools. It can also affect how your body absorbs important nutrients, causing weight loss and fatigue. In case the cancer starts in the endocrine cells, you may start to develop dark colored urine.
The difficult part is that many of these symptoms, such as nausea and vomiting, mirror everyday problems. A tumor growth that presses on the stomach or spine can cause abdominal or back pain. But, without knowing you have cancer, your initial reaction may be to see a doctor for muscle pain.
Often, the location of your cancer can determine certain symptoms, which could serve as a lifesaver. The pancreas resembles a flat pear, dissected into a head, body and tail. The head is closer to the liver, gallbladder and intestines. A growth in this area can affect the bile duct, leading to jaundice.
Sure enough, with Dr. Silverstein, the yellowing eyes his nurse noticed in 2014 turned out to be jaundice.
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“This prompted me to do some tests. At the time, I felt perfectly healthy and didn’t feel bad at all, “he says. He scheduled a CT scan and did a blood test. His labs showed elevated liver function and the scan showed a mass of 2.5. cm to the head of the pancreas.
Early and aggressive treatments are as important as early diagnosis. Dr. Silverstein says pancreatic cancer patients should move quickly, especially if they need surgery.
“Surgery is still the mainstay of therapy and surgical removal of the disease is the only realistic hope of a cure,” says Dr. Geister. “You can also receive chemotherapy before surgery in an effort to shrink the cancer to make surgery possible or after surgery to try to prevent the cancer from recurring.”
Dr. Geister states that FOLFIRINOX is a very effective drug combination for the chemotherapy treatment of pancreatic cancer. The potent combination gets its name from the four drugs that make it up: leucovorin calcium, leucovorin fluorouracil, irinotecan hydrochloride and oxaliplatin.
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Eight days after Dr. Silverstein’s diagnosis, Dr. John P. Duffy, a hepatobiliary and abdominal transplant surgeon at the Nazih Zuhdi Transplant Institute, performed a Whipple procedure, a type of surgery that treats pancreatic cancer. Dr. Duffy removed the pancreas head, duodenum, part of the stomach, and other nearby tissues.
As part of his treatment, Dr. Silverstein received all-purpose chemotherapy drugs, such as gemcitabine and abraxane. He also received FOLFOX, a combination of drugs containing leucovorin fluorouracil and oxaliplatin. Although these drugs are very important in chemotherapy treatment, they also attack cells, both cancerous and healthy.
In addition to surgery and chemotherapy, immunotherapy in pancreatic cancer treatment is showing promise as a less toxic way to kill cancer cells. Your immune system is a powerful defender against bacteria and viruses, but it can struggle to recognize and fight cancer cells. Immunotherapy uses drugs to strengthen your immune system, so it is best prepared to seek and kill cancer.
During his treatment, Dr. Silverstein enrolled in a clinical trial that combined a PARP inhibitor with a checkpoint blocking agent. PARP enzymes help repair damaged cells. The PARP inhibitor blocks enzymes and makes it harder for cancer cells to “repair” damaged cells and grow or spread.
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Meanwhile, your immune system has protein checkpoints, which function as on / off signals, to send alerts to cells to act on certain immune responses. Some checkpoints keep cells off to prevent them from attacking your own cells. But some cancer cells have a similar composition that allows them to remain hidden, causing the immune system to think that the cancer cells are normal cells. Checkpoint inhibitors block these signals, allowing your immune system to better identify and attack cancer cells.
The relationship between the immune system and genetics begins with the genome test, which analyzes mutations in tumors. This process has many names, such as precision medicine molecular testing, DNA testing, or personalized medicine.
Each cell has DNA, and the DNA contains genes that instruct your body on how to function. As the human body develops, cells divide and produce an exact copy of the gene. Sometimes, there is a mistake in this process that causes genetic mutations. Not all mutations are harmful, but that’s how cancer begins.
Many anticancer drugs have a broad goal, which means that their goal is to kill cancer cells regardless of type or stage. But cancer cells vary for each individual as your genetic makeup may not be the same as someone else’s. For example, a cancer treatment that works on hundreds of people won’t have the same effect on you if your cancer is.
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