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Pancreatic Cancer/ Surgical Oncology

Jennifer LaFeminaJennifer LaFemina, MD, surgical oncologist at UMass Memorial Medical Center and assistant professor of surgery at University of Massachusetts Chan Medical School.

Dr. LaFemina received her medical degree from the David Geffen School of Medicine at UCLA. She completed her residency at Massachusetts General Hospital and a fellowship in surgical oncology at Memorial Sloan-Kettering Cancer Center. Her clinical interests include pancreatic diseases.

According to the American Cancer Society, the lifetime risk of having pancreatic cancer is about 1 in 71. Treatment centers that care for a large number of patients with pancreatic cancer, including our Cancer Center of Excellence Pancreas Program, have been proven to have better patient outcomes.

Jennifer LaFemina, MD, surgical oncologist, answers your questions about pancreatic cancer, cancer surgery and more.

Physician

Jennifer LaFemina, MD


Questions

Q:

What is the surgical treatment of pancreatic cancer?

A:

Surgery for pancreatic cancer can be curative or palliative. The goal of curative surgery is to remove the tumor and surrounding lymph nodes. At this time, surgery remains the only option for cure. The specific type of surgery is determined based on the tumor’s location.

For tumors of the pancreatic head, a pancreaticoduodenectomy (or Whipple procedure) involves removing the pancreatic head as well as portions of the bile duct and duodenum, the gallbladder, and in some cases, a portion of the stomach. For cancers of the pancreatic tail, a distal (left-sided) pancreatectomy may be performed to remove the tumor. It is common to have the spleen removed during this operation.

If the tumor has spread to distant organs or lymph nodes or if the tumor cannot be removed from surrounding organs or blood vessels, curative surgery may not be possible. However, it is sometimes necessary to relieve blockages (also called, “obstruction”) of the bile duct and the first portion of the duodenum. Many times, the blockages may be relieved with a stent, which is a device that is placed by our gastroenterologists. However, in some cases, it is necessary to perform a surgical bypass, which connects the bile duct to the small intestine and/or the stomach to the small intestine.

Q:

I'm wondering about the types of alternative treatments offered at UMass Memorial Medical Center for pancreatic cancer patients at different stages…

A:

Thank you for your question. We have a number of resources available to provide a comprehensive support system for patients at every stage of their cancer treatment. These resources include the Simonds-Hurd Complementary Care Center in Fitchburg, which is dedicated to offering a wide range of integrative practices that promote wellness, recovery, resilience and strength. Additional information may be found here.

Additionally, the UMass Cancer Center of Excellence has the Integrative Oncology Initiative: Mind-Body Therapies to Improve Well-Being, a weekly class for patients, family members and health care providers to learn techniques to improve well-being during cancer therapies.

Finally, there are a number of programs sponsored by the American Cancer Society, entitled “Look Good, Feel Better” and “I Can Cope.” If you would like more information on any of these programs, please call our HOPE line at 866-597-HOPE.

Q:

I'm a 47-year-old male in good health. My father was diagnosed with stage 3 pancreatic cancer and passed away after a 2-year battle at the age of 77. I am curious - Does a family history of the disease and a personal history of chronic pancreatitis increase my risk of getting pancreatic cancer?

A:

Both a family history of pancreas cancer and a history of chronic pancreatitis are two known risk factors associated with an increased risk of pancreatic cancer. Therefore, it is important to discuss these risk factors with your primary care doctor and to be aware of early signs of pancreatic cancer.

It is also important to reduce behaviors, such as smoking and alcohol use, to reduce the risk of pancreatitis. If additional family members have a history of pancreatic cancer or pancreatitis, consider consulting a genetic counselor.

Q:

Why is pancreatic cancer more difficult to detect early on than some other types of cancer?

A:

Pancreatic cancer is difficult to detect early for a number of reasons. First, at this time, there is no available screening test for pancreatic cancer. CA19-9 is a marker found in the blood but is only about 80 percent accurate in identifying patients with this disease.

Researchers at the University of Massachusetts Medical School are working to identify additional markers that might allow us to generate a screening test that allows for detection of this cancer at any early stage and that is available to the general population.

The second dilemma is that early symptoms of pancreatic cancer generally go unnoticed or unrecognized: nonspecific weight loss and vague abdominal pain. It is not until the disease has progressed that more obvious symptoms, such as jaundice (yellowing of the skin and eyes), may develop.

In order to improve the outcomes associated with this disease, we must not only educate the community and health care professionals, but also focus our research efforts on finding a way to diagnosis this disease in its early stages.

Q:

What are the odds at beating a fatty tissue Sarcoma which when surgically removed was the size of volleyball? I don't know yet if it spread or not. Does chemo or radiation help? And what is the two year survival rate?

A:

There are many forms of sarcoma, many of which behave quite differently in terms of their ability to spread and their responsiveness to chemotherapy and radiation. In general, though, removal of the tumor is an integral part of the management of these tumors.

However, because these tumors vary so greatly, it is important to understand the specific type of sarcoma that you have, as this helps determine the role of additional therapies and helps to estimate recurrence and survival rates.

Q:

My brother is 53 years old, diagnosed with stage 2 pancreatic cancer, and has had one round of chemo and radiation. He has refused any further treatments. Prognosis? Time left without any further treatments? Why can radiation treatment be only performed once?

A:

Every tumor grows and responds differentially, and at an individual level, prognosis is difficult to predict without further information. However, without treatment, it is likely that his tumor will progress. External beam radiation may be administered to the tumor and surrounding tissues. In general, radiation is given in multiple sessions, over a five to six week period, until the maximum radiation dose has been administered.

Q:

I was wondering if there were early signs of this type of cancer that could help in early detection? Also if it is detected early, does the % of people that survive increase drastically?

A:

The early symptoms of pancreatic cancer are nonspecific but can include nonspecific weight loss and vague abdominal pain. It is not until the disease has progressed that symptoms, such as jaundice (yellowing of the skin and eyes), may develop. If you do recognize any of these symptoms, it is important to seek early evaluation by your primary care doctor.

Unfortunately, the majority of patients present with disease in the later stages. However, YES, survival is significantly improved if the cancer is detected in the earlier stages.

Q:

Is there a link between pancreatic cancer and breast cancer? I have a family history of both and am concerned that I should undergo some type of genetic counseling.

A:

Yes. There is a strong association between pancreatic cancer and breast cancer. There are three major genes associating familial pancreatic and breast cancers. If you have a family history of both cancers, a family or personal history of these cancers at a young age, or multiple family members who are affected, it is important to consider consulting a genetic counselor.

Information to help determine if there is a genetic syndrome responsible for the disease includes: determining the age of affected members, the number of affected members, and relation of these family members to the patient. If you would like to set up an appointment with a genetic counselor, please call our HOPE line (866-597-HOPE).

Q:

What are some of the advancements in treatment of pancreatic cancer within the past few years (5 years)? My husband was treated for pancreatic cancer at UMass Memorial back in 2008, and now my brother has been newly diagnosed with pancreatic cancer, and he is curious about the newest treatments available to him.

A:

There have been a number of advances in the treatment of pancreatic cancer in the last five years. First, since the mid-1990s, gemcitabine has been the principal chemotherapeutic agent used for this disease. However, recently, FOLFIRINOX—a combination chemotherapy regimen—has been demonstrated to have a significant survival benefit for patients with Stage IV pancreatic cancer.

Second, in recent years, there has been an increased understanding and appreciation for the role of neoadjuvant therapy—therapy given before surgery—for patients who have resectable or borderline resectable pancreatic tumors. There are a number of theoretical benefits, including but not limited to potential downstaging of the cancer and the optimization of treatment delivery (i.e., patients receive chemotherapy before surgery when they are more fit to tolerate medications).

The UMass Memorial Cancer Center of Excellence and Pancreatic Multidisciplinary Team have adopted a strategy that incorporates both of these advances for many patients diagnosed with pancreatic cancer.

These advances are two steps in improving the outcomes of patients with pancreatic cancer. However, moving forward, research efforts must focus not only on better therapies but also improved means to diagnosis this cancer early—the combination of the two will be necessary to find the cure for pancreatic cancer.