Pancreatic Cancer – An Introduction, with Dr. Andrew Ko

Last Updated: May 23, 2018

In this video, Dr. Andrew Ko gives an overview of pancreatic cancer, including new areas of research about its treatment.

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Guide to Pancreatic Cancer

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Cancer.Net®: Doctor-Approved Patient Information from ASCO®

Pancreatic Cancer: An Introduction

What is the Pancreas?

Andrew H. Ko, MD: The pancreas is an organ that sits deep within the abdomen, more towards the back and it serves a number of different functions.  It actually has an endocrine component as well as what’s called an exocrine component.  What I mean by the endocrine component is that it produces a number of different hormones that are important in regulating various processes in the body.

So, the most well recognized hormone that the pancreas produces is insulin.  And insulin is a hormone that regulates a person’s blood sugars.  So, after he or she eats a big meal, the pancreas will produce and secrete a lot of insulin to help prevent blood sugars from rising too high.

And then there are a number of other hormones that also regulate glucose or sugar metabolism.  A hormone called gastrin which stimulates the stomach to produce acid, that also helps in breaking down food right after you eat it.  The other aspect of the pancreas is the exocrine component and that’s a number of digestive enzymes that the pancreas also produces.

And so after a person eats a meal, the pancreas will produce a number of enzymes that help break down the components of food, the fats, and the sugars, and the proteins, to help the body digest and be able to absorb those nutrients.

Types of Pancreatic Cancer

Dr. Ko: Cancers that arise from the pancreas represent an abnormal growth or proliferation of cells from some - one of the cell types within the pancreas

So the most common type of pancreatic cancer is what’s called an adenocarcinoma.  And that’s cancer that develops from the exocrine component that I just described to you.  So you’ll sometimes hear about that as a ductal adenocarcinoma because these are cancers that are felt to originate from the ducts, the cells that line the ducts through which the enzymes pour into and empty into the intestine.

The rare type of pancreatic cancer are called islet cells tumors or pancreatic neuroendocrine tumors, and as the name implies those are tumors that arise from the cells that produce the various hormones that I mentioned.  So, a pancreatic neuroendocrine tumor that secretes insulin, what we call an insulinoma, and those comprise maybe about 10 percent of all tumors that arise in the pancreas.  Whereas the more common type of adenocarcinoma makes up about 85 percent or so.

It’s important to know is this an adenocarcinoma, is it an islet cell tumor.  These have very different prognostic implications, very different therapeutic implications.

Stages of Pancreatic Cancer

Dr. Ko: So, similar to other cancers, pancreatic cancer is staged and the stage of the cancer will help determine the type of treatment that should be offered in that situation.  So there is a stage one through four, one being the earliest stage, in which case surgery is often the best option.  All the way to stage four, which means that the cancer has spread or metastasized in which case chemotherapy or systemic therapy that can go all over the body to try to treat the cancer wherever it exists throughout the body would be the mainstay of treatment.

Yeah, so one of the issues with pancreatic cancer is that there is no population wide screening tool, that can be used the way there is mammogram for breast cancer or colonoscopy for colon cancer for example.  So, too often pancreatic cancer is diagnosis at more advanced stages of the disease, stage three or stage four, in which case surgery no longer becomes possible.

Part of that also is that the symptoms of pancreatic cancer sometimes can be fairly non-specific.  A period of abdominal pain, some unexplained weight loss that might be going on for a number of months.

So, approximately 10-15 percent of patients at the time of diagnosis will be candidates for surgery.  Meaning that their cancer has remanded confined to the pancreas or maybe it’s spread just to some local lymph nodes nearby but hasn’t gone to other parts of the body. 

So, pancreatic cancer, if it spreads, will often times go to the liver, elsewhere in the abdomen, sometimes to the lung and bones, and rarely if ever to the brain.  The majority of patients who are not candidates for surgery will typically receive systemic therapy or chemotherapy.

And chemotherapy is a fairly broad term and so there are a number of different chemotherapy drugs now that are available for use in pancreatic cancer.  The other modality that we’ll sometimes think about is radiation treatments.

Latest Advances in Pancreatic Cancer Treatment

Dr. Ko: So, there are a couple of new combination chemotherapy regimens. that was developed in France, it was called [inaud.] and that’s really an acronym of four different drugs combined together.  And the results seen with that combination are better than any that was seen in any previous drug combination used in pancreatic cancer.  So that’s definitely been an important advance.

It’s not a regimen that is appropriate for all patients, because as you might imagine when you’re combining multiple drugs together in addition to better efficacy you also have more side effects and toxicity.  So, that regiment does need to be used with some degree of caution. 

More recently there’s been the approval of a drug called [inaud.], which when combined with [inaud.] shows a distinct survival benefit compared to [inaud.] by itself.  So, just in these past few years we now have several new options and now we’re able to sequence these treatments, so a person might try something in the first line setting when they’re newly diagnosed at the time of progression

And then there is the whole arena of what I’ll call personalized medicine, where again pancreas cancer still has a ways to go but there’s a lot of interest in recognizing that two people may have a diagnosis of stage four pancreatic cancer.  But there are cancers actually are quite different from one another, so it might not be appropriate to treat them identically. 

There is a lot of interest also in not just the pancreatic cancer itself, but while called the microenvironment.  So, pancreatic cancer often times induces the body to develop an inflammatory response or reaction and that in and of itself may simply be a physical barrier that prevents drug delivery, for drugs to actually get into and be able to kill cancer cells.

there is a fair amount of excitement in terms of studying different ways in which we can harness the body’s own immune system to try to fight cancer.

So, there is absolutely a lot to be hopeful about in pancreatic cancer.  I think we’ve learned some important lessons in terms of designing clinical trials in pancreatic cancer. 

I think this fuels additional excitement and energy in terms of studying this even further in the first line setting, for patients after they’ve progressed on previous chemotherapy.

And then we’re increasingly seeing a group of patients who may have inoperable disease at the time of diagnosis, but now that we have better treatments that might help to shirk their cancer more.  We’re even taking some of these patients at a later time to surgery.

the survival of patients with pancreatic cancer, especially with advanced stages of pancreatic cancer, has been steadily improving as we have these new therapeutic options.

 Where to Get More Information

Dr. Ko: So when a person is newly diagnosed with cancer, he or she and their families are all going to look for where to turn to in that situation and the internet is great in a way, because you have a wealth of available information,

I’ve been privileged to serve as a specialty editor for cancer.net , which is a wonderful resource for patients, caregivers, providers to go to to learn about both the nuts and bolts of pancreatic cancer or any other cancer of interest.  As well as to get some updates on treatments, some of the newer research arenas.

And we update this on a regular basis so it’s always fresh and up to date information, so you’ll know where to go to to hear about cutting edge developments, things that might have potential therapeutic implications now or in the future, interesting clinical trials that are going on. 

And cancer.net is one of those websites where you have the most up to date valuable information that’s been carefully reviewed by experts in the field.  And you can feel assured that that’s reliable information that you can use to plan out your next steps.

The National Cancer Institute  also has a database that includes how all clinical trials going on in a particular disease at a given time, and I think one of the ways that we really move this field forward is when individuals choose to participate in clinical trials and so there is that link between cancer.net and the clinical trials databases.

[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical OncologyConquerCancerFoundation.org  

Special Thanks:

Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

Carolyn B. Hendricks, MD, The Cancer for Breast Health

Hasbro Children’s Hospital

Helen F. Graham Cancer Center at Christiana Care Health System

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University

Video Footage and photography courtesy of:

St. Jude Children’s Research Hospital Biomedical Communications

Moffitt Cancer Center

University Hospitals Case Medical Center Seidman Cancer Center

The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.

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