Pancreatic Cancer Awareness Month

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:13latest information on cancer care
00:13 --> 00:15by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week it's a conversation about
00:21 --> 00:24pancreatic cancer with Doctor Thiru Muniraj.
00:24 --> 00:26Doctor Muniraj is an associate
00:26 --> 00:28professor of medicine and digestive
00:28 --> 00:30diseases at the Yale School of Medicine,
00:30 --> 00:32where Doctor Chagpar is a professor
00:32 --> 00:33of surgical oncology.
00:35 --> 00:36Maybe we can start off
00:36 --> 00:38by you telling us a little bit more
00:38 --> 00:40about yourself and what it is you do.
00:41 --> 00:44I'm a gastroenterologist and advanced
00:44 --> 00:46endoscopist with a special interest
00:46 --> 00:50and expertise in pancreas and my
00:50 --> 00:52journey was not straightforward.
00:52 --> 00:55I have been a physician for 25 years
00:55 --> 00:56in different continents,
00:56 --> 00:58kept open mind throughout and then
00:58 --> 01:01got into the pancreas and advanced
01:01 --> 01:05endoscopy field where I think it's a
01:05 --> 01:07perfect balance between good critical
01:07 --> 01:10thinking and procedural aspects to make
01:10 --> 01:13a good difference in someone's life,
01:13 --> 01:15especially when dealing with
01:15 --> 01:17problems like pancreatic cancer.
01:17 --> 01:21So predominantly I do endoscopies,
01:21 --> 01:23especially for pancreas and bile ducts.
01:23 --> 01:26So as we're thinking about
01:26 --> 01:27pancreatic cancer awareness month,
01:27 --> 01:29it's one of those months that
01:29 --> 01:31we know a little bit about.
01:31 --> 01:32I think all of us have heard
01:32 --> 01:33about pancreatic cancer.
01:33 --> 01:35Certainly there have been a
01:35 --> 01:36number of celebrities who have
01:36 --> 01:38passed away of this disease,
01:38 --> 01:40but it's not one of the ones that's
01:40 --> 01:42top of mind like breast cancer or
01:42 --> 01:45colon cancer or lung cancer.
01:45 --> 01:48So can you give us a sense of
01:48 --> 01:51the epidemiology of pancreatic cancer?
01:51 --> 01:52How common is it?
01:52 --> 01:54How lethal is it?
01:54 --> 01:55Are there different kinds,
01:55 --> 01:56that kind of thing?
01:57 --> 01:58Yeah, sure.
01:58 --> 02:01Like you already pointed out,
02:01 --> 02:03this pancreatic cancer prevalence
02:03 --> 02:05is going up every year.
02:05 --> 02:07And more than that, the
02:07 --> 02:09National Cancer Institute predicts
02:09 --> 02:12that by 2030 pancreatic cancer
02:12 --> 02:14will be the second leading cause of
02:14 --> 02:17cancer death in the United States,
02:17 --> 02:20leading the top three with
02:20 --> 02:22lung cancer and colon cancer.
02:22 --> 02:26Every year we see around 60,000 patients
02:26 --> 02:28with pancreatic, a new diagnosis,
02:28 --> 02:32but almost 50,000 patients die
02:32 --> 02:34with pancreatic cancer too.
02:34 --> 02:37We see in several other cancers,
02:37 --> 02:40we are making a good change in the
02:40 --> 02:43prognosis and the cancer treatment.
02:43 --> 02:44But unfortunately,
02:44 --> 02:46pancreatic cancer death rates
02:46 --> 02:47are not falling at par with
02:47 --> 02:49other cancers we deal with.
02:49 --> 02:51Why is that? I mean, why is
02:51 --> 02:53pancreatic cancer increasing?
02:53 --> 02:55Yeah, there are a lot of risk factors,
02:55 --> 02:58but some of the risk factors
02:58 --> 03:00are not straightforward,
03:00 --> 03:03like smoking is one of the risk
03:03 --> 03:06factors, but a modifiable risk factor,
03:06 --> 03:09but the risk it causes pancreatic
03:09 --> 03:12cancer is not that great. And again,
03:12 --> 03:15obesity is increasing in the country.
03:15 --> 03:19Right now there's a prediction that by 2030
03:19 --> 03:22the incidence of obesity will be like 50%,
03:22 --> 03:23like everyone and every second
03:23 --> 03:26person we meet will be obese.
03:26 --> 03:28And obesity also causes a higher
03:28 --> 03:31risk to get a pancreatic cancer.
03:31 --> 03:34But even though those risks are very minimal,
03:34 --> 03:35there are genetic risks too,
03:35 --> 03:37which are not modifiable.
03:37 --> 03:41And the family history,
03:41 --> 03:42if someone has breast cancer,
03:42 --> 03:43ovarian cancer,
03:43 --> 03:45that puts them at a higher risk
03:45 --> 03:47of getting a pancreatic cancer.
03:47 --> 03:49And same that if someone
03:49 --> 03:52has a first degree relative or a
03:52 --> 03:54sibling with pancreatic cancer,
03:54 --> 03:56they are four to five times higher
03:56 --> 03:57chance of getting a pancreatic
03:57 --> 03:59cancer than the general population.
04:02 --> 04:05So when we think about those risk factors,
04:05 --> 04:08I mean, presumably the genetics of
04:08 --> 04:11the population are going to remain
04:11 --> 04:14relatively the same over time
04:14 --> 04:15unless there's some predisposition
04:15 --> 04:18for people with a particular
04:18 --> 04:20mutation to be more proliferative
04:20 --> 04:23in their birth rate than others.
04:23 --> 04:25We know that the rates of smoking
04:25 --> 04:26in general have declined.
04:26 --> 04:29So is the reason why the pancreatic
04:29 --> 04:31cancer rates are increasing really
04:31 --> 04:34tied to the obesity rate or
04:34 --> 04:36is there something else
04:36 --> 04:38that's driving those rates up or
04:38 --> 04:39is that something that's just
04:39 --> 04:41not very clear at the moment?
04:42 --> 04:44Yeah, I think it's really
04:44 --> 04:45not clear at this moment.
04:45 --> 04:47A lot of research goes into that,
04:47 --> 04:49like predicting why the
04:49 --> 04:51prevalence is going up.
04:51 --> 04:53And also a lot of research is
04:53 --> 04:55going into how can we diagnose
04:55 --> 04:57these pancreatic cancer
04:57 --> 05:00patients early enough so that we can
05:00 --> 05:02really give a curative surgery or
05:02 --> 05:04curative treatment so that we can
05:04 --> 05:06minimize the cancer deaths as well.
05:07 --> 05:10So let's dive into the screening
05:10 --> 05:13in the prevention part of it.
05:13 --> 05:15So certainly in terms of primary
05:15 --> 05:17prevention or reducing one's risk,
05:17 --> 05:19it sounds like
05:19 --> 05:22the usual things that we advise almost
05:22 --> 05:24everybody, maintain an ideal body weight,
05:24 --> 05:26eat right, exercise, don't smoke,
05:26 --> 05:29don't drink, would apply here as well.
05:29 --> 05:33But when we think about prevention and
05:33 --> 05:35we think about screening, you know,
05:35 --> 05:38for many of the other cancers,
05:38 --> 05:40we have screening tests, right?
05:40 --> 05:42We have mammograms for breast cancer,
05:42 --> 05:46we have colonoscopies for colon cancer.
05:46 --> 05:49Now we even have low dose CT for people
05:49 --> 05:51who are at high risk of lung cancer.
05:51 --> 05:53Do we have any screening
05:53 --> 05:55tests for pancreatic cancer?
05:57 --> 05:59That's a really good point you're bringing
05:59 --> 06:01up and is like most cancers right now.
06:01 --> 06:04We have a good screening tool to pick
06:04 --> 06:05these cancers early enough where
06:05 --> 06:08we can give a curative treatment.
06:08 --> 06:09But unfortunately for pancreatic
06:09 --> 06:13cancer still we do not have an
06:13 --> 06:15effective and reliable screening test,
06:15 --> 06:19especially for someone totally asymptomatic.
06:19 --> 06:20There is no good screening
06:20 --> 06:22test where we can recommend
06:22 --> 06:24in our current tools.
06:25 --> 06:26But at the same time,
06:26 --> 06:29if someone has a strong family history
06:29 --> 06:31of pancreatic cancer or other cancers
06:31 --> 06:34like breast and ovarian cancers,
06:34 --> 06:36we have screening programs
06:36 --> 06:38available which will help early
06:38 --> 06:40diagnosis and improve outcomes.
06:40 --> 06:43But most of these screening tools
06:43 --> 06:47rely on imaging such as
06:47 --> 06:50MRI scans or sometimes we do
06:50 --> 06:53endoscopic ultrasound which would
06:53 --> 06:56need anesthesia and sometimes
06:56 --> 06:58a combination we switch between
06:58 --> 07:00MRI and endoscopic ultrasound.
07:00 --> 07:02But for general population who
07:02 --> 07:05are asymptomatic or do not have
07:05 --> 07:06any family history,
07:06 --> 07:08there is still no good screening tool
07:08 --> 07:11to pick these cancers early enough.
07:12 --> 07:14And so if there
07:14 --> 07:16is no good screening
07:16 --> 07:19tools for the general population,
07:19 --> 07:21one of the things that we often
07:21 --> 07:23recommend is that people know the signs
07:23 --> 07:26and symptoms so that at least you can
07:26 --> 07:29present to your doctor and not bury
07:29 --> 07:31your head in the sand if you have
07:31 --> 07:33what might be otherwise
07:33 --> 07:34considered a red flag.
07:34 --> 07:37So can you talk a little bit
07:37 --> 07:39more about how pancreatic cancer
07:39 --> 07:42presents and what might be the
07:42 --> 07:44signs and symptoms that our
07:44 --> 07:45listeners should be watching for?
07:46 --> 07:48Yeah, I'm happy to share.
07:48 --> 07:51Often pancreatic cancer goes unnoticed
07:51 --> 07:54and undiagnosed for quite a long time.
07:54 --> 07:55That's the really,
07:55 --> 07:57really scary part and sad part too.
07:57 --> 08:01The reason? Many times the pancreatic
08:01 --> 08:06cancer when it presents itself, it's too late.
08:06 --> 08:10Often the symptoms are so mild like
08:10 --> 08:13abdominal discomfort or mild nausea,
08:13 --> 08:15which could be from anything, right?
08:15 --> 08:18One won't think of pancreatic
08:18 --> 08:20cancer right away.
08:20 --> 08:22The only problem is if that
08:22 --> 08:23discomfort persists and it's
08:23 --> 08:25not going away in few weeks,
08:25 --> 08:27then I would suggest patients
08:27 --> 08:29should contact their primary
08:29 --> 08:31doctor or a gastroenterologist
08:31 --> 08:33to initiate further work up.
08:33 --> 08:36But sometimes it's not that easy.
08:36 --> 08:38I had a patient a few months
08:38 --> 08:40ago who had back pain.
08:40 --> 08:43Months of back pain and first went to
08:43 --> 08:45orthopedic surgeon before coming to me.
08:45 --> 08:47Sometimes pancreatic cancer
08:47 --> 08:49presents like a back pain too.
08:49 --> 08:53But if someone has a jaundice that is
08:53 --> 08:58dark urine or yellow skin pigmentation,
08:58 --> 08:59that's somewhat easy.
08:59 --> 09:02That prompts the patient to go to the
09:02 --> 09:05doctor right away and then you get
09:05 --> 09:08work up with either CT scan or MRI.
09:08 --> 09:10Occasionally pancreatic cancers can
09:10 --> 09:13present like a pancreatitis and that
09:13 --> 09:15could be one of the red flags to
09:16 --> 09:19think of pancreatic cancer like hidden
09:19 --> 09:22pancreatic cancer causing pancreatitis.
09:22 --> 09:27Another very peculiar thing is weight loss.
09:27 --> 09:32Sometimes we see unrecognized weight loss.
09:32 --> 09:34I know everyone wants to lose weight,
09:34 --> 09:37but it's not easy to achieve weight loss.
09:37 --> 09:39And if you know,
09:39 --> 09:42someone says that I lost 30 pounds in
09:42 --> 09:44one month and haven't been working out,
09:44 --> 09:47unless you're
09:47 --> 09:50doing some major lifestyle change,
09:50 --> 09:51it's not that easy.
09:51 --> 09:54I usually ask them was it easy to lose
09:54 --> 09:57weight and if they say, yes it was very easy,
09:57 --> 09:59then that's kind of red flag to
09:59 --> 10:02dig deeper to see what is
10:02 --> 10:04causing the weight loss.
10:04 --> 10:06Another thing which I would
10:06 --> 10:08point out is diabetes.
10:08 --> 10:12There is some strange link between
10:12 --> 10:15diabetes and pancreatic cancer.
10:15 --> 10:17There is some research going on in this too.
10:17 --> 10:22A new onset diabetes for someone 50
10:22 --> 10:25or over that should prompt thinking
10:25 --> 10:28about a hidden pancreatic cancer.
10:28 --> 10:30But of course I want to alert the
10:30 --> 10:32listeners that not every diabetic
10:32 --> 10:34patient gets pancreatic cancer
10:34 --> 10:37or is at risk of pancreatic cancer.
10:37 --> 10:38There are 30 million diabetics
10:38 --> 10:39in the country,
10:39 --> 10:42but there's only 50 to
10:42 --> 10:4560,000 pancreatic cancers per year.
10:45 --> 10:47But in the pancreatic cancer
10:47 --> 10:49patients after diagnosis,
10:49 --> 10:50if you look at them,
10:50 --> 10:52they can lose the diabetes control
10:52 --> 10:55the blood sugar showed up.
10:55 --> 10:58So any acute change in diabetes control
10:58 --> 11:02or a new onset diabetes that should
11:02 --> 11:05also prompt someone to look deeper
11:05 --> 11:08if there's any hidden malignancy,
11:08 --> 11:10especially pancreatic cancer.
11:12 --> 11:15Yeah, I have a good friend who actually
11:15 --> 11:17falls into that latter category who,
11:17 --> 11:18you know, was diabetic.
11:18 --> 11:20But all of a sudden she
11:20 --> 11:23found that her, her diabetes really
11:23 --> 11:25wasn't under control and it was
11:25 --> 11:27very hard to
11:27 --> 11:29keep her blood sugars under
11:29 --> 11:32control as she had in the past.
11:32 --> 11:33And lo and behold,
11:33 --> 11:36she went and she presented to her
11:36 --> 11:38primary care doctor and ultimately
11:38 --> 11:41was found to have a pancreatic cancer.
11:41 --> 11:44So can you talk a little bit now that
11:44 --> 11:46you've nicely laid out kind of the
11:46 --> 11:49landscape of what people should look for.
11:49 --> 11:51If you have any of those signs or
11:51 --> 11:53symptoms and are concerned and you
11:53 --> 11:54go to your primary care doctor,
11:54 --> 11:56can you talk a little bit about
11:56 --> 11:59what the work up is to try to
11:59 --> 12:01find these pancreatic cancers?
12:01 --> 12:03What can people expect and how is
12:03 --> 12:05the diagnosis ultimately made?
12:06 --> 12:09Yes. If someone has this kind of
12:09 --> 12:13red flags or high risk symptoms,
12:13 --> 12:15then the first work up of course
12:15 --> 12:19a lab test of blood work to look
12:19 --> 12:21for elevation in liver test.
12:21 --> 12:23And then the most important
12:23 --> 12:26aspect of the work up is some
12:26 --> 12:28kind of cross-sectional scans,
12:28 --> 12:31either CT scan or MRI scan.
12:31 --> 12:36Often CT or MRI will find the mass,
12:36 --> 12:38the pancreatic cancer mass
12:38 --> 12:40in one or two centimeters.
12:40 --> 12:42But occasionally if it's smaller than that,
12:42 --> 12:46sometimes scans can miss that too.
12:46 --> 12:49Then we rely on what is called
12:49 --> 12:50as endoscopic ultrasound,
12:50 --> 12:52which is done by gastroenterologists
12:52 --> 12:53like myself.
12:53 --> 12:55Then the patient needs to go
12:55 --> 12:57under anesthesia and the endoscope
12:57 --> 12:59goes through the mouth and
12:59 --> 13:01scan through the stomach wall.
13:01 --> 13:03As listeners may know,
13:03 --> 13:06the pancreas lies just behind the stomach.
13:06 --> 13:07So once you go inside the stomach
13:07 --> 13:09and scan through the stomach wall,
13:09 --> 13:12you can get a precise look at the
13:12 --> 13:14pancreas and even pick up subtle
13:14 --> 13:17masses or very small tiny masses too.
13:17 --> 13:21Sometimes we rely on cancer biomarkers
13:21 --> 13:25like one called California 19-9,
13:25 --> 13:28but we often don't use that as
13:28 --> 13:31the first test to screen or
13:31 --> 13:33diagnose pancreatic cancer.
13:33 --> 13:36The reason behind is most pancreatic
13:36 --> 13:39cancer patients may have very
13:39 --> 13:41high numbers in California 99,
13:41 --> 13:45but there are some blood group patients
13:45 --> 13:47may not mount that California 99
13:47 --> 13:50so it could be falsely negative.
13:50 --> 13:52At the same time,
13:52 --> 13:56if someone has a bile duct stone or
13:56 --> 13:58a benign problem in the bile duct
13:58 --> 14:02or just a pancreatitis that can also
14:02 --> 14:04spuriously falsely show very high
14:04 --> 14:08levels of this cancer biomarker C in 99.
14:08 --> 14:10So for that reason we don't rely on
14:10 --> 14:12that a lot, especially to diagnose,
14:12 --> 14:15but we definitely rely on CT
14:15 --> 14:17scan or MRI scan to start with.
14:18 --> 14:20Fantastic. Well, we're going to take a
14:20 --> 14:22short break here for a medical minute,
14:22 --> 14:24but please stay tuned to learn more
14:24 --> 14:26about the care of pancreatic cancers
14:26 --> 14:28with my guest, Doctor Thiru Muniraj.
14:29 --> 14:31Funding for Yale Cancer Answers
14:31 --> 14:33comes from Smilow Cancer Hospital,
14:33 --> 14:35where their Center for Gastrointestinal
14:35 --> 14:38Cancers is committed to detecting pancreatic
14:38 --> 14:40cancer early and using state-of-the-art
14:40 --> 14:42technology to treat the condition.
14:42 --> 14:47Learn more at smilowcancerhospital.org.
14:47 --> 14:49The American Cancer Society
14:49 --> 14:51estimates that nearly 150,000 people
14:51 --> 14:54in the US will be diagnosed with
14:54 --> 14:56colorectal cancer this year alone.
14:56 --> 14:57When detected early,
14:57 --> 14:59colorectal cancer is easily
14:59 --> 15:01treated and highly curable,
15:01 --> 15:03and men and women over the age of 45
15:03 --> 15:05should have regular colonoscopies
15:05 --> 15:07to screen for the disease.
15:07 --> 15:08Patients with colorectal cancer
15:08 --> 15:10have more hope than ever before,
15:10 --> 15:13thanks to increased access to advanced
15:13 --> 15:15therapies and specialized care.
15:15 --> 15:17Clinical trials are currently
15:17 --> 15:19underway at federally designated
15:19 --> 15:21comprehensive cancer centers such
15:21 --> 15:23as Yale Cancer Center and Smilow
15:23 --> 15:25Cancer Hospital to test innovative
15:25 --> 15:27new treatments for colorectal cancer.
15:27 --> 15:30Tumor gene analysis has helped improve
15:30 --> 15:32management of colorectal cancer by
15:32 --> 15:35identifying the patients most likely
15:35 --> 15:37to benefit from chemotherapy and
15:37 --> 15:39newer targeted agents resulting in
15:39 --> 15:41more patient specific treatment.
15:41 --> 15:43More information is available
15:43 --> 15:44at yalecancercenter.org.
15:44 --> 15:47You're listening to Connecticut Public Radio.
15:48 --> 15:50Welcome back to Yale Cancer Answers.
15:50 --> 15:52This is Doctor Anees Chagpar and
15:52 --> 15:54I am joined tonight by my guest,
15:54 --> 15:55Doctor Thiru Muniraj.
15:55 --> 15:58We're talking about the care of
15:58 --> 16:00pancreatic cancer patients in honor
16:00 --> 16:02of Pancreatic Cancer Awareness Month.
16:02 --> 16:05Now right before the break we talked
16:05 --> 16:07about the fact that pancreatic cancer
16:07 --> 16:10incidence is increasing in this country
16:10 --> 16:13for reasons that are not entirely clear,
16:13 --> 16:15although may be related to obesity.
16:16 --> 16:18We talked about the fact that for the
16:18 --> 16:20vast majority of the general population
16:20 --> 16:22we really don't have a screening test.
16:22 --> 16:25So there are a number of things that
16:25 --> 16:27you can look for and talk to your
16:27 --> 16:29doctor about if you have symptoms
16:29 --> 16:31or signs that might be concerning.
16:31 --> 16:33Right before the break,
16:33 --> 16:36you talked about the fact that often times
16:36 --> 16:39the next step is cross-sectional imaging
16:39 --> 16:43and biomarkers are not really perfect
16:43 --> 16:45in this regard.
16:45 --> 16:48But can you talk a little bit about how
16:48 --> 16:51exactly we go about making that diagnosis?
16:51 --> 16:53I mean for many cancers,
16:53 --> 16:55there's actually a biopsy that takes place.
16:55 --> 16:58Is that the same for pancreatic cancer?
16:58 --> 16:59And if so,
16:59 --> 17:02how is that done and what's the next step?
17:04 --> 17:06That's true and once we
17:06 --> 17:09do a CT scan or MRI scan and if
17:09 --> 17:12we find a mass or even if we see
17:12 --> 17:14subtle signs which are prompting
17:14 --> 17:16that there could be a mass,
17:16 --> 17:19the next best test is to get
17:19 --> 17:21a biopsy without a tissue.
17:21 --> 17:23Then it's pretty hard to even
17:23 --> 17:25establish the diagnosis and for
17:25 --> 17:28that matter to start the treatment.
17:28 --> 17:31So the biopsies are often done
17:31 --> 17:32by a gastroenterologist,
17:32 --> 17:35advanced endoscopist who performs what
17:35 --> 17:37is called as endoscopic ultrasound.
17:37 --> 17:40So the endoscopic ultrasound is
17:40 --> 17:42a type of endoscopy which is
17:42 --> 17:44done often as an outpatient.
17:44 --> 17:47The patient can come in and
17:47 --> 17:50go home the same day and it's
17:50 --> 17:52done under anesthesia like someone
17:52 --> 17:55has a colonoscopy under anesthesia.
17:55 --> 17:58Most often that's how it is done.
17:58 --> 18:00The endoscope goes through the mouth
18:01 --> 18:03and then we enter the stomach and
18:03 --> 18:06then we scan through the stomach wall
18:06 --> 18:09and find where the pancreatic mass is
18:10 --> 18:13and precisely locate and identify that.
18:13 --> 18:14And once we identify,
18:14 --> 18:17then we pass a very tiny thin
18:17 --> 18:20needle through the stomach wall.
18:20 --> 18:22That needle is often thinner
18:22 --> 18:25than the IV needle what patients
18:25 --> 18:27often have for IV fluids.
18:27 --> 18:30And then once we get a good sample
18:30 --> 18:34from that pancreatic mass and we have a
18:34 --> 18:38facility called rapid onsite cytology.
18:38 --> 18:40What that means is we have a luxury
18:40 --> 18:43of having a pathologist come to the
18:43 --> 18:46endoscopy suite and look at the sample
18:46 --> 18:49under microscope in real time when
18:49 --> 18:52we are still doing the procedure and
18:52 --> 18:55we have world class endoscopy cytologists,
18:55 --> 19:00they will diagnose then and there often
19:00 --> 19:02sometimes they would take the slides
19:02 --> 19:05to their lab to process more and we
19:05 --> 19:07also do what is called a score biopsy,
19:07 --> 19:10getting more tissue from the
19:10 --> 19:12pancreatic mass and that is very
19:12 --> 19:14helpful to do further testing,
19:14 --> 19:17especially genetic testing on that sample
19:17 --> 19:20to determine what is the best treatment,
19:20 --> 19:22especially a personalized treatment
19:22 --> 19:24for that particular patient.
19:24 --> 19:27So everything is done as an outpatient.
19:27 --> 19:29That procedure takes 30 minutes to
19:29 --> 19:32one hour and the patients leave
19:32 --> 19:34the endoscopy unit after half an
19:34 --> 19:35hour of the procedure is over.
19:38 --> 19:39So let's talk a little
19:39 --> 19:40bit more about this personalized
19:40 --> 19:42medicine that you were mentioning.
19:42 --> 19:44I mean, we've talked a lot on the
19:44 --> 19:46show about personalized medicine.
19:46 --> 19:49It seems to be the buzzword these
19:49 --> 19:51days in terms of cancer treatment,
19:51 --> 19:54especially as we discover more and more
19:54 --> 19:57about the genetics of these cancers.
19:57 --> 20:00So can you talk a little bit about
20:00 --> 20:03what kinds of therapies patients
20:03 --> 20:06might find themselves
20:06 --> 20:09facing after a biopsy.
20:09 --> 20:12I mean, is this chemotherapy,
20:12 --> 20:14is it surgery, is it radiation,
20:14 --> 20:16is it immunotherapy?
20:16 --> 20:18Kind of give us a landscape
20:18 --> 20:21of what people can expect.
20:22 --> 20:28Yeah. So surgery is the curative treatment.
20:28 --> 20:31But unfortunately when we see a pancreatic
20:31 --> 20:34cancer patient over 50% of the time
20:34 --> 20:36the cancer has already metastasized.
20:36 --> 20:39That means gone to a different organ.
20:41 --> 20:44That's for diagnosis and
20:44 --> 20:46screening and picking up the subtle
20:46 --> 20:49findings of the symptoms and the
20:49 --> 20:53rest 50% of the patients, around 10 to 20%,
20:53 --> 20:56they'll be eligible for a
20:56 --> 20:58surgery right away.
20:58 --> 21:00But again another 30% of patients have
21:00 --> 21:03what is called locally advanced.
21:03 --> 21:06That means they have to go through
21:06 --> 21:08chemotherapy or radiation first
21:08 --> 21:11to shrink the tumor down and
21:12 --> 21:15then eventually go for surgery.
21:15 --> 21:17Like you mentioned,
21:17 --> 21:19there's personalized medicine that is
21:19 --> 21:23directing the treatment of chemotherapy or
21:23 --> 21:26immunotherapy towards that particular tumor.
21:26 --> 21:27Each tumor,
21:27 --> 21:28each body is different.
21:28 --> 21:30We respond in a different way.
21:30 --> 21:32And once the genetic
21:32 --> 21:34makeup of that particular tissue,
21:34 --> 21:37then we can direct the treatment
21:37 --> 21:38towards that particular tissue,
21:38 --> 21:40that particular patient who
21:40 --> 21:43will respond better.
21:43 --> 21:45It's like in a Petri dish,
21:45 --> 21:47how you do a culture for bacteria
21:47 --> 21:49and figure out which antibiotics acts
21:49 --> 21:52better for that particular bacteria.
21:52 --> 21:54Same concept applies here and
21:54 --> 21:56recently NCI has recommended that
21:56 --> 21:59we do that kind of molecular level
21:59 --> 22:01genetic testing for most samples.
22:03 --> 22:07And when you say
22:07 --> 22:10many of these patients the
22:10 --> 22:12cancer has already metastasized.
22:12 --> 22:14So surgery really wouldn't be
22:14 --> 22:17indicated as a curative treatment.
22:17 --> 22:20Is that why the prognosis is so poor?
22:20 --> 22:23And can you talk a little bit
22:23 --> 22:26about trends in terms of of prognosis?
22:26 --> 22:30So first off, what kind of prognosis
22:30 --> 22:32does pancreatic cancer carry?
22:32 --> 22:35And second, while we've seen the increase
22:35 --> 22:38in incidence of pancreatic cancer,
22:38 --> 22:40are we making any dent in terms
22:40 --> 22:42of survival for pancreatic cancer?
22:44 --> 22:47That's a very important question.
22:47 --> 22:49We spoke about why the pancreatic
22:49 --> 22:52cancer soon is going to be the second most
22:52 --> 22:55common cause of cancer death in the country.
22:55 --> 22:58The reason behind that is although a lot
22:58 --> 23:01of progress is being made in survival,
23:01 --> 23:04like prolonging the survival for
23:04 --> 23:06someone who has pancreatic cancer
23:06 --> 23:07making them live longer,
23:07 --> 23:10still we are not able to cure
23:10 --> 23:12completely the pancreatic cancer.
23:12 --> 23:14So that's the reason the cancer
23:14 --> 23:16deaths are still not dropping
23:16 --> 23:19down as we would like.
23:19 --> 23:21The medical community is working a lot
23:21 --> 23:24to put research and their minds into it.
23:24 --> 23:27How we can change and make a meaningful
23:27 --> 23:31dent in the prognosis of pancreatic cancer.
23:31 --> 23:32Currently,
23:32 --> 23:36if you want to give a cure,
23:36 --> 23:38you want to get the tumour out.
23:38 --> 23:41That can be done with the curative
23:41 --> 23:43surgery only if we find the tumour
23:43 --> 23:46very early on when it is very tiny,
23:46 --> 23:49which has not involved any blood vessels
23:49 --> 23:52or travelled to the distant organs.
23:52 --> 23:55So a lot of effort goes into picking
23:55 --> 23:58the tumors in a very early stage,
23:58 --> 24:01do multiple clinical trials and
24:01 --> 24:03research or focus towards that
24:03 --> 24:07mainly to change the prognosis,
24:07 --> 24:09change the landscape of pancreatic
24:09 --> 24:12cancer to drop the death rate.
24:14 --> 24:16Can you talk a little bit more about
24:16 --> 24:18those clinical trials that are
24:18 --> 24:20aimed at finding these cancers early?
24:20 --> 24:23I mean, are they really focused on
24:23 --> 24:26people who we know are at higher
24:26 --> 24:28risk due to baseline genetics?
24:28 --> 24:31For example, having a BRCA one or
24:31 --> 24:34two gene mutation and then trying
24:34 --> 24:36to screen them with cross-sectional
24:36 --> 24:39imaging or talk a little bit more
24:39 --> 24:40about these clinical trials and
24:40 --> 24:42what we can expect in the future?
24:44 --> 24:47Yeah, sure. So these clinical trials
24:47 --> 24:50are again focused on enriched patient
24:50 --> 24:53population because as we spoke we
24:53 --> 24:56cannot be doing a screening test for
24:56 --> 24:58every general population because one,
24:58 --> 25:02if we start picking up a small raise in CN
25:02 --> 25:0599 that will only increase anxiety and
25:05 --> 25:08put patients through totally unnecessary
25:08 --> 25:11testing and that will only increase
25:11 --> 25:13anxiety among general population.
25:13 --> 25:15So we're trying to focus on
25:15 --> 25:16high risk patients.
25:16 --> 25:19High risk patients means someone who has
25:19 --> 25:22family history of pancreatic cancer or
25:22 --> 25:24like you pointed out the BRCA mutation.
25:24 --> 25:27One and two especially BRCA 2 has a
25:27 --> 25:30higher risk of having a pancreatic
25:30 --> 25:32cancer than the general population.
25:32 --> 25:35So once we find a high risk enriched
25:35 --> 25:38population like also we spoke
25:38 --> 25:39about and diabetes.
25:39 --> 25:42So once we find that enriched population,
25:42 --> 25:45we have different screening programs
25:45 --> 25:48where we alternate between MRI scan in and
25:48 --> 25:51US and most of these are all done
25:51 --> 25:54on an annual basis to catch early cancer.
25:56 --> 25:59So is this now just on clinical
25:59 --> 26:01trial or is this something that if
26:01 --> 26:04we have somebody who's listening to
26:04 --> 26:06this show now and let's say they
26:06 --> 26:09do fit into one of those criteria,
26:09 --> 26:12let's say they have had new onset
26:12 --> 26:15diabetes or they have been losing
26:15 --> 26:20weight and it's been quote easy,
26:20 --> 26:23should they be getting this scan
26:23 --> 26:27done as part of standard of care?
26:27 --> 26:29If if people have a genetic mutation,
26:29 --> 26:31should they be having annual scans
26:31 --> 26:34as part of standard of care or do
26:34 --> 26:36they need to find a clinical trial
26:36 --> 26:38near them that is offering this?
26:39 --> 26:42As of now major centers in
26:42 --> 26:44the country including Yale,
26:44 --> 26:46we offer clinical trials for the
26:46 --> 26:48same question what you asked for,
26:48 --> 26:51but it's still not a standard of care
26:51 --> 26:53to perform routine scans for patients
26:53 --> 26:56who have family history of an aunt or
26:56 --> 26:58uncle having a pancreatic cancer.
26:58 --> 27:01So if someone has a family member having
27:01 --> 27:04a pancreatic cancer especially first
27:04 --> 27:06degree relative or if someone has a
27:06 --> 27:09personal history of having a BRCA mutation.
27:09 --> 27:12Then it's advisable to contact
27:12 --> 27:14your primary physician,
27:14 --> 27:17gastroenterologist and reach out to
27:17 --> 27:20the nearest multi speciality centre
27:20 --> 27:23where we have access
27:23 --> 27:25for the clinical trial to enroll
27:25 --> 27:27and start putting the patients
27:27 --> 27:29into alternating between MRI and
27:29 --> 27:31EUS and having a close follow up.
27:32 --> 27:35When do you anticipate having the
27:35 --> 27:37results of those clinical trials so
27:37 --> 27:39that the general population who's
27:39 --> 27:42at higher risk can avail themselves
27:42 --> 27:44of it as standard of care rather
27:44 --> 27:46than only on a clinical trial?
27:47 --> 27:50Yeah, we have a
27:50 --> 27:52population of 350 million and the pancreatic
27:52 --> 27:55cancer only 50,000 or 60,000 per year.
27:55 --> 27:59So the goal is to find an enriched
27:59 --> 28:02population who will be higher risk of
28:02 --> 28:05pancreatic cancer and use a screening
28:05 --> 28:07test to that particular population.
28:07 --> 28:10So that if we are not driving
28:10 --> 28:13everyone anxious and also we are picking
28:13 --> 28:15up some meaningful early cancers
28:15 --> 28:18where we can change patient's life.
28:18 --> 28:21Lot of work is still going on in this area.
28:21 --> 28:24I'm hopeful that at least in the next few
28:24 --> 28:26years there'll be some standard of
28:26 --> 28:28care which a primary care physician can
28:28 --> 28:31use to pick this cancers early enough.
28:32 --> 28:34Doctor Thiru Muniraj is an associate
28:34 --> 28:36professor of medicine and digestive
28:36 --> 28:38diseases at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu,
28:42 --> 28:45and past editions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:54cancer here on Connecticut Public Radio.
28:54 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Pancreatic Cancer Awareness Month with guest Dr. Thiru Muniraj November 5, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095