People with Pancreatic Cancer are Living Longer, Thanks to Improved Approaches

photo courtesy of Mayo Clinic

By Mayo Clinic – A diagnosis of pancreatic cancer is almost synonymous with hopelessness. As the least survivable type of cancer, the perception is understandable. “As soon as patients were diagnosed, they were often told by their physician to start making arrangements,” says Mark Truty, M.D., a surgical oncologist at Mayo Clinic who specializes in pancreatic surgery. But the tides are turning, thanks to new and improved treatment methods that are helping people with pancreatic cancer live longer. Dr. Truty and Robert McWilliams, M.D., a medical oncologist at Mayo Clinic, talk about Mayo Clinic’s approach to pancreatic cancer care, and how it’s leading to improved survival and quality of life.

Before moving forward with treatment, Dr. Truty says, it’s critical to understand as much about each person’s cancer as possible. In most instances, a CT scan or MRI scan is used to identify the location of the cancer and possible spread, but Dr. Truty says standard scans are just one piece of the puzzle. “Historically, patients have gotten a scan where the tumor appears to be localized, and then they underwent surgery. But that paradigm has not resulted in the outcomes we wanted.” This is where PET scans and additional molecular testing play an important role. PET scans and newer genetic testing are key to staging the cancer and assessing its behavior accurately. They can help determine if treatment is working effectively to shrink the tumor, whereas traditional CT scans have distinct limitations in assessing response in pancreatic primary tumors. “If we see a response we’re anticipating on the PET scan, those are the patients that do very well. If we’re not seeing a response, then we have to pivot and switch their therapy to see if we can achieve a better outcome,” he says, “We’ve also been using novel genetic testing developed at Mayo Clinic to test the blood of patients, as well as the fluid of the abdomen through laparoscopy, to see if we can pick up some cancer DNA.”

Initial testing and staging of pancreatic cancer can help uncover weaknesses or potential threats for each unique pancreatic cancer case. Dr. Truty says patients who are able to have surgery to remove their pancreatic cancer can live significantly longer, but in cases where the tumor has grown outside of the pancreas to encase critical blood vessels, pancreatic cancer has been considered inoperable. About one-third of pancreatic cancer tumors grow to surround blood vessels outside the pancreas. “Those patients have historically not been considered for surgery,” he says. “Theoretically, 50% of patients with diagnosed pancreatic cancer have the potential to undergo an operation. The question is: How do we get them to surgery? And how do we optimize their outcomes to make sure that they live as long as they possibly can?” Drs. Truty, McWilliams and pancreatic cancer experts at Mayo Clinic use an approach called neoadjuvant therapy, which delivers chemotherapy — or a combination of chemotherapy and radiation — to destroy microscopic cancer cells in the body before surgery. By combining this method with personalized surgery for each patient’s anatomy, they can remove tumors entirely and reconstruct blood vessels as needed. This has resulted in the ability to operate on patients who previously did not have that option, leading to better results than ever before. “We’re creating custom surgeries for each patient that aren’t being done anywhere else on the planet. That’s why so many people come to us after they’ve been told their tumors are inoperable,” says Dr. Truty.

Though surgery can lead to the best outcomes in many cases, Dr. Truty emphasizes that the goal of pancreatic cancer treatment is not surgery. “The goal for anyone with cancer is to extend their life and maintain a reasonable quality of life. Sometimes an operation is necessary to achieve this, and sometimes it will decrease the likelihood of one or the other, or both. That’s why before we even consider an operation, we have to make sure that operation has the highest probability that we’ll achieve both of those goals.”

Pancreatic cancer continues to have the highest mortality rate, and this progress, he says, is driven by clinical trials. “Clinical trials are how we advance the science. For patients who are looking for the latest and greatest and want to help advance the options for their cancer, participation in clinical trials is crucial.” Dr. Truty says he hopes more people with pancreatic cancer seek out second opinions from cancer centers who are leveraging new approaches and providing patients more options.

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