Surgery is the only potential for cure for patients with pancreatic cancer. Unsatisfied with current options, an OHSU gastrointestinal surgeon is developing a program he hopes will lead to earlier diagnosis, quicker intervention, and more lives saved.
When Eleanor Smith came to Oregon Health & Science University for pancreatic cancer treatment, she was given something most patients with her diagnosis don't often receive-- hope. Hope that stems from the compassion, expertise and tireless dedication of pancreatic surgeon Brett Sheppard, M.D.
"I was scared to death when I heard I had this [pancreatic cancer]. I'd never been sick in my life. Dr. Sheppard took my fear away. He instilled confidence under terrifying circumstances. He made me and my family feel as though we were the only family in the world. There's just something about his character that makes you put your hope in him. I sure wouldn't be here if it weren't for him," said Smith, 72, of Sheridan, Ore.
Hope is an essential but rare commodity for patients with pancreatic cancer, according to Ann Moore, 54, of Bend, Ore., who was diagnosed with pancreatic adenocarcinoma in 2004. She sought second, third and fourth opinions, but her prognosis was persistently grim.
"My tumor was massive and involved all the blood vessels," said Moore. "Because of its location, I was told it was inoperable and therefore incurable. I was repeatedly told there was zero percent chance of cure. After a year of chemotherapy and radiation my tumor had shrunk to the point where Dr. Sheppard was willing to perform surgery.
Sheppard explained that it was possible that the portal vein, a large vein that is formed by fusion of other veins, would need to be removed and reconstructed. This was previously thought to mean surgery could not be performed, but in some cases it is possible. Sheppard and his team now perform this very complex surgery in up to 20 percent of patients seen for pancreatic tumors.
"Dr. Sheppard explained that the surgery would be dangerous, but I was willing to do anything to live," said Moore."
Sheppard, a professor of surgery in the OHSU School of Medicine and a member of the OHSU Cancer Institute and the OHSU Digestive Health Center, performed a lengthy surgery and removed half the pancreas, all of the duodenum and half the bile duct to remove the cancer. Today Moore is back on the golf course and Smith has returned to her beloved yard work. Both remain cancer-free.
These and dozens of patients like them have made finding better treatments, and even a cure, for pancreatic cancer patients a top priority for Sheppard, and his optimism and compassion are inspiring patients around the state.
In the hope of saving more lives, Sheppard and colleagues in the OHSU Digestive Health Center are developing a system through which clinicians hope to more easily identify people at increased risk for the disease. Early identification, explains Sheppard, allows physicians to identify malignancies sooner and begin aggressive treatment quicker.
"Like breast cancer, if we diagnose pancreatic cancer early enough, we can dramatically increase the potential for cure. However, pancreatic cancer is not common enough to justify screening in the general population, and even if it was, there are no screening blood tests or radiologic procedures sensitive enough to pick up the disease early on," said Sheppard.
That's why the surveillance program his team is creating, called the Oregon High-Risk Pancreatic Family Registry, is so important.
"Pancreatic cancer develops in a progressive fashion. Through close surveillance, we can identify patients whose pancreatic cells are changing toward cancer and intervene early," he said.
It makes sense to only monitor those patients at high risk for this disease, according to Sheppard, and they include: two or more first-degree relatives who've had pancreatic cancer; first-degree relatives of patients with pancreatic cancer at a young age; patients who have familial diseases, such as hereditary pancreatitis; those who carry the BRCA2 gene, a marker for breast cancer; and patients with syndromes such as familial adenamotous polyposis (FAP), Peutz-Jeghers and high-risk familial malignant melanoma.
Once identified, in addition to undergoing CT (computed tomography) scans and endoscopic ultrasound, these individuals will be asked to participate in the registry's surveillance program. Pancreatic fluid and blood will be taken to help develop early-warning markers of pancreatic cancer that can then be applied to the general population. Over time, close, sequential study should aid in the development of targeted therapies directed against the changing genome or molecular targets that can also be applied to the general population.
"OHSU is one of a few high-volume centers where our teams have refined the high-risk surgical techniques and postoperative care necessary to perform life-saving surgery on dozens of people battling one of the most lethal forms of cancer [pancreatic cancer]. However, this disease clearly needs to be attacked on several fronts. There is an absolute need for improved chemotherapy and radiation and other treatments as surgery cannot alone cure patients with pancreatic cancer except in its earliest stages," said Sheppard.
In the end, after the surgery, the chemotherapy and the fatigue from all the treatments, the worst part of having pancreatic cancer, Moore explained, was the mental anguish, being told over and over that you're going to die.
"People with pancreatic cancer think and are told there is no hope. Dr. Sheppard and I proved there is."
Pancreatic cancer is the fourth leading cause of cancer death in the United States with a 99 percent mortality rate. It will affect the lives of some 32,000 Americans this year.
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