LustgartenLIVE! From the Clinic to the Lab to YOU

On March 30, National Doctors’ Day, a roundtable of cancer experts discussed care today and what breakthrough developments in research mean for future patients. In case you missed it, please see the recorded webinar and questions and answers that were discussed throughout the webinar.

Risk and Screening

Is there any connection between melanoma and pancreatic cancer? My husband passed from pancreatic cancer but had many melanomas. Do I need to be concerned about my children?
The majority of pancreatic cancer seems to be from bad luck, rather than any inherited disposition. For the melanoma question, melanoma has a stronger association with risk exposure (sunlight) rather than an inherited basis. On rare occasion, inherited genetic mutations in some genes, like CDKN2A, can predispose to both cancers. For your husband and the other Q&A questions regarding inherited risk – the best first step is to have the pancreatic cancer patient tested for an inherited mutation first, and if a mutation is found, to discuss that result with a genetic counselor, who can help guide testing of family members. If inherited testing of the pancreatic cancer patient is not possible, e.g. patient expired, then close family members can ask their doctor for a referral to a genetic counselor, who can help address testing.

I lost husband 5 years ago to pancreatic cancer; diagnosed stage four with metastasis. Tumor was ordinary adeno carcinoma. No genetic testing performed. Dr. Tuveson said we figured out the why. Only risk factors he had was over the age of 65 and male. What is the why? What genetic tests can my adult sons pursue?
Most pancreatic cancer is not due to inherited risk. That said, your children can ask their doctor for a referral to a genetic counselor to explore the possibility of getting genetic testing.

I have stage IV pancreatic cancer. My father, his brother and his cousin all passed from pancreatic cancer. Based on this family history, would you consider my two sons and siblings as high risk? If so, is there a recommended screening program or organization I should contact?
You can consider discussing genetic testing for yourself with your oncologist, and if anything is found, then to discuss the result with a genetic counselor and the role of testing for family members.

What symptoms would a patient present to their internist that would prompt a referral to a pancreatic specialist to achieve an early diagnosis?
General symptoms that may occur include depression, new-onset diabetes, fatigue, loss of appetite and acute pancreatitis attacks. The more common symptoms are related to the location of the tumor. If the tumor is in the tail of the pancreas, lower abdomen pain, nausea, pain after eating, back pain, and unintended weight loss are commonly observed. Back pain and upper abdomen pain indicates the tumor may be in the middle (body) of the pancreas. Lastly, tumors in the head of the pancreas may cause dark urine and light stool, jaundice, nausea and unintended weight loss.

Early Detection

Why is it that pancreatic cancer is still caught at such advanced stages? My mother had 8 weeks from diagnosis to death 18 years ago. This month, someone in my community was diagnosed with pancreatic cancer 4 weeks ago and is now dying. Are there tests to catch pancreatic cancer earlier?
Pancreatic cancer is difficult to detect early because of many reasons. First, the pancreas is located where the early tumors cannot be seen or detected by providers during routine exams. Another factor is that patients usually do not have symptoms until the tumor has grown to a large size or has already spread to other organs. Currently, there is not a screen that can detect pancreatic cancer at an early stage. However, researchers are working to develop methods and tests that will enable early detection. Individuals that have a strong family history of pancreatic cancer or a known genetic syndrome may qualify for endoscopic ultrasound or MRI.

Could testing for BRACA and PALB2 at a certain age be a way to fine tune who should be tested?
Potentially. Healthy carriers of these genes are considered/recommended for screening. It would be good to seek out.

Recurrence

Is there any research being done for those who have had surgery with some lymph node involvement and fear recurrence?
Indeed there is. Typically we use imaging to surveil for recurrence of disease. One type of research that is being actively explored here is something called MRD testing, where a blood test is done, to look for mutations in the bloodsteam that are specific to the tumor and may suggest recurrence. This approach is now being used in colon cancer, and making it ways into other cancers, including pancreatic cancer.

Now that I have had the Whipple surgery, a full six months of Folfironox and clear scans and blood tests, what else should I be doing prophylactically to ward off a recurrence? What is the likelihood of a recurrence. I am a 67 year old male in good health.
The likelihood of recurrence depends on various factors (such as stage of tumor at time of surgery, size and type of tumor, degree of metastasis) and it is important to continue to make routine visits with your doctor for surveillance. Things that you can do to improve your risk include eating healthy, exercising, and avoiding tobacco.