Pancreatic cancer is aggressive and tough to beat. “We don’t have good treatments, and the prognosis is dismal,” says Nisa Kubiliun, M.D., Clinical Chief of the Division of Digestive and Liver Diseases and Director of Endoscopy at UT Southwestern. While researchers are working to improve treatments, heading off pancreatic cancer before it strikes is crucial. By identifying, evaluating, and treating people at high risk for pancreatic cancer, the team at UT Southwestern’s Pancreatic Cancer Prevention Program is doing just that.
Finding Those at Risk
Unlike mammograms for breast cancer or colonoscopies for colon cancer, there are no recommended screenings for people at average risk for pancreatic cancer. But the prevention program can help those who are at higher risk of developing this cancer, including:
● People who have a first-degree relative with pancreatic cancer.
● People with a genetic mutation that puts them at higher risk. The BRCA genes that are linked with higher breast cancer risk, for example, are also markers for higher pancreatic cancer risk. There are several known genes that can cause elevated lifetime pancreatic cancer risk.
● People with cysts on their pancreas. These cysts are often discovered incidentally – someone might be evaluated for another health concern, such as appendicitis or a kidney problem, and the CT scan shows a pancreatic cyst. In the past, these cysts were ignored. Now, there’s a process in place so when a pancreatic cyst is discovered in a scan at any UT Southwestern facility, the patient, the referring doctor, and the Pancreatic Cancer Prevention Program are all notified.
Developing the Best Plan
To address the complex factors that accompany pancreatic cancer prevention, a multidisciplinary team of experts meets to review every case. The team includes:
Interventional gastroenterologists, who can evaluate and test pancreatic cysts
● Surgical oncologists, who can remove some or all of the pancreas
● Cancer genetic counselors, who can evaluate genes that might increase pancreatic cancer risk
● Radiologists, who can review and evaluate scans for changes or other concerns
Together, these specialists assess each patient’s risk and recommend a detailed, customized plan of action.
The team might review the scans of someone with a cyst, determine that the risk is low, and recommend annual scans to watch for changes. Surveillance is often the best course of action.
On the other hand, based on the characteristics of the cyst or the person’s family history, team members might decide the cyst needs further evaluation. In those cases, doctors will use endoscopic ultrasound guidance and a fine needle to remove fluid from the cyst for examination.
For the small number of patients at highest risk, the team might recommend removing some or all of the pancreas. “Our goal is to get to that pathology before it’s cancer – not to let it turn into a tumor,” Dr. Kubiliun says. “We can remove large parts of the pancreas – even the entire pancreas sometimes – and patients can have excellent outcomes.”
Collecting Data for Future Studies
Research is a big part of the Pancreatic Cancer Prevention Program. The team collects pancreatic cyst fluid specimens, blood samples, and patients’ detailed family and personal histories. “We want to capture all significant data points,” Dr. Kubiliun says. In the future, if one person develops cancer and another doesn’t, the team can use the data to look for markers that might identify risk and help guide patient care.
UT Southwestern’s physicians and scientists also collaborate with peers at other academic medical centers to improve the early identification of pancreatic cancer through a large, constantly updated database. This research gives patients access to the latest approaches in fighting pancreatic disease.
Should You Consider Genetic Screening?
If you have a first- or second-degree relative (parent, sibling, child; grandparent, aunt/uncle, niece/nephew, grandchild) who was diagnosed with pancreatic cancer, consider talking to a genetic counselor. He or she can explain the benefits of evaluating your genetic risk.
Dr. Kubiliun says that most people considering genetic screening worry about two things – cost and future insurability. But she says a test that screens for a large panel of genes costs about $250 if insurance does not cover the testing, and federal law (the Genetic Information Nondiscrimination Act, enacted in 2009) covers most people, so they don’t have to be concerned about ability to get medical insurance in the future.