Mount Sinai Health SystemDr. Christopher DiMaio is a gastroenterologist who specializes in benign and malignant pancreatic disorders.
The Specialist:
The Director of Therapeutic Endoscopy at Mount Sinai, Dr. Christopher DiMaio is a gastroenterologist who specializes in benign and malignant pancreatic disorders. November is Pancreatic Cancer Awareness Month.
Who’s at risk:
Almost 50,000 Americans a year receive the diagnosis of pancreatic cancer — the disease that killed Steve Jobs, Patrick Swayze, and Luciano Pavarotti.
“Pancreatic cancer is the presence of a malignancy that arises from either the pancreas duct or the pancreatic cells,” says Dr. Christopher DiMaio, a gastroenterologist who specializes in benign and malignant pancreatic disorders. “What we now know is that pancreatic cysts, or abnormal growths, can be precursors to cancer. So that means we can keep an eye out for these cysts as a risk factor of pancreatic cancer.”
While not as common as cancers of the breast, lung and prostate, pancreatic cancer is deadlier than many cancers.
“Pancreatic is the fourth leading cause of cancer death in the U.S.,” DiMaio says. “Right now, we don’t have universal screening guidelines for pancreatic cancer, But we’re trying to identify high-risk patients so they can be more carefully monitored.”
Men and women are both affected by pancreatic cancer, which is most often diagnosed in people in their 60s and 70s.
“Other risk factors include smoking and having a family history of the cancer,” says DiMaio. “Patients with chronic pancreatitis are at increased risk, as are patients with certain genetic syndromes. But essentially it’s not a discriminating disease. People of all backgrounds and walks of life get pancreatic cancer.”
Signs and symptoms:
Pancreatic cancer can be difficult to detect, especially in the early stages. “Unfortunately, the signs and symptoms can be very vague, and often don’t present until the disease is quite advanced,” says DiMaio. “Worrisome signs include yellowing of the skin and eyes (jaundice), abdominal pain, back pain and unexplained weight loss.” Another sign may be new or worsening diabetes.
Traditional treatment:
There is no screening equivalent to mammograms for pancreatic cancer.
“Our goal is to identify people who may be at higher risk than the average person and put them in a screening program,” DiMaio says. “People who would be candidates for this type of screening include patients with a strong family history of pancreas cancer, particularly if they have more than one parent or sibling or a relative who had the disease before the age of 50, and people with certain genetic syndromes.”
The presence of pancreatic cysts is another potential indication that extra monitoring is appropriate.
“Most patients are diagnosed with pancreatic cysts incidentally, which means they are getting a scan for something else that just happens to pick up the cysts,” says DiMaio. “The good thing is that finding these cysts allows us to watch them for any changes that would suggest that they might become cancerous — and then we can remove the affected area, ideally before the precancerous cyst can even evolve fully into cancer.” It’s important to have any pancreas cysts evaluated to see if they have suspicious features.
Both pancreas cysts and cancer are diagnosed by imaging. “We usually make the diagnosis with a CT scan or specialized MRI, and then confirm it by using an endoscopic ultrasound (EUS),” DiMaio says. “The ultrasound gives us the ability to look at the pancreas in great detail and take needle biopsies.”
The first step for treating pancreatic cancer is usually surgery. “If the pancreas cancer hasn’t spread, removing the tumor can be curative,” DiMaio says. “The majority of patients are diagnosed with advanced disease that has spread to the lymph nodes, blood vessels or other organs. At that point, chemotherapy is the main focus of treatment.” Radiation can also be part of the plan.
Research breakthroughs:
Plenty of promising work is being done on how to detect and treat pancreatic cancer. “We’re on the verge of having new ways to biopsy these cysts to make a more accurate diagnosis of what kind of cyst it is, and what the risk is of it turning cancerous,” says DiMaio. “There’s also continued interest in looking for endoscopic approaches to treating pancreas cysts and cancers, by either injecting substances into the tumor or using a tiny probe to heat and burn the tumor. But these techniques are still completely experimental.”
Questions for your doctor:
If you have a family history of pancreatic cancer or a personal history of chronic pancreatitis, ask, “Should I be monitored for pancreatic cancer?” If you are found to have a pancreas cyst, ask, “Does this cyst have the potential to become cancer?” And “Can you refer me to a gastroenterologist who specializes in pancreatic cysts?” Follow up with, “What kind of further testing is needed?” And, crucially, “How closely does this need to be followed?”
“It’s frightening to learn that you have a lesion in your pancreas, but the vast majority of pancreatic cysts are benign,” DiMaio says. “However, knowing that some cysts have the potential for malignancy, you want to get the appropriate testing and surveillance. Even though the risk is between 1 and 3% that some types of cyst will turn cancerous, if you’re in that percentage, we want to be able to act fast.”
What you can do:
Get informed.
One trustworthy patient-oriented group is the National Pancreas Foundation (www.pancreasfoundation.org/). Mount Sinai hosts many resources for patients, including information on clinical trials (www.mountsinai.org) .
Know your family history.
If any of your relatives had pancreatic cancer, talk to your physician about whether you are a candidate for additional monitoring. Also be sure to draw any pancreatic disorders you’ve had in the past to your doctor’s attention.
Get any pancreatic cysts checked out. “No pancreatic cyst should be ignored,” DiMaio says. “Specialized testing is in order to determine if the cyst is worrisome or not.”
Reduce your risk. If you’ve had chronic pancreatitis, it’s vital not to drink or smoke so you don’t compound the damage. “In particular, if you’ve had unexplained pancreatitis, you should see a specialist,” DiMaio says. “Sometimes small tumors present that way.”
Watch out for GI symptoms. Any new GI symptoms, like abdominal pain or unexplained weight loss, merit a trip to the doctor to be evaluated.
By the numbers:
— Pancreatic cancer accounts for 3% of all cancers diagnosed in the U.S.
— About 48,000 people are diagnosed with pancreatic cancer every year.
— An estimated 3 million Americans have a pancreatic cyst.
—Between 1-3% of certain cysts might develop into cancer.
Source: Dr. Christopher DiMaio
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