Chippenham Hospital December 01, 2015

It’s the eighth most common malignancy, but the fourth most fatal. And although it carries a poor prognosis even when diagnosed early, this does not mean pancreatic cancer is untreatable, as one surgical oncologist is making great strides in the treatment of this cancer and the ways healthcare providers are handling the diagnosis of the disease.

Through his expertise and profound interest in the malignancy, Dr. Michael Rose of Surgical Associates of Richmond and Johnston-Willis Hospital says that pancreatic cancer is extraordinarily problematic from a biologic and technical standpoint, resulting in difficult operations and large challenges.

Often metastatic in presentation, the cancer frequently recurs and is anatomically in a position where it is extremely difficult to get a margin negative resection (meaning no cancer cells are seen at the outer edge of the tissue that was removed during surgery)– the standard operation for tumors located in the head of the pancreas.

Pancreatic Cancer Symptoms are often vague and easily attributed to other diseases. Symptoms can include anorexia, malaise, nausea, fatigue, weight loss, obstructive jaundice (yellowing of the skin), and abdominal and/or back pain.

According to the Mayo Clinic, pancreatic cancer begins in the tissues of the pancreas and often spreads rapidly. It is seldom detected in its early stages, which is a major reason why it is a leading cause of cancer death. Signs and symptoms may not appear until the cancer is advanced and complete surgical removal is not possible.

In regards to identifiable risks, Rose says that pancreatic cancer does not have a well-defined group of risk factors. Most people present with sporadic carcinoma, and while this form of cancer is much more common after age 50 or 60, he has seen patients in their young 30’s with the disease.

Among one of the many challenges associated with pancreatic cancer upon diagnosis is that many patients are never even offered surgery nor are they sent to a surgical oncologist or individual with interest in pancreatic cancer, because of its perception in the community among many health care providers and primary care physicians.

“The thing that I’m most excited about in the last 8-10 years is our attempt to broaden the groups of individuals who are able to undergo surgery,” said Rose. “At least 40-50 percent of individuals in this country who have potentially resectable cancer aren’t even sent to someone like me, because everyone says it’s a terrible cancer. The reality is you can approach it in that fashion and you can have data to support that, but if you do that, then you’ve denied hope to everybody.”

As a result, Rose says his job is to remain careful and selective and although he recognizes there is an extremely select group of individuals, in the appropriately selected patient, it warrants an aggressive approach.

The surgical options for pancreatic cancer have become more standardized, such as the Whipple Procedure, or pancreatoduodenectomy. Rose, who has performed approximately 150 Whipple procedures at Johnston-Willis in the last 12 years, says much of this is largely due to work which augments each other at MD Anderson and Memorial Sloan Kettering.

The operation has become much safer, more straightforward, more standardized with shorter hospital and ICU stays and significantly lower complication rates.

And so when it comes to his patients, Rose is in it with them to continue fighting.

“They didn’t have nurse navigators when I began my practice. I’m the nurse navigator, I do their palliative care. I follow them forever. It’s the fundamental reality because it is my job to ensure they do well and if they develop distant disease or progression of disease, this is my job to make sure they have an optimal quality of life. I do this because not many people want to.

One of the biggest roles in my lifetime has been to try to educate my peers and that if nothing else, patients have the opportunity to have a conversation and say ‘what are my options?’ I am absolutely blunt, forthright with my patients and they all know this coming in, because I have to be, but everybody should be afforded the conversation.”