Selected Podcast

Identifying Patients at High Risk for Pancreatic Cancer

The fourth leading cause of cancer death in the U.S., the symptoms of pancreatic cancer often don't appear until most treatments are no longer an option.

Learn more about the risk factors and how UVA is working to more quickly identify patients at high risk for pancreatic cancer.
Identifying Patients at High Risk for Pancreatic Cancer
Featured Speaker:
Dr. Todd Bauer
Dr. Todd Bauer, a surgical oncologist, is part of the multidisciplinary team at the UVA High-Risk Pancreatic Cancer Clinic. His specialties include surgical treatments for pancreatic and liver cancer; he also leads a laboratory research program in pancreatic cancer that is seeking to develop personalized treatments for patients.

Organization: UVA High-Risk Pancreatic Cancer Clinic

Melanie Cole (Host): The fourth leading cause of cancer death in the US, the symptoms of pancreatic cancer don't often appear until many treatments are no longer an option. My guest is Dr. Todd Bauer. He's a surgical oncologist, and he's part of the multidisciplinary team at the UVA High-Risk Pancreatic Cancer Clinic. Welcome to the show, Dr. Bauer. Speak about pancreatic cancer a little bit for us. Why is it considered such a deadly disease?

Dr. Todd Bauer (Guest): Well, there are several factors that contribute to that. For one, pancreatic cancer is a cancer that behaves very aggressively. The second problem is we don't have very effective chemotherapies to treat this disease like we do in many other types of cancer. I would say the third challenge in pancreatic cancer is that when patients find out they have the disease, the tumor is usually already advanced to a metastatic stage or to a stage where we can't offer surgery. In that setting, it's very difficult to treat.

Melanie: So what would put someone at risk for pancreatic cancer?

Dr. Bauer: Well, there are several risk factors we know of. They would include smoking, obesity. Diabetes has recently been shown to be a risk factor. We also know that patients that have two or more family members with pancreatic cancer are at a higher risk. Also, some patients with certain types of pancreatic cysts, we know that they're at higher risk. There are a few other genetic mutations, notably the BRCA gene, which most commonly is associated with breast cancer but we now know that these patients are also at higher risk for pancreatic cancer.

Melanie: Well, that's fascinating. So what symptoms would people have? I know that typically sometimes you don't have symptoms until it's a little bit advanced and, as you say, metastasized, but are there some symptoms that might pop up that people can give them a little bit of a warning sign to get in?

Dr. Bauer: There are. One of the more common symptoms is jaundice, so the patient's eyes and skin will turn yellow. Skin may start itching. Their urine may get real dark. That's the sign that the tumor has caused an obstruction of the bile duct. But in a lot of patients, the early symptoms are very subtle—maybe loss of appetite, maybe some very subtle abdominal discomfort, things that patients could attribute to just an indigestion. So that's part of the challenge is unless the patients get jaundice and turn yellow, the symptoms tend to be rather subtle.

Melanie: How is it diagnosed? Because I know that if you've come up with some of these symptoms, you're looking at a lot of things first. Is it tough to diagnose?

Dr. Bauer: Well, usually early in the course, particularly if a patient gets jaundice, then they'll end up getting an ultrasound and, quite often right after that, a CAT scan. That's really how we make the diagnosis is eventually, the patient gets a CAT scan, and then we can see that there's a mass in the pancreas and possibly some obstruction of the bile ducts to the liver.

Melanie: What treatments are available? If it's caught early, obviously maybe you have more treatment options available. But what are the treatments for pancreatic cancer?

Dr. Bauer: Well, you brought up an important point. Catching it early, it makes all the difference. So if we catch it early, before the tumor has had a chance to spread, then we're going to offer surgery, and that could be potentially curative. The most common operation we do is called the Whipple operation. Even when we do surgery, we're still going to recommend chemotherapy and radiation after surgery, because we want to give these patients the best chance for a cure.

Melanie: And the Whipple, that's quite a big surgery, right? It takes a quite a while and, really, it's an in-depth surgery.

Dr. Bauer: It is. It's about a 6- to 8-hour operation, and it's probably one of the bigger operations that is done in surgery. So it is a real undertaking for the patients to undergo this surgery and then the recovery. And the recovery from that operation, it can be two to three months until the patient is fully back to their normal status.

Melanie: So Dr. Bauer, describe what makes UVA's high-risk pancreatic cancer clinic different from other pancreatic cancer clinics.

Dr. Bauer: Sure. Well, our goal from the onset was to build a clinic that would really pull in and identify all patients that we know are at a substantial increased risk for pancreatic cancer. So this comprehensive nature to the clinic is really what makes this unique. So we include patients with family history of pancreatic cancer, patients with a pancreatic cyst—usually that's caught on a CAT scan done for another reason—patients that have the BRCA gene mutation or one of several other gene mutations, patients with familial pancreatitis, and lastly, those with chronic pancreatitis. The other feature we thought of was while we had this group of patients that we know are high-risk, we're going to screen them very intensively with MRI and endoscopic ultrasound on an annual basis. The goal would be if they were to develop a cancer, we would hope that we would catch it earlier by screening them before they have symptoms, and then we'd be able to cure a greater proportion of those patients.

Melanie: That's fantastic, Dr. Bauer. Now, what about after surgery and after treatment? Are they now at risk for diabetes? Do you keep a pretty careful watch afterward?

Dr. Bauer: We do, and that's an important point to discuss with the patients. As it turns out, only about 20 percent of patients become diabetic after the surgery. In those patients and all patients after the surgery, we keep an eye on their blood sugar. If they need medication to help control their sugars, then we institute that early.

Melanie: Now, can you speak just a little—we only have a minute or two left—about your research into pancreatic cancer?

Dr. Bauer: Sure. That's something I'm very excited about. We have a team of over 13 researchers from nine different departments across the university, and the whole focus of this research program is how we can study human pancreatic cancer, tumors that we take out of the patients, put them into mice, and we ask the question: how can we come up with a therapy that we can take back to the patient and improve their outcome? With this model, using tumors right from the patients with the patient's consent, and studying them in mice, we've come up with some new treatment therapies that have not been tested before in pancreatic cancer, and we hope to put these into clinical trials in the near future. So we have great hope that we're going to make strides in treating this difficult disease.

Melanie: That's amazing. I certainly applaud your research. Keep up the great work. Now, in the last minute and a half or so, wrap it up for us. Give some hope to people listening about pancreatic cancer and really what's going on out there.

Dr. Bauer: Well, I have great hope for this disease. While the statistics have been quite grim over the past several decades, the understanding that we now have as to what makes these tumors grow and how we can target those pathways with newer drugs, I'm very hopeful that over the next 10 years, we're going to make a significant impact. Right now, we know we cure some patients with surgery and chemotherapy, and I see that number going up substantially over the next 10 years. And I think we're going to be making great progress in some early detection scans that will help us find the disease earlier.

Melanie: Thank you so much, Dr. Todd Bauer, surgical oncologist at the UVA High-Risk Pancreatic Cancer Clinic. You're listening to UVA Health System radio. For more information, you can go to This is Melanie Cole. Thanks for listening.