Selected Podcast
Pancreatic Cancer
Lynt Johnson, MD, discusses the prevalence of pancreatic cancer in Western nations as opposed to Eastern countries, specifically the 30,000 diagnoses that arise each year in the United States. While no known risk factor has been identified, unsubstantiated reports suggest an association to poor dietary choices. Dr. Johnson also reviews early- and late-stage symptoms (unexpected weight loss, poor appetite, jaundice, changes in urine and stool coloring, and pain, respectively), survival rates, traditional treatment options based on severity, and a new, innovative surgical procedure with which The George Washington University Hospital has seen success.
Featured Speaker:
Learn more about Lynt Johnson, MD
Lynt Johnson, MD
Lynt B. Johnson, MD, MBA is a member of the medical staff at The George Washington University Hospital. He joined as Professor of Surgery and Executive Director of the newly formed Liver and Pancreas Institute for Quality (LPIQ). He is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.Learn more about Lynt Johnson, MD
Transcription:
Michael Smith, MD (Host): Welcome to GW Healthcast. I’m Dr. Mike Smith and today’s topic is pancreatic cancer. My guest is Dr. Lynt Johnson. Dr. Johnson is the Executive Director for the Liver and Pancreas Institute for Quality and is a member of the medical staff at the George Washington University Hospital. He is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Johnson, welcome to the show.
Lynt Johnson, MD (Guest): Thank you. Good morning. Thanks for having me.
Dr. Smith: Sure, so this is obviously, anytime we talk about cancer, right, that scares a lot of people and we understand that rightly so and pancreatic cancer is one I think, that has been in the media. We have seen celebrities seemingly healthy, all of the sudden they are diagnosed with pancreatic cancer and it seems that the disease takes its course pretty quickly. So, I think this is an important topic to discuss with the general public. Dr. Johnson, what is the prevalence of pancreatic cancer?
Dr. Johnson: So, in the United States, there are about 30,000 new cases of pancreatic cancer each year. And pancreatic cancer is seen most often in western countries more so than eastern countries and much of that is felt to be associated with our dietary and consumption tendencies here in the west.
Dr. Smith: So, that’s interesting. Does the research point to any sort of food group that we are eating too much? Is it linked more to sugars, the fats? Is it just over-consumption? We know that in this country with all the processed foods, the fast food restaurants we kind of call it overfed and undernourished. Is it simply just that or is there some specific risk there for a food group?
Dr. Johnson: No, no one really knows a specific risk factor. What we do know is that our typical diet is very different than eastern countries and the prevalence is much higher in western style countries. There have been some reports, although not substantiated about risk related to sodas and diet sodas in particular, in animals but I would say that none of those have been substantiated to the extent that we think that there’s true evidence that there’s an association there.
Dr. Smith: But we know there’s a difference basically, a basic difference between how people eat in the east versus how we eat in the west and so there is something that is playing a role and so we just need to maybe focus on less food, less processed food, right and just more fresh fruits and vegetables. It is interesting Dr. Johnson, why is it that – because pancreatic cancer has been in the media mostly because a couple of celebrities in the recent past have unfortunately died because of the disease and it does seem to occur in people that appeared healthy and then all of the sudden, very quickly they succumb to the disease. Why is that?
Dr. Johnson: Well, the difficulty in diagnosing pancreatic cancer is extremely challenging and most patients don’t have symptoms until the disease is fairly advanced and therefore, when patients get diagnosed, many of them have progressed beyond what can be a curative treatment for their cancers and that’s part of the challenge. Additionally, unlike almost every other cancer over the last 40-50 years, where the survival statistics have improved over those decades; pancreatic cancer still remains very dismal in terms of the overall survival rates and the rates have not changed over those 40-50 years.
Dr. Smith: Is that simply because we are diagnosing the cancer in late stages?
Dr. Johnson: It’s a combination. We still are diagnosing them very late, but we also have not made much advance in terms of chemotherapy or other nonsurgical therapies for patients with advanced disease and some of that has to do with the fact that unlike a lot of cancers where they have a very healthy blood supply to it; pancreatic cancer in particular, is a cancer that lives in a kind of a hypoxic or non-blood supplied environment, so that it’s much harder to get systemic therapies into the tumor to get a response. But only about 10% of all patients who have pancreatic cancer are eligible for surgery which is the only known curative treatment for pancreatic cancer and so by and large, the majority of patients are patients who rely on other therapies and those therapies generally include radiation treatments and chemotherapy.
Dr. Smith: Okay and I want to get into why so few people are candidates for surgery, and I know also this is kind of your area of expertise, there are some innovations surgically speaking for the treatment of pancreatic cancer but before we do that, I want to back up just for a moment and talk about symptoms. Knowing that a lot of people don’t even realize they have it, maybe a year or so goes by and all of the sudden boom, they are hit hard with symptoms. Are there early symptoms that we should pay attention to and if so, when then should we seek the help of a doctor?
Dr. Johnson: Well, I think in terms of early symptoms, certainly any unexpected weight loss, poor appetite are things that should trigger some investigation. When patients develop pain per se, generally and usually it’s not abdominal pain but actually back pain, because the pancreas lies across the vertebral column or the back bone and the nerves along there are what kind of get trapped in the tumor and cause this back pain, generally at that point, it’s more advanced. The most common symptoms that patients have is jaundice which is a yellowing that oftentimes is seen in the eyes, or in the sclera or the white part of the eyes, they can also see a darkening of their urine almost a coca cola colored urine and their stools become very light and that’s all because the tumor blocks the bile duct which drains bile out of the liver into the intestines. And that’s the most common symptom that patients present with.
Dr. Smith: So, let’s talk about treatment now. You had mentioned that very few patients are candidates for surgery. Why is that?
Dr. Johnson: Well, it’s very interesting. Patients can present with what we call metastatic disease, that is the cancer has already spread from the pancreas into other organs and the most common organs that it generally spreads to is the liver. And so, if the tumor has gone outside of the local area of the pancreas, then surgery is not beneficial for those patients. There, however is another group of patients that have locally dominant disease, that is the cancer that is just confined within the pancreas and generally we are speaking about the head of the pancreas in regard to the difficulty in surgery. And the problem in those patients oftentimes is the tumor has infiltrated around blood vessels that go underneath the pancreas and supply blood to and from the small intestine and if those blood vessels are encased or the tumor has wrapped itself around that, then that makes surgery extremely challenging and extremely difficult. We and a few others have developed a technique of treating many of these patients with this blood vessel involvement with initially with chemotherapy and radiation and then later on going in a few months later and taking out the entire pancreas and taking out those parts of the blood vessels and then reconnecting them so that the intestines remain viable. And early data, a lot of it from European countries have shown that the success rate of doing that complex surgery is no different than doing the primary treatment or primary surgery for pancreatic cancer in the head which is called the Whipple procedure. So, doing that Whipple without the blood vessel involvement, seems to give you the same results and so we have been offering that to patients over the last couple of years.
Dr. Smith: So, in summary, Dr. Johnson, what would you like people to know about pancreatic cancer?
Dr. Johnson: First of all, it is a very tough cancer. But there is hope through certainly surgery to cure a small percentage of patients. Additionally, there are a lot of – a number of new therapies that are coming down the pike in terms of treatments that are currently in what we call clinical trials that are being tested that I think will allow patients to have a better outcome as we go in the future. Some of these therapies may include treatments that allow your own immune system to attack the cancer and provide a durable and long-term response so that patients can live a long with their cancer as opposed to die from their cancer and we are hopeful that those results will be available within the next three to five years.
Dr. Smith: Well, Dr. Johnson, I want to thank you for the work that you are doing and thank you for coming on the show today. You’re listening to GW Healthcast. Please visit GWDocs.com to get connected with Dr. Johnson or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
This is Dr. Mike Smith. Thanks for listening.
Michael Smith, MD (Host): Welcome to GW Healthcast. I’m Dr. Mike Smith and today’s topic is pancreatic cancer. My guest is Dr. Lynt Johnson. Dr. Johnson is the Executive Director for the Liver and Pancreas Institute for Quality and is a member of the medical staff at the George Washington University Hospital. He is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Johnson, welcome to the show.
Lynt Johnson, MD (Guest): Thank you. Good morning. Thanks for having me.
Dr. Smith: Sure, so this is obviously, anytime we talk about cancer, right, that scares a lot of people and we understand that rightly so and pancreatic cancer is one I think, that has been in the media. We have seen celebrities seemingly healthy, all of the sudden they are diagnosed with pancreatic cancer and it seems that the disease takes its course pretty quickly. So, I think this is an important topic to discuss with the general public. Dr. Johnson, what is the prevalence of pancreatic cancer?
Dr. Johnson: So, in the United States, there are about 30,000 new cases of pancreatic cancer each year. And pancreatic cancer is seen most often in western countries more so than eastern countries and much of that is felt to be associated with our dietary and consumption tendencies here in the west.
Dr. Smith: So, that’s interesting. Does the research point to any sort of food group that we are eating too much? Is it linked more to sugars, the fats? Is it just over-consumption? We know that in this country with all the processed foods, the fast food restaurants we kind of call it overfed and undernourished. Is it simply just that or is there some specific risk there for a food group?
Dr. Johnson: No, no one really knows a specific risk factor. What we do know is that our typical diet is very different than eastern countries and the prevalence is much higher in western style countries. There have been some reports, although not substantiated about risk related to sodas and diet sodas in particular, in animals but I would say that none of those have been substantiated to the extent that we think that there’s true evidence that there’s an association there.
Dr. Smith: But we know there’s a difference basically, a basic difference between how people eat in the east versus how we eat in the west and so there is something that is playing a role and so we just need to maybe focus on less food, less processed food, right and just more fresh fruits and vegetables. It is interesting Dr. Johnson, why is it that – because pancreatic cancer has been in the media mostly because a couple of celebrities in the recent past have unfortunately died because of the disease and it does seem to occur in people that appeared healthy and then all of the sudden, very quickly they succumb to the disease. Why is that?
Dr. Johnson: Well, the difficulty in diagnosing pancreatic cancer is extremely challenging and most patients don’t have symptoms until the disease is fairly advanced and therefore, when patients get diagnosed, many of them have progressed beyond what can be a curative treatment for their cancers and that’s part of the challenge. Additionally, unlike almost every other cancer over the last 40-50 years, where the survival statistics have improved over those decades; pancreatic cancer still remains very dismal in terms of the overall survival rates and the rates have not changed over those 40-50 years.
Dr. Smith: Is that simply because we are diagnosing the cancer in late stages?
Dr. Johnson: It’s a combination. We still are diagnosing them very late, but we also have not made much advance in terms of chemotherapy or other nonsurgical therapies for patients with advanced disease and some of that has to do with the fact that unlike a lot of cancers where they have a very healthy blood supply to it; pancreatic cancer in particular, is a cancer that lives in a kind of a hypoxic or non-blood supplied environment, so that it’s much harder to get systemic therapies into the tumor to get a response. But only about 10% of all patients who have pancreatic cancer are eligible for surgery which is the only known curative treatment for pancreatic cancer and so by and large, the majority of patients are patients who rely on other therapies and those therapies generally include radiation treatments and chemotherapy.
Dr. Smith: Okay and I want to get into why so few people are candidates for surgery, and I know also this is kind of your area of expertise, there are some innovations surgically speaking for the treatment of pancreatic cancer but before we do that, I want to back up just for a moment and talk about symptoms. Knowing that a lot of people don’t even realize they have it, maybe a year or so goes by and all of the sudden boom, they are hit hard with symptoms. Are there early symptoms that we should pay attention to and if so, when then should we seek the help of a doctor?
Dr. Johnson: Well, I think in terms of early symptoms, certainly any unexpected weight loss, poor appetite are things that should trigger some investigation. When patients develop pain per se, generally and usually it’s not abdominal pain but actually back pain, because the pancreas lies across the vertebral column or the back bone and the nerves along there are what kind of get trapped in the tumor and cause this back pain, generally at that point, it’s more advanced. The most common symptoms that patients have is jaundice which is a yellowing that oftentimes is seen in the eyes, or in the sclera or the white part of the eyes, they can also see a darkening of their urine almost a coca cola colored urine and their stools become very light and that’s all because the tumor blocks the bile duct which drains bile out of the liver into the intestines. And that’s the most common symptom that patients present with.
Dr. Smith: So, let’s talk about treatment now. You had mentioned that very few patients are candidates for surgery. Why is that?
Dr. Johnson: Well, it’s very interesting. Patients can present with what we call metastatic disease, that is the cancer has already spread from the pancreas into other organs and the most common organs that it generally spreads to is the liver. And so, if the tumor has gone outside of the local area of the pancreas, then surgery is not beneficial for those patients. There, however is another group of patients that have locally dominant disease, that is the cancer that is just confined within the pancreas and generally we are speaking about the head of the pancreas in regard to the difficulty in surgery. And the problem in those patients oftentimes is the tumor has infiltrated around blood vessels that go underneath the pancreas and supply blood to and from the small intestine and if those blood vessels are encased or the tumor has wrapped itself around that, then that makes surgery extremely challenging and extremely difficult. We and a few others have developed a technique of treating many of these patients with this blood vessel involvement with initially with chemotherapy and radiation and then later on going in a few months later and taking out the entire pancreas and taking out those parts of the blood vessels and then reconnecting them so that the intestines remain viable. And early data, a lot of it from European countries have shown that the success rate of doing that complex surgery is no different than doing the primary treatment or primary surgery for pancreatic cancer in the head which is called the Whipple procedure. So, doing that Whipple without the blood vessel involvement, seems to give you the same results and so we have been offering that to patients over the last couple of years.
Dr. Smith: So, in summary, Dr. Johnson, what would you like people to know about pancreatic cancer?
Dr. Johnson: First of all, it is a very tough cancer. But there is hope through certainly surgery to cure a small percentage of patients. Additionally, there are a lot of – a number of new therapies that are coming down the pike in terms of treatments that are currently in what we call clinical trials that are being tested that I think will allow patients to have a better outcome as we go in the future. Some of these therapies may include treatments that allow your own immune system to attack the cancer and provide a durable and long-term response so that patients can live a long with their cancer as opposed to die from their cancer and we are hopeful that those results will be available within the next three to five years.
Dr. Smith: Well, Dr. Johnson, I want to thank you for the work that you are doing and thank you for coming on the show today. You’re listening to GW Healthcast. Please visit GWDocs.com to get connected with Dr. Johnson or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
This is Dr. Mike Smith. Thanks for listening.