Gary Gecelter, MD, Chairman of Surgery at Catholic Health Services (CHS), has vast experience with pancreatic cancer. He and his team of surgical oncologists at the CHS Cancer Institute are at the forefront of technical advances in surgical delivery, able to offer minimally invasive options for the management of the pancreas, colon, lung, and abdominal cancers.
November is Pancreatic Cancer Awareness Month and Dr. Gecelter took some time to answer our questions about the disease and what is being done at CHS to treat it.
Pancreatic cancer is perhaps the scariest kind of cancer anyone hears about. Give us a snapshot of the situation.
Dr. Gecelter: Let’s start with the good news: not all tumors in the pancreas are fatal; the bad player is ductal adenocarcinoma – cancer of the duct system of the pancreas. Even so, if we can detect it early, when it’s the size of a pea, we can ‘resect’ it and the patient can be cured.
So some pancreatic cancers are more treatable than others?
Dr. Gecelter: Correct. Take the kind that Steve Jobs had, called a neuroendocrine carcinoma; those are more treatable. Unfortunately, he delayed surgery by choosing an alternative, unconventional strategy. But a neuroendocrine carcinoma can be cured when treated appropriately in a timely fashion.
Similarly, there are pancreatic cystic tumors that are slow growing and are often identified incidentally. As with colon polyps, when a patient is found to have a cyst in the pancreas, it can be evaluated endoscopically and removed before it becomes malignant.
So the key is always lead time. Identifying the cyst or tumor as early as possible.
Dr. Gecelter: Yes. The problem with pancreatic cancer is that the patient rarely presents with symptoms until it’s advanced. But increasingly these tumors are being diagnosed incidentally, when the patient gets imaging for other reasons; for example, a CT scan or MRI for kidney stones or diverticulitis. The imaging will reveal a cyst in the pancreas, which gives us adequate time to evaluate its potential for cancer and, if necessary, remove it.
Are all pancreatic cysts considered pre-cancerous?
Dr. Gecelter: No, many are not. We use endoscopic ultrasound to get a detailed look at the cyst, and can often identify that certain cysts will never be malignant. Still, other cysts will show the potential to be dangerous; in those cases we’ll want a deeper evaluation. Fortunately, people tend to get far more imaging than they used to, so we’re able to make more and more early detections.
Are there new hopes on the horizon?
Dr. Gecelter: Yes, we’re gaining a greater ability to evaluate ‘resectability’ – the ability to remove a tumor by separating the pancreas from the vital structures it surrounds.
For more information on pancreatic cancer and the CHS Cancer Institute, please visit https://www.chsli.org/chs-cancer-institute.htm