Pancreatic Cancer Care at BMC

In a highly supportive and collaborative environment, pancreatic cancer physicians who are nationally recognized leaders in the care of patients with all stages of pancreatic cancer provide the most advanced, coordinated, and comprehensive medical care available—treatment that is effective and innovative in curing and controlling cancer and managing its impact on quality of life.

At BMC, diagnosis and treatment of patients with pancreatic cancer combines the resources of a multidisciplinary clinical center dedicated to personal, patient-focused care with the state-of-the-art expertise and technological advances of a major teaching hospital. As the primary teaching affiliate of the Boston University School of Medicine, BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.

Boston Medical Center's Hepatobiliary and Pancreatic Tumor Program was established in 2008 to effectively treat the growing number of patients being diagnosed with cancers of the liver, bile ducts, gallbladder, and pancreas.

What Is Pancreatic Cancer?

Pancreatic cancer is caused by the abnormal growth of cells in the pancreas.

The pancreas is located deep inside the abdomen behind the stomach in an area called the retroperitoneum and is surrounded by the liver, spleen, small intestine, and other organs.

There are two types of glands in the pancreas: exocrine glands and endocrine glands. Exocrine glands produce pancreatic enzymes that help to digest proteins and starches. These enzymes are secreted into the pancreatic duct and empty into the first part of the small intestine, called the duodenum, when eating.

Endocrine glands (found in clusters called islets) produce insulin and other regulatory hormones. These hormones circulate through the body via the bloodstream and keep various systems in check. For example, insulin helps regulate blood sugar levels.

Pancreatic tumors can be benign (noncancerous) or malignant (cancerous). Benign tumors are generally not life threatening and can often be removed. Malignant tumors, on the other hand, can be life threatening, as they sometimes invade surrounding tissues and organs and can spread to distant sites in the body.

Pancreatic cancers are divided by location. Proximal pancreatic cancers are cancers that develop in the uncinate process and head of the pancreas. Distal pancreatic cancers are cancers that develop in the body and tail of the pancreas.

Pancreatic cancers can develop in both exocrine and endocrine cells. Exocrine tumors are more common than endocrine tumors (also referred to as islet cell tumors or neuroendocrine tumors).

Symptoms of Pancreatic Cancer

Many early-stage pancreatic cancers do not cause symptoms, with symptoms only developing with progression. Common symptoms include:

  • Yellow skin and eyes, dark urine, and pale stools (jaundice)
  • Pain in the upper abdomen
  • Chronic pain the middle part of the back
  • Nausea and vomiting
  • Stools that float in the toilet
  • Loss of appetite or feeling full
  • Unintentional weight loss
  • Weakness and fatigue

Many of these symptoms can be caused by health problems other than pancreatic cancer. Individuals experiencing any of these symptoms should see their physician.

Causes of Pancreatic Cancer

Although the exact causes of pancreatic cancer remain unknown, certain risk factors connected to the disease have been identified:

  • Tobacco use: Smoking tobacco is a key risk factor for developing pancreatic cancer. Smokers are at twice the risk of developing the disease as nonsmokers (American Cancer Society 2015a).
  • Age and sex: The risk of developing pancreatic cancer increases with age, and the disease is more prominent in men versus women.
  • Race: Pancreatic cancer occurs more frequently in African Americans than Caucasians, although the reasons for this are not completely understood.
  • Family history and genetic mutations: One in 10 cases of pancreatic cancer are considered familial and are thought to be the result of genetic mutations (American Cancer Society 2015a). Genetic testing can detect these mutations in some cases.
  • Obesity: The risk of developing pancreatic cancer is approximately 20% higher in people who are overweight or obese (American Cancer Society 2015b).
  • Diabetes: Type 2 diabetes is associated with pancreatic cancer, and while the association is not clear, it may increase a person's risk of developing the disease.
  • Pancreatitis and cirrhosis: The risk of developing pancreatic cancer is higher in people who have chronic pancreatitis (inflammation of the pancreas) and cirrhosis (scarring of the liver due to inflammation).

Risk factors currently under study include diet (particularly a diet high in animal fat) and alcohol consumption (American Cancer Society 2015a; National Cancer Institute 2010)

Stages of Pancreatic Cancer

Staging is used to determine the extent of the cancer. The most common system used to stage pancreatic cancer is the American Joint Committee on Cancer’s TNM system. The TNM system takes into account the size of the primary tumor (T), whether cancer is present in nearby lymph nodes (N), and whether the cancer has metastasized (spread) to other organs or tissues in the body (M). View TNM staging for pancreatic cancer here.

The three categories are combined to determine the overall stage of the cancer. This is called stage grouping.

  • Stage I: The cancer is only present in the pancreas.
  • Stage II: The cancer has invaded nearby tissues but has not invaded nearby blood vessels. The cancer may have spread to the lymph nodes.
  • Stage III: The cancer has invaded nearby blood vessels.
  • Stage IV: The cancer has spread to other organs in the body.

(National Cancer Institute 2010)

The grade of the cancer—how the cells appear under a microscope—also plays an important role in determining the extent of the cancer. Cancers are graded on a scale of G1 (the cells appear relatively normal) to G3 (or G4) (the cells appear very abnormal).

For treatment purposes, physicians may group pancreatic cancers into the following four categories:

  • Resectable: The entire cancer can be surgically removed.
  • Borderline resectable: Surgeons may be able to remove the entire cancer, even though it may have spread to nearby blood vessels. Sometimes a trial of chemotherapy is performed to try to shrink the tumor prior to surgery.
  • Locally advanced (unresectable): The cancer is still local, but it cannot be entirely removed.
  • Metastatic: The cancer has spread to distant sites in the body.
    (American Cancer Society 2015a)

Patients are encouraged to discuss cancer staging and treatment options with their physicians.

Gastroenterology and Hepatobiliary Tumor Board at BMC

The results of the diagnostic tests are discussed at the Gastroenterology/Hepatobiliary Tumor Board. During this weekly meeting, the entire multidisciplinary team comes together to discuss new cases and develop individualized treatment plans for each patient.

Contáctenos

Tratamientos y Servicios

Cirugías de cáncer de páncreas

La cirugía es actualmente el tratamiento más eficaz para el cáncer de páncreas. Los dos tipos de cirugía que se utilizan para tratar el cáncer de páncreas son la cirugía potencialmente curativa y la cirugía paliativa. Se realiza una cirugía potencialmente curativa si parece que el cáncer se puede extirpar por completo. Si el cáncer se ha extendido demasiado para extirparlo por completo, los pacientes pueden ser tratados con cirugía paliativa. En lugar de tratar de curar el cáncer, los objetivos de la cirugía paliativa son aliviar los síntomas y prevenir los problemas causados por el cáncer, como el cáncer que bloquea los conductos biliares o el intestino.

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Quimioterapia

La quimioterapia es un medicamento o una combinación de medicamentos que se usan para tratar el cáncer. La quimioterapia puede administrarse por vía oral (en forma de pastilla) o inyectarse por vía intravenosa (IV).

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Terapia dirigida

La terapia dirigida es un tipo de tratamiento contra el cáncer que usa medicamentos u otras sustancias para identificar y atacar con precisión las células cancerosas. Por lo general, la terapia dirigida daña menos las células normales que otros tratamientos contra el cáncer.

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Radioterapia

La radiación utiliza un equipo especial para liberar partículas de alta energía, como rayos X, rayos gamma, haces de electrones o protones, para matar o dañar las células cancerosas. La radiación (también llamada radioterapia, irradiación o terapia de rayos X) se puede administrar internamente a través de la implantación de semillas o externamente usando aceleradores lineales (llamada radioterapia de haz externo o EBRT).

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CyberKnife

CyberKnife emite haces de radiación altamente dirigidos directamente a los tumores, de forma indolora y no quirúrgica. Guiados por un software de imágenes especializado, podemos rastrear y ajustar continuamente el tratamiento en cualquier punto del cuerpo, y sin la necesidad de los marcos de la cabeza y otros equipos que se necesitan para algunas otras formas de radiocirugía.

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Cuidados paliativos para el cáncer de páncreas

Los pacientes reciben cuidados paliativos para controlar el dolor y otros síntomas causados por el cáncer y para aliviar los efectos secundarios del tratamiento. Existen varios métodos de control del dolor, que incluyen analgésicos, bloqueos nerviosos (un procedimiento en el que se usa alcohol para bloquear el dolor) y terapias complementarias (como masajes o acupuntura). La cirugía paliativa, como la colocación de un stent o la cirugía de derivación, también se puede utilizar para aliviar el bloqueo del conducto biliar y los síntomas que puede causar.

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Diagnósticos y Pruebas

Pancreatic cancer can be difficult to diagnose early, as symptoms frequently do not develop until the later stages of the disease. Patients who are experiencing any of the symptoms of pancreatic cancer should see their physician, who will perform a series of diagnostic exams and tests. The results of these exams and tests will also help the patient and his or her physician decide the best treatment options.

Pancreatic Cancer Imaging Tests and Procedures

Several types of imaging tests and procedures are used to diagnose pancreatic cancer. The patient’s physician may request one or more of the following:

Tomografía computarizada (TC)

Las tomografías computarizadas utilizan equipos de rayos X y procesamiento por computadora para producir imágenes bidimensionales del cuerpo. El paciente se acuesta en una mesa y pasa a través de una máquina que parece una rosquilla grande y cuadrada.

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Imágenes por resonancia magnética (IRM)

Esta prueba utiliza un campo magnético, pulsos de radiofrecuencia y una computadora para producir imágenes detalladas de las estructuras corporales en varios lugares. Es posible que le pidan que beba una solución de contraste para obtener mejores imágenes, y lo más probable es que se acueste en una mesa en movimiento mientras se toman las imágenes.

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Ultrasonido

La ecografía de diagnóstico, también llamada ecografía o ecografía médica de diagnóstico, es un método de obtención de imágenes que utiliza ondas sonoras de alta frecuencia para producir imágenes de estructuras dentro del cuerpo. Las imágenes pueden proporcionar información valiosa para diagnosticar y tratar una variedad de enfermedades y afecciones. La mayoría de los exámenes de ultrasonido se realizan con un dispositivo de sonar fuera del cuerpo, aunque algunos exámenes de ultrasonido implican colocar un dispositivo dentro del cuerpo.

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Tomografía por emisión de positrones (PET)

Una tomografía por emisión de positrones se utiliza para detectar reacciones celulares al azúcar. Las células anormales tienden a reaccionar y "iluminarse" en la exploración, lo que ayuda a los médicos a diagnosticar una variedad de afecciones. Para la tomografía por emisión de positrones, se inyecta en el torrente sanguíneo una sustancia química inofensiva, llamada radiotrazador.

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Colangiopancreatografía retrógrada endoscópica (CPRE)

Durante una CPRE, el gastroenterólogo usa un endoscopio, un tubo largo, delgado y flexible con una luz y una cámara al final, a través del esófago, el estómago y la primera parte del intestino delgado, llamada duodeno.

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Endoscopia

Recibirá un sedante y analgésico por vía intravenosa. Una vez que se sienta cómodo, el médico examinará el área con un endoscopio, un tubo iluminado con una pequeña cámara en el extremo. El médico podrá ver cualquier anomalía y tomar muestras de tejido (biopsias) si es necesario.

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Análisis de sangre

Una herramienta común para la detección de enfermedades, los análisis de sangre brindan información sobre muchas sustancias en el cuerpo, como glóbulos, hormonas, minerales y proteínas.

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Biopsia

Cualquier masa sospechosa de tejido o tumor se somete a una biopsia o extracción de células de la masa. Esta es la única técnica que puede confirmar la presencia de células cancerosas.

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Nuestro Equipo

Medical Oncologists

Matthew H Kulke, MD

Section Chief, Hematology and Medical Oncology
Medical Director, Clinical Cancer Center
Co-Director, BU-BMC Cancer Center
Zoltan Kohn Professor of Medicine, Boston University School of Medicine

Medical Oncology Nurse Practitioners

Radiation Oncologists

Surgical Oncologists

Jennifer F Tseng, MD, MPH

Surgeon-in-Chief, Boston Medical Center
Utley Professor and Chair of Surgery, Boston University School of Medicine

David McAneny, MD

Chief Medical Officer and Senior Vice President of Medical Affairs
Professor of Surgery and Associate Dean for Clinical Affairs, Boston University School of Medicine

Teviah E Sachs, MD, MPH

Section Chief, Surgical Oncology
Associate Professor of Surgery, Boston University School of Medicine, Boston MA

Special Interests

Surgical Oncology, Liver, Pancreas and Biliary Cancers, Cancers of the Stomach, Sarcoma, Melanoma

Provider headshot - surgery department

Surgical Oncology Physician Assistants

Interventional Radiologists

Suvranu Ganguli, MD

Section Chief, Interventional Radiology
Professor of Radiology, Boston University School of Medicine

Kevin P Daly, MD

Program Director, ESIR
Clinical Associate Professor of Radiology, Boston University School of Medicine

Placeholder only - will replace

David Guez, MD

Assistant Professor of Radiology, Boston University school of Medicine

Mikhail Higgins

Director, Medical Student Clerkship
Assistant Professor of Radiology, Boston University School of Medicine

Interventional Radiology Physician Assistants

Gastroenterologists

David P Nunes, MD

Director of Hepatology
Associate Professor of Medicine, Boston University School of Medicine, Boston MA

Christopher S Huang, MD

Director of Endoscopy
Associate Professor of Medicine, Boston University School of Medicine

David R Lichtenstein, MD

Director of Endoscopy Program
Associate Professor of Medicine, Boston University School of Medicine, Boston MA

Gastroenterology Nurse Practitioner

Recursos del Paciente

Pancreatic Cancer Clinical Trials

BMC offers a number of clinical trials specifically for pancreatic cancer patients. Promising new techniques in the diagnosis, treatment, and care of patients with cancer are tested in these studies. The number and types of clinical trials available are constantly changing.

Cancer Center Support

Additional Information

Patient Testimonies

"I recently had my second surgery with Dr. McAneny. I feel very fortunate & privileged he is my surgeon. His compassion is undeniable, surgical skills beyond exceptional, and no limit to his patience and understanding. I had many questions, he answered them all, and I never felt rushed at appointments. He is a great surgeon and a wonderful person. He is second to none!"

~ Kathy

"Dr. Tseng is so knowledgeable, personable and caring. She puts you at ease, give you hope and confidence in your outcome and makes you feel like you are her priority (which you are). I will forever be thankful for having found her."

~ Anonymous

References

American Cancer Society. 2015a. Pancreatic Cancer Overview. PDF.

-----2015b. "What are the risk factors for pancreatic cancer?" Last modified January 9, 2015.
http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-risk-factors

American Joint Committee on Cancer. 2009. Pancreas Cancer Staging. 7th ed. PDF. https://cancerstaging.org/references-tools/quickreferences/Documents/PancreasSmall.pdf

National Cancer Institute. 2010. What You Need To Know About™ Cancer of the Pancreas. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. https://www.mycareplusonline.com/sites/default/files/cmgfiles/WYNTK_Pancreas_Cancer.pdf

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