Pancreatic Cancer: Pushing the Envelope for Better Care

Physicians at Baptist Health Miami Cancer Institute are challenging the norm when it comes to pancreatic cancer surgery — the only known cure for the disease. Typically reserved for patients whose cancers are in the earliest stage and are located away from vital organs and blood vessels, surgery (often including the Whipple procedure) is now offered with good success to a broader range of patients at the Institute.

Horacio Asbun, M.D., chief of hepatobiliary and pancreatic surgery at Baptist Health Miami Cancer Institute

“We are pushing the envelope,” says Horacio Asbun, M.D., chief of hepatobiliary and pancreatic surgery at the Institute. “We are able to do so because we work with a great multidisciplinary team and we have developed new surgical techniques and advances in technology that enable us to operate safely, eradicating the disease and allowing more patients to have a life that is cancer-free.”

Nearly 66,500 people will be diagnosed with pancreatic cancer in the U.S. this year. Unfortunately, about 80 percent of patients are diagnosed at a late stage, making treatment difficult and prognosis poor, according to the American Cancer Society.

Domenech Asbun, M.D., hepatobiliary and pancreatic surgeon at Baptist Health Miami Cancer Institute

“There are still no reliable, routine screenings for pancreatic cancer,” explains Domenech Asbun, M.D., also a hepatobiliary and pancreatic surgeon at the Institute. “Early detection remains a challenge, but recent advances have improved survival by about 3 percent overall, which may not seem like much, but is an important step in the fight against a deadly cancer.”

Here are a few takeaways you should know if you or a loved one has been diagnosed with pancreatic cancer.

If you have options, choose a cancer center and surgeon wisely

Not all pancreatic cancer programs are equal, says Dr. Horacio Asbun, who is the driver behind the first international evidence-based guidelines on minimally invasive pancreas resection surgery, called “The Miami Guidelines.” The Guidelines, developed in agreement with nine surgical societies and 70 experts from 23 countries, recommend patients utilize high-volume centers, where at least 20 Whipple procedures are performed by experienced surgeons each year.

The decision to proceed with surgery isn’t one that is taken lightly, says Dr. Domenech Asbun. “You want to be sure that no cancer cells are left behind,” he says. “That’s why some patients will receive chemotherapy or radiation prior to surgery. If the tumor shrinks and they have a good response, you can be more comfortable being aggressive and moving ahead with surgery. It’s not that every patient who gets surgery is always cured. But if you want a cure, you have to consider surgery.”

Miami Cancer Institute also offers something few other cancer centers can — all three forms of the Whipple procedure (traditional open surgery, laparoscopic surgery and robot-assisted surgery). That means treatment can be tailored to the individual.

Be sure there’s an expert team by your side

The Institute’s multidisciplinary Tumor Board meets weekly to discuss patients and the wide variety of treatments available, including surgery, chemotherapy and specialized radiation therapy such as MR-guided radiation.

Ramon Jimenez, M.D., surgical oncologist and chief of the Division of Melanoma and Soft Tissue Sarcomas at Baptist Health Miami Cancer Institute

For some very complex cases, the Institute also brings two surgeons into the operating room, a luxury that is not reimbursed by insurance, but is endorsed by Miami Cancer Institute, says Dr. Horacio Asbun. In addition to the Asbuns, surgeon Ramon Jimenez, M.D., is an integral part of the hepatobiliary  team and they all work in tandem. The surgeons are widely published in medical journals and regularly lecture at world congresses and other international meetings. In December, Dr. Horacio Asbun is being recognized as an Honorary Member of the Japan Society for Endoscopic Surgery.

Patients attest to the high quality of Miami Cancer Institute’s gastrointestinal surgical oncology team, with 98.41 percent saying they would “likely recommend” in the last quarter.

There are more advances on the horizon

Funding for pancreatic cancer clinical trials is increasing, the doctors say, and there is some promising work being done with biomarkers and molecular studies.

“If you can better identify those at high risk, then that subgroup could undergo screenings such as MRIs or endoscopic ultrasound,” says Dr. Domenech Asbun. “In addition, with the use of molecular markers, we are beginning to better identify patients with pre-malignant cystic lesions who are actually at higher risk of developing cancer. So, where we might have followed them conservatively before, armed with this new information we may choose to be more aggressive in treatment.”

As patients with pancreatic cancer live longer lives with a good quality of life, the physicians are optimistic. “We are moving forward with a number of innovative things, all with the intention of improving care for our patients,” Dr. Horacio Asbun says.

Lower your risk

The doctors would like to remind you that to lower your risk for all cancers, you should not smoke, eat a healthy diet, lose weight if you are overweight, abstain from alcohol, exercise, manage stress and sleep well.

If you have a close relative with pancreatic cancer or other cancers, ask your physician about genetic testing. People with diabetes and those who have had pancreatitis are also at higher risk.

Symptoms of pancreatic cancer include fatigue or weakness, unexplained weight loss, nausea, jaundice, back or abdominal pain and gallbladder or liver enlargement. If you have any of these signs, speak to your primary care doctor.