When Dr. David Kooby writes or talks about pancreatic cancer — specifically pancreatic ductal adenocarcinoma — he can’t get around the reality of a grim prognosis.
The best approach to fight this cancer is surgery that carves out the malignant cells, but Kooby said only 15 percent to 20 percent of patients, who average about 67 years of age, are candidates for the operation because the disease is too advanced or they aren’t healthy enough for the procedure.
Perhaps 20 percent of those who get the surgery see a long-term survival benefit. That’s three or four out of every 100 patients diagnosed who will live for several years after surgery, said Kooby, a member of Ahavath Achim Synagogue who is the director of surgical oncology at Emory St. Joseph’s Hospital.
That’s not to say the surgery is rarely worthwhile. The average patient who gets no treatment lives six months after a ductal adenocarcinoma diagnosis; the life expectancy grows to eight or nine months with chemotherapy. With surgery, survival is typically closer to 20 months, the doctor said.
Kooby and his colleagues are working hard to improve the surgical odds and perhaps have reason for optimism in a tool developed by Georgia Tech and Emory engineers and scientists.
“We are hopeful that survival for patients will improve in the years to come,” he said.
The additional grim news is that surgeons need more success against pancreatic cancer because the incidence of the disease is growing.
The Centers for Disease Control and Prevention reported about 29,000 new cases annually 15 years ago; now the number is about 50,000.
Multiple factors are producing more cases, Kooby said. The most obvious is that baby boomers are hitting their 60s and 70s, so more people are in the age group most likely to develop the disease. Better diagnostic technology is helping find tumors whose spread might have confused doctors 20 years ago. And people are more likely to talk about pancreatic cancer now.
The biggest risk factor for pancreatic cancer is something you can control — smoking — and Kooby said it’s likely that obesity and diet play roles in cancer in a digestive organ. Dysfunction in the pancreas is connected to diabetes, so it’s not surprising that the development of diabetes later in life is associated with pancreatic cancer.
There also are genetic influences, including the BRCA gene linked to breast cancer. If you have a family history of pancreatic cancer, your risk is higher. But unlike breast, colorectal, prostate and lung cancers, there’s not a good screening test for pancreatic cancer, so it’s hard to catch early even if you think you’re at risk.
The symptoms often are nonspecific, such as weight loss and malaise, but jaundice in someone in his 60s is a strong sign, as are dark urine from bile getting into the bloodstream or white stools from bile not making it to the colon.
For those pancreatic cancer patients who have surgery, Kooby said, one of the keys to success is removing the whole tumor but as little healthy tissue as possible. Taking out the whole pancreas, for example, leaves the patient with diabetes and digestive problems. The more of the pancreas you can leave, the better.
“We’re pioneering ways to identify where the tumor ends and normal tissue begins to optimize tumor removal,” Kooby said.
That’s where a surgical tool called the SpectroPen, announced by Emory and Georgia Tech five years ago, might make a difference.
A medical dye that binds to proteins in the bloodstream is injected into the patient at the start of surgery. Because the blood vessels around a tumor are abnormal, the amount of dye spikes at the edges of a tumor. The SpectroPen uses a spectrometer to identify with precision those areas and thus define the margins of the tumor.
In preliminary testing, the pen seems useful, Kooby said.
“We’re in an era when we are — although there is a long way to go in understanding, treating and helping patients with this disease — making some progress,” he said. “We have to maintain some optimism for the future.”