Talking FACS
Host: Dr. Jennifer Hunter, Assistant Director for Family and Consumer Sciences Extension, University of Kentucky
Guest: Dr. Michael Cavnar, Surgical Oncologist and Assistant Professor of Surgery, UK Markey Cancer Center
Special Edition Series – Cancer Conversations Episode 14
0:01 Welcome to Talking FACS and thank you for tuning in to Cancer Conversations on Talking FACS; a podcast collaboration between the University of Kentucky Markey Cancer Center and the UK College of Agriculture, Food and Environment's Cooperative Extension Service.
We will share with you the latest developments in cancer prevention, diagnosis, treatment and research from the experts at Markey Cancer Center; Kentucky's only National Cancer Institute designated Cancer Center.
Talking FACS is hosted by the UK Family and Consumer Sciences Extension Program. Our educators share research knowledge with individuals, families and communities to improve quality of life.
0:41 Dr. Jennifer Hunter: Hello and welcome to Talking FACS. This is your host, Dr. Jennifer Hunter, Assistant Director for Family Consumer Sciences Extension at the University of Kentucky.
Today, I'm pleased to have joining me, Dr. Michael Cavnar, an Assistant Professor of Surgery and a Surgical Oncologist with the UK Markey Cancer Center. Welcome, Dr. Cavanar.
1:00 Dr. Michael Cavnar: Thanks for having me.
1:01 Dr. Hunter: So, as many of our listeners know, we have done a series that we call Cancer Conversations and have talked about many different types of cancer. And today, we're going to focus on pancreatic cancer.
And I just wanted to start today with really just kind of the basics of what actually is pancreatic cancer.
1:22 Dr. Cavnar: So, the pancreas is an organ that sits in the middle of the abdomen and it has a number of different important functions. One of those functions is that it produces digestive enzymes that help digest food. And another important function many people will be familiar with is it produces insulin to help control the blood sugar. There's a few other hormonal functions that are not as relevant to this discussion.
Pancreatic cancer is when people form a cancer that usually arises from the duct, which is the tube that comes out of the pancreas and where those digestive juices come out. And you can form a pancreatic cancer anywhere within the pancreas.
1:58 Dr. Hunter: So, I feel often just when the general person hears about cancer and thinks about cancer, that lung cancer is really common; we seem to get a lot of education information about that, breast cancer; we get a lot of education and information about that, and there's a lot of communication, but maybe not as much about pancreatic cancer. So, can you tell us a little bit about prevalence rates?
2:20 Dr. Cavnar: Yes. So, pancreatic cancer is actually the fourth most common cancer in both men and women. There's about 50 thousand cases a year; just over 50 thousand cases a year in 2018.
2:31 Dr. Hunter: And what about risk factors?
2:34 Dr. Cavnar: There are a variety of risk factors for pancreatic cancer; none of which are a sort of smoking gun that is a one-to-one correlation with that risk factor in pancreatic cancer.
And some of these are the typical cancer risk factors such as smoking, obesity. There's a bunch of low-level associations with things like high red meat consumption, low vitamin D, even periodontal disease or gum disease.
There's an interesting relationship between diabetes and pancreatic cancer. So, long-term diabetes can be a risk factor for pancreatic cancer. Also, new development of diabetes can be a symptom of pancreatic cancer, especially in people who are thin or elderly.
3:14 Dr. Hunter: So, you mentioned symptoms. What would be general symptoms that someone may experience with pancreatic cancer?
3:20 Dr. Cavnar: The symptoms can be vague and they often include abdominal discomfort of any variety. It could be mild and just discomfort. It could be a burning pain; pain that goes from the middle of the abdomen through to the back, nausea, vomiting. Those are all pretty nonspecific things and those could be associated with many different symptoms.
One of the important ones that comes up is, is jaundice, which is where the eyes become yellow and the whole body gets yellow. That may be associated with itching; severe itching all over the body. And that is a little bit more specific to pancreatic cancer that forms in the head of the pancreas.
4:03 Dr. Hunter: And how is an individual screened for pancreatic cancer? Are there such things as early detection or early screenings?
4:10 Dr. Cavnar: So, there's generally not a scheduled or planned screening the way that people get colonoscopies for colon cancer or mammograms for breast cancer detection and now even lung cancer screening for smokers. And that's because the pancreas is a very different type of organ.
The role of screening is really only developed for people who are at a very high risk for pancreatic cancer. And those are people that have a very strong family history of pancreatic cancer. And there's a few sort of rare mutations that people can have that are very highly associated with pancreatic cancer.
And essentially, the guidelines would say those people should be screened, but they're pretty vague guidelines; they don't say necessarily how often or how to handle indeterminate findings, where it’s like they see a little something in the pancreas, do you remove it? Do you biopsy it?
So, I think to answer your question overall is that the role of screening is fairly limited for the average person in pancreatic cancer.
5:06 Dr. Hunter: What does a screening look like? What does that consist of?
5:09 Dr. Cavnar: So, it usually be some type of imaging and that could be either a CT scan with contrast or an MRI with contrast or another thing called an endoscopic ultrasound, which is a procedure done by a gastroenterologist.
5:22 Dr. Hunter: And so if someone is experiencing some of those symptoms that you mentioned earlier and as you said, because as you're rallying them up, I was thinking, “Oh, my goodness, that could be almost anything.” What should be their next step? What should someone do?
5:34 Dr. Cavnar: Well, as you said, those are often common symptoms and those could range anything from food poisoning to a variety of conditions like an ulcer.
And so, I think the first step is that the patient to go see their primary doctor and they should be evaluated and physical; they should examine the patient – physical exam, obviously noting any signs of jaundice and particular if the patient thinks that they've become yellow.
One important point about that is the patient himself often does not notice it. It's usually the family members and notices because it happens slowly over time. But going into their physician for an evaluation and routine blood work will pick up things like elevated liver enzymes, which may be a hint of this.
Also, an evaluation of the blood sugar. So, as I mentioned, diabetes or new onset worsening of blood sugar control can be a sign of developing pancreatic cancer.
Now, in most people who develop diabetes, it's not, but it's something that it's important that physicians are aware of, too, is that if a patient has newly worsening diabetes, that's something to think about.
6:40 Dr. Hunter: So, if an individual visits their family physician and they are referred for additional specialty care and diagnosed with pancreatic cancer, what would potential treatment options be for that individual?
6:54 Dr. Cavnar: So, the treatment is highly variable from patient to patient. And one of the most important things in care of pancreatic cancer is going to a center that has a lot of experience. It's not just a surgeon. You need a radiologist who is very experienced in this, a gastroenterologist or GI doctor, a medical oncologist, radiation oncologist, nursing, social work.
All that falls under the umbrella of multidisciplinary care. And these patients are complicated and the treatment pathway, varies highly from patient to patient. So, it's really important to go see care at a specialized center for this.
7:33 Dr. Cavnar: And can you share with us a little bit about how aggressive is pancreatic cancer?
7:38 Dr. Cavnar: Pancreatic cancer is actually one of the most aggressive forms of cancer that we take care of.
7:44 Dr. Hunter: And maybe this might be different for different people, but if someone had stage one pancreatic cancer, how quickly might it progress over time?
7:53 Dr. Cavnar: So, if they were diagnosed newly with the pancreas mass and let's say they had an operation to remove it, typically people, even with stage one pancreatic cancer receive chemotherapy. And the outcome would depend on what chemotherapy treatments they have.
But on average, even early stage pancreatic cancer is like a stage one pancreatic cancer. Only about 40 percent of people are alive at five years. So, you can imagine the remainder of those patients have some form of progression. And in some patients, that happened several years later but in others, that can happen even within months of surgery.
8:30 Dr. Hunter: I appreciate you being here with us today and sharing additional information with us about pancreatic cancer. Because, again, I think that it's important for our listeners that the more that we can have these conversations, encourage conversations with family physicians.
And we talk often about those needing to be open and honest conversations of truly communicating about your symptoms, that the more likelihood that it is to, I guess, be diagnosed and find a potential treatment options.
Thank you so much for being here today. And just to remind our listeners as part of the show notes that we'll have a complete transcription of today's conversation as well as a link to the Markey Cancer Center, if you're looking for additional information. Thank you so much.
9:18 Thank you for listening to Cancer Conversations on Talking FACS. Our goal is to connect you with the latest advances in cancer research in the Commonwealth.
If you enjoyed today's podcast and have a suggestion for a future show topic, please message us on the UK Markey Cancer Center Facebook page at facebook.com/ukmarkey. Or visit our website at markey.uky.edu for more information.
You can find University of Kentucky Family and Consumer Sciences Extension Programs at your local extension office or online at fcs.uky.edu. Building strong families. Building Kentucky. It starts with us.
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