Surgical Care of Pancreatic Cancer

June 01, 2021

Information

May 30, 2021

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

ID6660

To CiteDCA Citation Guide

00:00Support for Yale Cancer Answers
00:02comes from AstraZeneca, dedicated
00:04to advancing options and providing
00:06hope for people living with cancer.
00:09More information at
00:12astrazeneca-us.com.
00:15Welcome to Yale Cancer Answers with
00:17your host doctor Anees Chagpar.
00:19Yale Cancer Answers features the
00:21latest information on cancer care by
00:23welcoming oncologists and specialists
00:25who are on the forefront of the
00:27battle to fight cancer. This week
00:29it's a conversation about pancreatic
00:31cancer with Doctor John Kunstman.
00:33Doctor Kunstman is assistant
00:34professor of surgical oncology
00:36at the Yale School of Medicine,
00:38where Doctor Chagpar is a
00:40professor of surgical oncology.
00:43John, maybe we can start off by you
00:45telling us a little bit more about
00:47pancreatic cancer. How common is it?
00:49Who gets it, and why should we care?
00:52Well, I think there's several
00:54components to that answer.
00:56Anybody can get pancreas cancer,
00:59but it is generally a disease that,
01:00like most cancers, occurs as we age.
01:03There is a little bit more
01:04likelihood for men to get it,
01:05but of course women can
01:07get pancreas cancer too.
01:08I think it's a disease that
01:10we should all be aware of,
01:11because as most cancers can be
01:14screened for nowadays, pancreas
01:16cancer is one that we really don't
01:18have an effective screening test for.
01:19So we want everybody to be aware of it.
01:22Also, by 2030,
01:23the National Cancer Institute
01:25predicts that pancreas cancer will
01:27be the second leading cause of
01:29cancer death in the United States,
01:31so I think it's something that's
01:33worth our attention.
01:34John, why is that?
01:36Why is it going to be the second
01:39leading cause of cancer related deaths?
01:41I hadn't heard that before.
01:43Is it because it's getting more common,
01:45or is it because it's getting more lethal?
01:48There is an increase in the
01:50prevalence of pancreas cancer,
01:52although it's not the main reason.
01:53The main reason is that
01:54the more common cancers that
01:57currently are more apt to cause
01:59cancer deaths in the United States,
02:01the treatment of those cancers,
02:03such as breast cancer or
02:04lung cancer or colon cancer,
02:06which are all more common
02:07than pancreas cancer,
02:08are improving and the death rate is falling.
02:10Whereas in pancreas cancer the death
02:12rate hasn't improved at the same rate.
02:15So let's talk a little bit about
02:18pancreatic cancer and you
02:20mentioned that we don't
02:23have screening for pancreatic cancer,
02:26but it certainly is a cancer
02:28that people should be aware of.
02:30How can people
02:32understand whether or not they
02:34have pancreatic cancer when
02:36there is no screening test.
02:38Can you tell us what the symptoms
02:40are that we might be looking out for?
02:42That's a terrific question,
02:44and because that is one of the
02:46main reasons that the death rate
02:48for pancreas cancer is so high,
02:49and it's viewed as such an aggressive cancer.
02:52Many times patients are unaware
02:53when they have a pancreas cancer
02:55until it's become quite advanced
02:57and the symptoms are quite subtle.
02:59In terms of the symptoms that most
03:02people will experience there are very mild
03:04things like abdominal discomfort,
03:06things that could easily be
03:08attributed to something else,
03:09such as a stomachache or just eating
03:11a bad meal or something like that.
03:13But for patients with pancreas cancer,
03:15that discomfort persists for a long time.
03:17It's not episodic, it's not going away.
03:19It's something that really should
03:21lead to a visit to the doctor.
03:23Also, things that are not subtle
03:25but can sometimes go unrecognized by
03:27patients as being very important,
03:29are things like jaundice or pancreatitis.
03:32Those are obviously big time medical
03:34issues that deserve attention,
03:35but many times can go on unappreciated
03:38as pancreas cancer being the cause
03:40of those findings for too long.
03:43I'd also like to mention weight loss.
03:45Unfortunately, in the United States,
03:47many people have trouble,
03:49myself included,
03:49losing weight and when we're adults
03:52it's difficult to lose weight durably
03:54without a major lifestyle change,
03:57and many patients with pancreas cancer
03:58We noticed over the past weeks to
04:01months that they've lost weight without
04:03making any major lifestyle changes.
04:05Many patients with pancreas cancer
04:07find that the first sign was that
04:09unrecognized weight loss when they go
04:10back and think about what might have
04:12happened prior to their diagnosis.
04:14After what duration of time should
04:18people with these symptoms go in and
04:20seek medical advice?
04:23Is that a day, a week, a month, a year?
04:26I think it really gets into the weeks,
04:28something that
04:30can be attributed to one of those
04:33other causes like a stomach bug.
04:35Usually we're feeling better within
04:37a week once we start having those
04:39vague symptoms and they're really
04:40starting to affect our lives once
04:42we get to the weeks time frame,
04:44it's time to go see your doctor.
04:46Also same thing with the weight loss.
04:48A few pounds is not a big deal and it
04:50might just be that you're doing better
04:51with your exercise regimen or watching
04:53what you eat a little bit better.
04:55But when we start losing 10,15
04:57or 20 pounds without making a
05:00major major lifestyle change,
05:01that should start to wave
05:02the red flag a little bit.
05:04And so when we go to our doctor, what
05:07should we be expecting our doctor to do?
05:10It really should be a lot of questions,
05:14detailed questions when
05:15you go to see your doctor,
05:17a physical examination for possible
05:19diagnosis of pancreas cancer.
05:21Apart from jaundice or the weight
05:23loss might not reveal a lot,
05:25but those careful questions about
05:27the nature of the symptoms,
05:29their duration and some of the specifics
05:32is really where the attention may
05:34bring up a possible diagnosis of a
05:36cancer you might want to prepare yourself
05:39for some uncomfortable questions too,
05:41about things like your bowel function
05:43because those can be affected by a pancreas cancer.
05:45And those are just your
05:47doctor trying to get to the bottom
05:49of those symptoms or findings.
06:08Should we be more concerned
06:09if we have a family history?
06:11Is pancreatic cancer one of those
06:13where we should get to know our family
06:16history and who's got what?
06:18Because that might increase our risk.
06:21It is actually that's one of the
06:23major risk factors for pancreas cancer.
06:26There are some minor risk
06:28factors that we can affect
06:29with our own lives, for instance,
06:31cigarette smoking or exposure to
06:33certain chemicals like asbestos
06:35do have a correlation with a
06:37higher risk for pancreas cancer.
06:39But that increase in risk
06:41is actually rather small.
06:43However, family history is a very
06:45strong risk factor for pancreas cancer,
06:48and it's thought that about 10% or maybe
06:51even a little more than that cases of
06:53pancreas cancer are hereditary in nature.
06:56If you have a primary relative,
06:58in other words,
06:59a sibling or parent that has pancreas cancer,
07:02your risk of getting pancreas cancer
07:05yourself is about four or five times higher.
07:07And if you have two first degree relatives,
07:10that risk goes up to six
07:11to seven times higher,
07:12so it is something that we
07:14should be aware of.
07:15And that we should be thinking about
07:17in terms of what our family knows.
07:19The other thing I just want to mention
07:21is that we talked about screening briefly
07:24before and for asymptomatic patients
07:26or patients with those vague symptoms,
07:28there's really no role with our current
07:31tools for screening for pancreas cancer.
07:33However,
07:34those patients that do have
07:36a strong family history,
07:38there are screening programs available,
07:41and it appears even in these early
07:42stages of those screening programs
07:44that they might be effective
07:46at improving outcomes for patients.
07:48What do they screen with?
07:49So that's a little bit of a debate right now.
07:53When we started screening for
07:55pancreas cancer and by we I
07:57mean the medical community,
07:59there was a very big debate
08:01about the best way to do it,
08:02and there's a few modalities
08:04that are available.
08:05Most of them are centered on imaging,
08:07such as CT or MRI,
08:10and right now we think that MRI is
08:12probably the better way to screen
08:15simply because there's less radiation
08:17exposure compared to CT scans.
08:19Also,
08:19endoscopy using a particular technique
08:22called endoscopic ultrasound,
08:24where a gastroenterologist uses a
08:26tiny ultrasound probe at the end
08:29of their endoscope to actually
08:31look through the walls of your
08:33stomach at the pancreas itself.
08:35Now, of course, that's a procedure,
08:37but it's a day procedure and most people
08:39can go home immediately thereafter,
08:40not unlike a colonoscopy.
08:43Those screening programs right now
08:45generally use a combination of those
08:48two techniques and imaging
08:51and some programs alternate them.
08:55And so John, a couple of questions on that.
08:58First, how often are these
09:01done in the screening programs?
09:04Like is this an annual thing or
09:05is it more like a colonoscopy
09:07where you can go for 10 years?
09:09So right now it's an annual
09:11thing or even semiannual,
09:13depending on the risk,
09:14and I just want to point out that this
09:17is an area of active investigation right now.
09:21There are several trials ongoing
09:24at major centers that do these
09:27screening programs investigating
09:28what the best modality is for
09:31not only detecting the cancer
09:33but using the information that's
09:35generated from that screening.
09:38And so that brings up
09:40another question which is that many screening tests,
09:45mammograms, colonoscopies,
09:47PAP tests, are covered by insurance.
09:52It sounds like this MRI and endoscopic
09:55ultrasound might be really expensive tests.
09:59Are they covered by insurance or is this
10:01all considered experimental right now?
10:04That's a great question too.
10:06In general they are covered.
10:08There are some active research protocols.
10:12If you are included in those
10:15active research protocols,
10:16generally the research
10:17study pays for the test,
10:19but most patients will find that
10:21it's covered one way or the other.
10:24My other question is,
10:27are there any blood tests for
10:29screening of pancreatic cancer?
10:31Many people are interested
10:32in the least invasive way to
10:35screen for cancer and are
10:36always thinking about tumor
10:37markers that might show up that
10:39might tell them that they are
10:41at increased risk for cancer.
10:43Anything like that in pancreatic cancer?
10:48There are some tumor markers that are fairly
10:52specific and sensitive for pancreas cancer,
10:55but those markers can also be
10:58elevated in patients without cancer,
11:00just as part of their day-to-day life.
11:02So for that reason, in asymptomatic
11:04patients or patients at average risk,
11:07we don't recommend any blood tests right now.
11:10That may sound a little bit strange to have
11:13a marker that we don't use in routine tests,
11:16but I'll give you an example.
11:18One of those markers is called CA 19-9,
11:21which is a blood marker,
11:23and that marker is elevated in most
11:26patients with pancreas cancer. However,
11:28that marker is secreted by the Biome.
11:31That's how it's metabolised in the body.
11:33So that means somebody that may
11:35have a little bit of sludge in
11:37their bile or even a gallstone
11:39which has nothing to do at all with pancreas
11:42cancer could have a very high C 19-9.
11:44So we don't want to have patients
11:47get screened and go through
11:48an enormous amount of testing,
11:50some of which might be invasive for
11:52something that's just a red herring.
11:54The other question that I have is you
11:57talked about people having a family
11:59history of pancreatic cancer being at
12:01four or five times the average population
12:04risk of developing pancreatic cancer.
12:06What if you don't have a family
12:09history of pancreatic cancer,
12:10but you might have a family
12:12history of other cancers,
12:14say more common cancers like
12:16breast cancer or prostate cancer?
12:19Does that increase your
12:20risk of pancreatic cancer?
12:22Sometimes it does,
12:25and the two genes that are most closely
12:28correlated that people know about with
12:30breast cancer or ovarian cancer and some
12:33others is the BRCA one and two genes,
12:36and those do convey a risk,
12:38particularly BRCA 2 for pancreas cancer.
12:41For patients that have family that
12:44have those other types of cancers,
12:46especially multiple family members.
12:48And I'm talking about again
12:51breast or ovarian cancer.
12:52It's worth talking to your doctor
12:55about considering a genetics referral.
12:57The medical genetics services at
12:59most centers now are well aware of
13:01these associations and can very
13:03easily with the blood test determine
13:05whether or not you have one of those
13:07mutations that you might be carrying
13:09that could increase your risk.
13:11Well, we're going to pick up this
13:13conversation right after we take a
13:15short break for a medical minute.
13:17Please stay tuned to learn more
13:18about the surgical care of
13:20pancreatic cancer with my guest
13:22Doctor John Kunstman.
13:23Support for Yale Cancer Answers comes
13:26from AstraZeneca, working to eliminate
13:28cancer as a cause of death. Learn more at
13:33astrazeneca-us.com.
13:35This is a medical minute about genetic
13:37testing which can be useful for
13:39people with certain types of cancer
13:41that seem to run in their families.
13:43Patients that are considered at risk
13:46receive genetic counseling and testing so
13:48informed medical decisions can be based
13:50on their own personal risk assessment.
13:53Resources for genetic counseling and
13:55testing are available at federally
13:57designated comprehensive Cancer centers.
13:59Interdisciplinary teams include geneticists,
14:02genetic counselors,
14:04physicians, and nurses
14:05who work together to provide
14:07risk assessment and steps to
14:09prevent the development of cancer.
14:11More information is available
14:13at yalecancercenter.org.
14:15You're listening to Connecticut public radio.
14:19Welcome
14:19back to Yale Cancer Answers.
14:21This is doctor Anees Chagpar and
14:23I'm joined tonight by my guest Doctor
14:26John Kunstman and we are talking about the
14:28surgical care of pancreatic cancer
14:29and John right before the break
14:31you were mentioning that patients
14:33who might not have a family history
14:36of pancreatic cancer but might
14:38have a family history of other
14:40cancers like breast and ovarian
14:42cancer should probably go and seek
14:45genetic counseling because those
14:48BRCA one and two gene mutations
14:51may increase their risk of
14:53pancreatic cancer as well,
14:55so are there other genetic
14:57syndromes that might also have
14:59implications for pancreatic cancer?
15:03Yeah, there are a few and some
15:05of them are quite rare, but one that
15:07also comes up not too infrequently
15:09is something called Lynch syndrome or
15:12hereditary nonpolyposis colon cancer.
15:14Now this disease is actually a
15:17constellation of genes that may or may
15:19not be mutated in a particular patient.
15:22And they are typically associated
15:24with colon cancer, hence the name.
15:26However, those screening programs we
15:29were talking about before for patients
15:31that do carry one of those mutations,
15:34again, screening programs would include
15:36them looking for pancreas cancer too,
15:40so I think it just underscores
15:43as you mentioned before,
15:44the need to really be in touch with
15:46your family medical history if you can,
15:48and if there is a strong family history,
15:51consider talking about it with your
15:53doctor and whether or not a genetics
15:55referral would be a good idea.
15:57John, I was
15:59wondering before the break
16:01you had mentioned the fact that
16:04pancreatic cancer can be increased
16:06in smokers and people who
16:08have been exposed to asbestos.
16:11We often think of those factors
16:13really playing into lung cancer
16:15as opposed to pancreatic cancer.
16:17But you also mentioned that one of the
16:21tumor markers for pancreatic cancer
16:24that CA 19-9 was one that was
16:28involved with the bile,
16:31and so I wonder whether things that
16:34affect the liver and the biliary
16:37system also affect pancreatic cancer?
16:40So are you at increased risk
16:41for example, if you are heavy on alcohol,
16:48or if you are obese,
16:51or if you have diabetes,
16:53any of those things that we think of
16:55that go along with liver disease also?
16:58affect the pancreas and increase
16:59your risk of pancreatic cancer.
17:02So let's take those one at a time.
17:04In terms of lifestyle risk,
17:06there's been a tremendous amount
17:08of study on pancreas cancer and
17:11those lifestyle considerations,
17:13and some have really not played out
17:15or have shown contradictory results.
17:17Depending on which study you read.
17:19And these are things like certain
17:21kinds of tea, red meat, vitamin D, etc.
17:26However, alcohol, the chief risk comes
17:28from those patients that develop
17:30pancreatitis as a result
17:33of their alcohol use,
17:34as many of your listeners may know,
17:36folks can get pancreatitis
17:38from heavy alcohol use,
17:40or some patients can get it
17:42even with mild alcohol use.
17:43Now it's not a subtle thing
17:45when you get pancreatitis,
17:46but for folks that have
17:47had multiple episodes,
17:48chronic pancreatitis if you will,
17:51the risk for pancreas cancer is much,
17:53much higher, extremely elevated.
17:55That can also happen to patients
17:57that have problems with recurrent
17:59gallstones that can create a
18:01phenomenon called gallstone
18:03pancreatitis quite different than the
18:05typical benign gallstones that lead
18:06to the discomfort people think about
18:08when they consider their gallbladder.
18:10But when any of those risk
18:12factors leads to pancreatitis,
18:14the risk for pancreas cancer
18:16goes up considerably.
18:18With regards to obesity,
18:20there is an association with a higher
18:23body mass index or risk of obesity
18:26that goes along with pancreas cancer.
18:29It's not as strong as,
18:31say,
18:31family history or history of pancreatitis,
18:34but it is there and it's particularly
18:37notable in patients that have a
18:39high BMI or obesity younger in life.
18:42And then I believe,
18:43the other one you mentioned was diabetes,
18:45and this is actually a bit
18:47of a confusing area.
18:49There is a very strong link with new
18:52onset diabetes and pancreas cancer,
18:54but all is not as it seems.
18:57Certainly that link is there,
19:00but most people that have newly diagnosed
19:03diabetes do not have pancreas cancer.
19:06However,
19:06for patients with the pancreas cancer,
19:09many of them will develop diabetes,
19:11hence the link.
19:12It turns out that it probably is
19:15not the diabetes itself that is
19:17creating the pancreas cancer,
19:19but the effect
19:20the cancer that's growing in the
19:23pancreas has on our ability to
19:26metabolize glucose effectively.
19:27So in other words,
19:28it's not the diabetes that seems
19:30to lead to the pancreas cancer.
19:32Rather,
19:32it's the pancreas cancer leading
19:35to the new diabetes.
19:36However,
19:37that link is not completely clear.
19:40It's still again an area of
19:42pretty active research.
19:43The other thing that is interesting,
19:46I had a friend who not long ago
19:50was diagnosed with pancreatic cancer,
19:52and she had been a diabetic all her
19:55life and one of the things that tipped
19:58off her doctor to the diagnosis
20:01was the fact that her diabetes
20:03became more difficult to control.
20:05Is that something that people who are
20:07diabetics should be paying
20:09attention to as well?
20:11Yes, and I think that
20:13illustrates the point perfectly.
20:15It's not so much that the diabetes was there,
20:18but it's a sudden change.
20:19In other words, somebody that wasn't
20:22diabetic may be in very good shape.
20:25No other risk factors for diabetes
20:27suddenly becomes diabetic or somebody
20:29that had a longtime case of diabetes
20:32with the medication management being
20:34very stable,
20:36suddenly worsening.
20:38And so all of these are good things to be
20:40looking for when you go to see your doctor.
20:43If you're concerned about a potential
20:46diagnosis of pancreatic cancer,
20:47which otherwise is a pretty sneaky cancer
20:50in terms of not really revealing itself.
20:53How is the diagnosis made?
20:55Well, generally speaking,
20:57the diagnosis is made in patients
20:59that have only subtle symptoms,
21:01with imaging many times those
21:03findings that we talked about, say,
21:06worsening diabetes coupled with weight loss.
21:09Or new abdominal complaints coupled
21:11with weight loss will lead to a scan,
21:13typically a CAT scan or sometimes an MRI,
21:16and that's usually the first hint that
21:18there could be something wrong now in
21:21patients that have new jaundice or
21:23something that's a little bit more obvious,
21:25sometimes the diagnosis is
21:26made in other ways,
21:27but typically it's imaging.
21:29And then what happens?
21:30Do these patients get a biopsy?
21:32Nowadays they typically do,
21:33and one thing I think that's
21:35important to highlight here and
21:37we're sort of segueing into this
21:39is that this is a cancer that really
21:42requires a large expert team to manage.
21:45Now we're talking about radiology here
21:47with regards to CAT scans and MRIs
21:49but ultimately when you
21:50do get a new diagnosis,
21:51it needs special cat scans and Mris,
21:55an expert radiologist to interpret
21:57them with regards to biopsy.
21:59It's typically done by a gastroenterologist
22:01and the techniques that they use
22:03are not the typical techniques they
22:05use that and discovered ultrasound
22:06that we were talking about before,
22:08or they may even need to do a procedure
22:10on the bile duct or pancreas.
22:12So these are all expert procedures
22:14and they really do require a big
22:16team even before you get to the
22:18involvement of an oncologist or surgeon.
22:21And presumably you know these days
22:23we talk on this show so much about
22:27personalized medicine and genomics
22:29and all of the fancy tests and assays.
22:32Is pancreatic cancer in that realm as well?
22:35Where
22:36we've moved so far in terms of the medical
22:39and surgical management of this disease,
22:41that there are nuances in
22:43terms of the pathology?
22:45That's a great point,
22:47and it certainly applies for pancreas cancer.
22:51Just in the last year,
22:52I guess a little over a year,
22:54the recommendation has come down
22:56from the NCI and the National
22:58Comprehensive Cancer Network,
23:00that every patient with a
23:04diagnosis of pancreas cancer,
23:06should have a genetics referral
23:08so that they can see whether any
23:10of those mutations are present.
23:12Why are we doing that?
23:13Well, we have all these new advances,
23:15including immunotherapy
23:16and targeted therapies.
23:18And we're finding that more and
23:20more patients may have something
23:22particular to their case that
23:24will ultimately direct the
23:26treatment in a specific way.
23:31And I think the other thing that's
23:34important to point out here,
23:36and certainly was the case with
23:38my friend was she was actually
23:41diagnosed in a smaller center.
23:44But I encouraged her to get a second opinion,
23:47and it changed the diagnosis from
23:51the perception that this may be
23:54metastatic to the perception that
23:57this might not be metastatic and
24:01could potentially be resectable with
24:03a bit of chemotherapy 1st to see if
24:06we could could shrink the disease.
24:08So can you talk about kind of
24:11getting a second opinion and how
24:13important that is and whether it
24:16changes things and how frequently?
24:20It's important for a couple of reasons
24:22and I don't want to minimize the role
24:26that every health care provider in system
24:29has in regards to battling this disease.
24:32Certainly the diagnosis can be made anywhere,
24:35but I think the important thing
24:37is you want to be managed,
24:39or at least have an opinion from a group
24:42that treats this disease frequently.
24:44Because there are a lot of nuances
24:46and one of them that you mentioned is
24:48determining whether or not a cancer
24:50of pancreas cancer can be removed
24:52with an operation we know with utter
24:55certainty that the patients that do
24:57the best are those that can have
24:59surgery to remove the tumor,
25:01and sometimes that
25:02opinion may change depending on
25:04whether you're at an experienced
25:06center and quite honestly,
25:08it might change from one
25:11experienced center to another.
25:13The other thing too is that
25:16multidisciplinary management,
25:17even if a cancer cannot necessarily
25:19be removed in pancreas cancer.
25:22There are many, many,
25:23many clinical trials with some
25:25of the newest agents that could
25:27be available to a patient,
25:28especially if they're treated at
25:31a comprehensive Cancer Center.
25:33I think that's a great point.
25:35And also we know in particular with
25:38the surgical outcomes folks do better
25:40if they're at not just a surgeon that
25:43does a lot of pancreas cancer surgery,
25:46but at a center that does a lot of surgery
25:48because of that multi disciplinary component,
25:51it's the intensive care units,
25:53the radiologist,
25:54the gastro neurologist that are
25:55at a big center that does,
25:58you know 20-30 ,forty,
26:00sometimes 100 plus cases a year.
26:03Those resources will be available
26:05at those centers and the outcomes
26:07are better in a commensurate way.
26:11And the other thing is,
26:12are all pancreatic cancers the same?
26:14I mean is this a homogeneous kind
26:17of disease or are there nuances
26:19and subtleties in terms of the
26:21different types of pancreatic cancer?
26:25There are and I think we talked a little
26:28bit about how some of the genetics of
26:31an individual tumor may actually change
26:33management from patient to patient.
26:35One thing I would like to mention
26:38really quickly is that about 75
26:41to 85% of cancers in the pancreas
26:44arise with association with a small
26:46polyp like lesion in the pancreas.
26:49But about 15 to 20% arise in coordination
26:54with something called intraductal
26:57papillary mucinous neoplasms.
26:59And these pancreas cysts are unique
27:01because unlike most pancreas cancers,
27:03we can't detect them prior to
27:06the emergence of the cancer.
27:08But these lesions,
27:10these precancerous cysts can be
27:13detected on endoscopy or on CAT scans,
27:17and we really think this might be a
27:18way to start making a dent in a certain
27:21fraction of these patients that have
27:23I PMNS,
27:23where we might be able to treat them
27:25prior to the emergence of the cancer.
27:29So how would that work John?
27:31Is that like you go for
27:33your yearly MRI because you're at
27:35high risk and they find this cystic
27:37lesion and you're able to remove
27:39it before it becomes a cancer.
27:42That's one scenario,
27:43another scenario that we're seeing
27:45very commonly as a patient might get a
27:47CAT scan or an MRI for something else.
27:49Whether it's back pain or they're
27:51in a car accident, or any reason.
27:53And there's a cyst seen in the pancreas,
27:56and one thing I just want to make sure
27:58your listeners understand is most
28:00pancreatic cysts are not precancerous,
28:04and these precancerous lesions won't
28:07actually turn into a cancer,
28:09but some will, so risk stratification,
28:13and careful decision-making,
28:14which again takes an experienced,
28:17multidisciplinary group,
28:18is really the key to managing them.
28:21And when we do see one of these
28:24precancerous cysts, or I PMNS,
28:25that looks like it might be
28:27turning into a cancer,
28:28or perhaps even have a small cancer present,
28:31we can act on it to remove it
28:33prior to the emergence of an
28:36aggressive metastatic cancer.
28:38Doctor John Kuntsman is an assistant
28:40professor of surgical oncology
28:42at the Yale School of Medicine.
28:44If you have questions,
28:46the address is canceranswers@yale.edu
28:48and past editions of the program
28:51are available in audio and written
28:53form at yalecancercenter.org.
28:54We hope you'll join us next week to
28:57learn more about the fight against
29:00cancer here on Connecticut Public Radio.