Advances in Treating Pancreatic Cancer Help Extend Survival

Because it develops in a hard-to-access organ and can grow silently for months or more before it produces any symptoms—making detection and treatment difficult—pancreatic cancer has long been regarded as one of the most challenging cancers.

That reputation is well deserved, experts acknowledge, but they emphasize that pancreatic cancer treatments today are aided by new technologies that are helping extend survival and improve quality of life for patients.

Pancreatic cancer accounts for approximately three percent of all cancers, according to the American Cancer Society (ACS), but it is the country’s third leading cause of cancer deaths among both men and women. It is expected to kill more than 50,000 U.S. adults this year.

At Baptist Health Miami Cancer Institute, Horacio Asbun, M.D., chief of hepatobiliary and pancreatic surgery, and his son, Domenech Asbun, M.D., a hepatobiliary, pancreas and foregut surgeon, have been at the vanguard of global pancreatic cancer research and treatment. The elder Dr. Asbun is considered a pioneer in the field of hepatobiliary surgery, and the minimally invasive techniques he has developed for pancreas surgery are employed by surgeons around the world.

For National Pancreatic Cancer Awareness Day, which was observed on November 16, the father-son team of surgeons spoke with Resource editors about where pancreatic cancer treatment is today and why those diagnosed with the disease have reason to be hopeful.

Resource: First off, could you explain why pancreatic cancer is typically so hard to detect?

Domenech Asbun, M.D.:The pancreas is a glandular organ that’s tucked behind the stomach and somewhat hidden in the abdomen. As a result, issues with the pancreas often go unnoticed until they directly affect the bile or pancreatic ducts, the two tubes that traverse the organ. This means that tumors can grow for months or even years without causing noticeable symptoms, making early detection a real challenge.

Domenech Asbun, M.D., hepatobiliary, pancreas and foregut surgeon with Baptist Health Miami Cancer Institute

Resource: Are there different types of pancreatic cancer?

Domenech Asbun, M.D.: Yes, pancreatic tumors can form in either the exocrine or endocrine cells of the pancreas, a gland in the abdomen located behind the stomach. Exocrine cells produce enzymes that help your body digest food, while endocrine cells make hormones—including insulin—that control your blood sugar levels. Exocrine tumors are far more common than endocrine tumors and are usually cancerous, or malignant. They typically start in the pancreatic ducts and are most often adenocarcinomas. Unfortunately, these tumors are usually not found until the cancer has advanced.

Endocrine tumors, however, are less common and can be malignant or benign. These tumors are sometimes referred to as pancreatic neuroendocrine tumors (NETs) or islet cell tumors. Although the treatment for endocrine tumors depends on the tumor’s type and stage, patients with endocrine tumors generally have a better prognosis compared with those with exocrine tumors.

Resource: What are the best surgical options now available for treating pancreatic cancer?

Horacio Asbun, M.D.: The location of the tumor dictates the type of surgical procedure. Left-sided tumors are typically treated with a procedure known as distal pancreatectomy or distal pancreatectomy with splenectomy, which means a removal of the left side of the pancreas and the spleen. Although this is a complex surgery, it is less intricate than dealing with lesions on the right side of the pancreas.

For right-sided lesions, the procedure of choice is a pancreatoduodenectomy, commonly referred to as the Whipple procedure. This is widely considered to be one of the most challenging surgeries within the abdominal area but it’s one I’ve been doing for more than 20 years. This involves the removal of the right portion, or the head of the pancreas, as well as adjacent structures including the duodenum and bile ducts.

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

Regardless of which side the tumor is on, there are two main approaches to pancreas surgery: the traditional open approach and the minimally invasive approach, which can be either laparoscopic or robotic surgery.

Laparoscopic and robotically assisted surgery are essentially the same thing, as far as the patient is concerned. Both methods result in a similar outcome, with surgery performed through small incisions. The primary distinction lies in the tools and techniques employed by the surgeon. Thanks to the enhanced 3D visualization and magnification afforded by laparoscopic or robotic technology, surgeons have better access to hard-to-reach abdominal areas.

Research has demonstrated that the minimally invasive approach yields several advantages, particularly in terms of reducing the length of hospital stays, alleviating postoperative pain and enabling patients to return to their regular lives and work sooner. With its extensive experience in minimally invasive surgery, Miami Cancer Institute is recognized as one of the world’s leading centers for the treatment of pancreatic and other cancers.

Resource: Aside from surgery, what other treatments are available for pancreatic cancer?

Domenech Asbun, M.D.: Traditionally, only about 15 percent of patients diagnosed with pancreatic cancer are eligible for surgery, and without surgery, achieving a full cure becomes extremely difficult. For patients who do undergo surgery, however, there is progress to report. While the chance of being fully cured within five years following pancreatic surgery remains around 30 to 40 percent, which is still not ideal, it is a significant improvement from initial figures, which once were as low as 10 percent.

We’ve changed our approach to potentially expand the pool of surgical candidates by leveraging chemotherapy, radiation therapy and other strategies so that we can now offer treatment options to those who were previously considered ineligible for surgery.

We’re also now utilizing fluorescence imaging during surgery, often referred to as Indocyanine Green (ICG) imaging, which involves injecting a solution into the patient’s veins and using a specialized camera to detect and highlight specific anatomic structures. ICG is a valuable tool for enhancing surgical precision and for potential earlier detection in the future. The technology is continuously being refined to improve surgical outcomes.

There is hope, too, for pancreatic cancer patients who don’t qualify for surgery. With the advent of newer chemotherapy agents and other treatment modalities, including high-dose radiation, many patients are benefiting from extended survival rates.

Resource: Any idea why pancreatic cancer rates have increased among younger individuals?

Domenech Asbun, M.D.: With pancreatic cancer, the average age at diagnosis used to be 70 but since the late 1990s, the number of new cases in both men and women has increased by around one percent a year. We’re not entirely sure what accounts for this increase but it is now widely acknowledged that both obesity and type 2 diabetes are considered risk factors for pancreatic cancer.

Given the ongoing epidemic of obesity in our society, which has persisted for many years and even decades, there is a growing suspicion that there may be a correlation between this social issue and the rising incidence of pancreatic cancer. Conditions such as low-grade inflammation, which can be associated with morbid obesity, may be contributing factors over time that eventually lead to the development of this cancer.

Resource: Is there anything younger individuals can do to be more proactive about early detection and prevention of pancreatic cancer?

Domenech Asbun, M.D.: Unfortunately, there is not a feasible generalized screening protocol for the entire population, and most people don’t qualify for actual screenings unless they have very significant risk factors, such as a first degree relative with pancreatic cancer or a known genetic mutation.

What’s crucial, as cliche as it may sound, is striving to maintain excellent overall health and taking care of your body. Lifestyle changes that reduce exposure to factors contributing to cancer development are the most effective steps anyone can take. This includes quitting tobacco use, as cigarettes and other tobacco products are closely linked to the development of pancreatic cancer. Additionally, weight loss and adopting a healthier diet have a direct correlation with pancreatic cancer risk.

Making these lifestyle changes may not be easy but they can significantly impact your health in the long term. Remember that it’s not about making drastic shifts overnight. Small, gradual steps towards change can lead to substantial improvements down the road.

Resource: What’s happening with pancreatic cancer research and clinical trials?

Horacio Asbun, M.D.: Currently, the primary objective in various research trials worldwide is to achieve early detection of pancreatic cancer. This is being pursued by measuring specific DNA circulating in bodily fluids, allowing for the detection of cancer at a very early stage—often before additional clinical signs become apparent.

Researchers are also focused on other identifying markers, which can be found in substances like pancreatic juice, often obtained through endoscopy procedures. Artificial Intelligence may also play a role in the future in detecting a malignant or potentially malignant lesion in imaging studies much earlier than what is currently evident. In addition, a very important area of research is zeroing in on the different molecular types of pancreatic cancer, which in the future will allow us to provide highly individualized care to patients.

Resource: What would you tell someone who has just learned they have pancreatic cancer?

Horacio Asbun, M.D.: They should know that there is always progress, and there is always hope. We have seen significant advances in improving survival and recovery rates, and in our ability to manage and treat the disease. This will continue to evolve, and that gives me more hope than I have experienced at any point in my 25-plus years treating this disease.