Giving patients new hope

PANCREATIC NEW TECHNOLOGIES, C ANCER SURGICAL PROCEDURES AND GROUNDBREAKING CLINICAL TRIALS GIVE PATIENTS NEW HOPE

“Researchers are pushing the envelope, trying new things, and that is how science is advanced.”

s a practicing physician at The Methodist Hospital for more than 40 years, Dr. Dan Jackson ordered thousands of imaging tests to assist in the diagnosis of his patients’ illnesses. In 2004, that same technology detected a small tumor that led to the diagnosis of one of the deadliest forms of cancer. It also saved his life.

Jackson, 88, had a chronic intestinal problem that caused him to be admitted to the hospital on several occasions. A magnetic resonance imaging scan (MRI) revealed a small mass on his pancreas and he was diagnosed with pancreatic cancer.

As a physician, Jackson knows how dangerous this type of tumor can be. “I told myself I was going to be OK,” said the internist, who until his retirement in 1992 practiced with his sons, Drs. Robert and Richard Jackson, also internists at Methodist. “I called it denial.” Jackson was referred to Methodist surgeon Dr. Wade Rosenberg, who has specialized in performing pancreatic cancer surgery in Houston since the 1980s. He successfully removed the tumor. Two months later, Jackson began a six-month regimen of chemotherapy and he is now cancer free.

For many years, a diagnosis of pancreatic cancer was one of the worst a patient could receive from a doctor. In more than half of all cases, the cancer has already spread to other parts of the body, usually the liver, by the time the patient visits a doctor with symptoms. The overall

Asurvival rate has been only about 5 percent. “Tumors in the body or tail of the pancreas, like Dr. Jackson’s, don’t typically cause a lot of symptoms, so patients have traditionally been diagnosed pretty far into the disease,” Rosenberg said. “For those types of patients, a big advance has been the current imaging technology.” Pancreatic cancer is often diagnosed earlier because of the widespread use of computed tomography scan (CT) and MRIs. Rosenberg said that this technology affects prognosis — the earlier the cancer is found, the better the chance of treating it successfully. There also are improved ways of determining if patients are

BY EMMA V. CHAMBERS AND STAFF REPORTS

candidates for surgery (if the cancer hasn’t spread to other organs and hasn’t affected blood vessels). Because of high-quality CT scan and ultrasound technologies, surgeons rarely operate on a patient only to discover the cancer can’t be removed, he added.

The pancreas is a small organ located near the lower part of the stomach and the beginning of the small intestine. It produces digestive enzymes and hormones, with insulin being the most important. The pancreas secretes these enzymes — through a system of ducts — into the digestive tract, while also secreting hormones directly into the bloodstream.

Patients who have pancreatic cancer often develop diabetes, but there is no evidence that diabetes causes pancreatic cancer. Jackson did develop diabetes after having part of his pancreas removed. He controls the disease with oral medication and diet.

Pancreatic cancer is a genetic disease, meaning it is caused by mutations in the body’s DNA. These changes can be inherited or acquired, either during cell replication or by exposure to cancercausing chemicals, but currently there is no test to determine a person’s risk for the disease.

In addition to imaging technology, groundbreaking clinical trials and surgical procedures are augmenting the treatment arsenal against pancreatic cancer.

“I am very optimistic about the future of care for these patients,” said Dr. Craig Fischer, pancreatic cancer surgeon and researcher at Methodist. Fischer is new to the Methodist team, having become the first academic recruit of Department of Surgery chair Dr. Barbara Bass. He brings with him one of the country’s most extensive backgrounds in innovative pancreatic cancer surgery and research.

He’s most encouraged about an upcoming clinical trial that offers a novel approach to killing cancer cells in the pancreas by using a combination of gene therapy and radiation. “This is really one of the more exciting advances in cancer care we’ve seen in a decade,” he said. “We are taking advantage of what has happened in the human genome project (a project designed to identify all the genes in human DNA) and other advances in science that are only two or three years old.”

Fischer said leading-edge research like this is evolving, and is only available at select centers in the country and Methodist is one of them. He added that a virus associated with the common cold is used as a “truck” to deliver a deadly gene directly into a pancreatic tumor. This strengthens the effects of radiation therapy and trains the body’s immune system to search for cancer in other parts of the body, as well.

This work was started at Methodist 10 years ago in prostate cancer, but soon it will be expanded to pancreatic cancer. “We are training our own body’s immune system to recognize cancer as the enemy and then attack only those cells, while leaving the rest of the body alone,” he said.

This new research is greatly needed because 85 to 90 percent of all patients who have a tumor in the pancreas cannot undergo surgery due to the tumor’s size. Surgery, however, is the only cure for the majority of pancreatic tumors.

Albert Bayeh, 50, was one of the lucky patients who did notice

Dr.Wade Rosenberg

symptoms that caused him to visit the doctor. “I had chronic heartburn that wouldn’t go away when I took medicine for it,” he said. “Then, I noticed my urine was getting darker and darker.”

Once an ultrasound revealed a mass, Bayeh braced for the worst. “I was prepared to hear him say it was cancer,” he said. “I have stayed positive during this entire process because I had confidence in my doctors and faith that if it was God’s time for me, it was my time.”

Bayeh then went to see Fischer at Methodist. After surgery and a short stay in the hospital, he went home to his family. He is now undergoing chemotherapy and hopes for a complete recovery.

Fischer is an authority in the removal of the blood vessels and use of the jugular vein to bypass them in order to remove all the cancer in surgery.He believes Methodist has now become one of the leading institutions in the country in pancreatic cancer care.

“Researchers are pushing the envelope, trying new things, and that is how science is advanced,” he said. “Not all the ideas are successful but innovation in science is made at the edge of the envelope. That’s what is happening at Methodist.”

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MULTIDISCIPLINARY CARE TEAMS USED TO TREAT CANCER, OTHER DISORDERS

As health care institutions seek improved approaches to advance patient care, Dr. Barbara Bass, chair of the Department of Surgery at The Methodist Hospital, is developing disease-based teams to treat patients with complex disorders, including cancer. Collaboration between health care professionals is not a new concept, but in most cases, it has been underutilized. Bass is working to form these teams to serve as springboards to cultivate more clinical research and basic science research programs at Methodist. Bass said cancer is a perfect example of a disorder that is optimally treated with the collaborative management of surgeons, medical oncologists, radiation therapy physicians, pathologists and radiologists.

For all cancers, including breast and colon, but especially for complex diseases like pancreatic cancer, rectal, esophageal or lung cancer, multidisciplinary planning and treatment are essential for optimal outcomes. In addition to the existing cadre of Methodist physicians who have expertise in these areas,

Bass, who specializes in endocrine and breast cancer, has recruited several new physicians including Dr. Craig Fischer (see article), Drs. Shanda Blackmon (thoracic surgical oncology) and

Bridget Fahy (colorectal surgical oncology). These physicians will work with specialists in other fields to build the diseasebased teams. Bass anticipates that all surgeons who practice will participate in these programs and the department will provide the infrastructure to facilitate their involvement. Once established, these programs will serve as the natural platform for clinical and translational research.