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HUP: New Advances in Pancreatic-Cancer Treatment

December 22, 2005 By:
Rita Charleston, JE Feature
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A rendition of the new Leonard and Madlyn Abramson Family Cancer Research Institute in Philadelphia

Some moments in life stop your heart, and are burned into your memory forever. Such is the case with Sheila and Ron Schwartz, who remember Father's Day 2004 as a black-letter day - a day when an ailing Sheila Schwartz discovered she had pancreatic cancer.

"We were informed that removal of the tumor is the only known medical cure for pancreatic cancer. As if this wasn't traumatic enough, doctors then told us that her cancer was inoperable," says Ron.

"I remember being so frightened that I looked up to heaven and said I'll make a deal: I will never smoke another cigarette again if you give me back my life. That day, I threw away a carton of cigarettes and have never smoked again," says Sheila.

No one knows for sure what role cigarettes play in the development or aggravation of this disease, but researchers are beginning to understand the genetic basis of the disease. Just as important, it is believed that people may be able to reduce the risk of pancreatic cancer with a few simple lifestyle changes, such as giving up cigarettes.

For Ron and Sheila Schwartz, one thing was for sure: This couple was not about to give up without a fight.

Within 48 hours, they discarded the earlier prognosis and went in search of other opinions. That led them to Douglas Fraker, M.D., chief of oncology surgery and endocrinology at the Hospital of the University of Pennsylvania. He then directed them to James Metz, M.D., associate professor of radiation oncology, and Dr. Weijing Sun, M.D., associate professor, hematology oncology.

All the doctors associated with Penn's Leonard and Madlyn Abramson Family Cancer Research Institute agreed to administer a rigorous, six-week treatment regimen of daily radiation with continual chemotherapy, done simultaneously in an effort to reduce the size of the tumor and force it away from the main blood vessels and arteries, resulting in, optimally, its surgical removal.

Eight weeks later came the news that the tumor had shrunk and had separated from the vein, allowing Jeffrey Drebin, M.D., Ph.D., chief of the division of gastrointestinal surgery and vice chairman for research in the department of surgery at HUP, to operate. Drebin plays a key role in the Abramson cancer center's efforts to conduct cutting-edge research.

On Nov. 9, 2004, Drebin and his staff performed a complicated, 10-hour surgery called a "Whipple Procedure." Developed by Dr. Alan O. Whipple in 1935, it is generally the removal of the gallbladder, common bile duct, part of the duodenum and the head of the pancreas.

Says Drebin: "Pancreatic cancer is one of the deadliest. Although it accounts for just 2 percent of new cancer cases in the Untied States, it's the fourth leading cause of all cancer deaths. That's because it spreads rapidly, and is seldom detected in its early stages.

Better Treatments Possible
"Probably 80 percent to 90 percent of the time, by the time it's diagnosed, it's already too far advanced, and surgical removal is no longer an option. In some cases, chemotherapy might slow it down a bit but is rarely curative.

"However, in some cases, as in Mrs. Schwartz's case, it had not actually spread anywhere else, so with protocols [that] we're evolving here, we were able to shrink the tumors to allow them to be removed."

For years, little was known about pancreatic cancer. But researchers are working hard at learning the root causes - knowledge that may lead to new, imporved and better treatments.

"Of course," insists Drebin, "pre-testing, when and if possible, is the Holy Grail for everyone. We need to develop something that would allow us to identify the patients who have cancer at a time when we could remove it. Unfortunately, these tumors are generally silent until it's too late."

Pancreatic cancer, the doctor continues, is slightly more common in men than in women, and slightly more common among Ashkenazi Jews. The risk rises as people age, with more than 80 percent of cases developing between the ages of 60 and 80. Cancer of the pancreas strikes approximately five out of every 100,000 people every year, and it is estimated that this year alone, some 32,000 Americans will be diagnosed with the disease.

Symptoms may include abdominal pain, jaundice, abdominal distention and, in some cases, severe back pain.

Research and Funding
"Research for pancreatic cancer has been woefully underfunded," attests Drebin. "For example, a study by the National Institute of Health a few years ago showed that the amount of money per cancer death funded by the National Cancer Institute amounted to about $9,000 per breast-cancer death, about $4,000 for prostate cancer, and only about $400 for pancreas cancer.

"The main reason is that a lot of people who survive breast and prostate cancer are worried about it coming back, being a problem for family members and so on. So all those people represent survivors who lobby for the funding for the research. Unfortunately, for pancreatic cancer there aren't many survivors, and it's the survivors who lobby for the funding for research."

In order to help counteract that, the couple has started the Sheila & Ronald Schwartz Fund to provide money for important research to find pre-testing techniques and ultimately a cure for this deadliest of cancers.

The funds raised, according to Ron Schwartz, are pledged to benefit the University of Pennsylvania Hospital and the research efforts of Drs. Drebin, Fraker, Sun and Metz.

To learn more about pancreatic cancer, go to: www.cancer.gov/cancer_information/ cancer_type/pancreatic. For information on the Schwartz Fund, call 215-349-5653.>/b>

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