Pancreas and Biliary Tumor Center Video and Transcript

  • Thomas E. Clancy, MD, FACS
    Surgical Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute
  • Brian M. Wolpin, MD, MPH
    Medical Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute

Benefits to Patients with Pancreaticobiliary Cancers

The mission of the Pancreas and Biliary Tumor Center at Dana Farber/Brigham and Women's Cancer Center is really threefold. The first is to provide compassionate care to our patients. The second is to provide comprehensive care to our patients. And the third is to participate in and lead innovative research into the diagnosis and management of these types of cancer.

Our vision at the Center is that we can bring together providers from all different disciplines and different specialties to work together with these diseases. We can listen to our patients and see what they want. And we know what they want; they tell us.  They want their doctors to talk to one another, to make sure that they're communicating between specialists and with their home providers. They want expertise. They want people who do this again and again, all the time. And they want to avoid delays.

Pancreatic or Biliary Tract Cancer Diagnosis and Treatment

One reason that these cancers are difficult to treat and diagnose is that there are no screening tests for either pancreatic or biliary tract cancers; meaning that, say, for a colonoscopy to help colon cancer, or a mammogram to help breast cancer. There are no equivalent tests available for pancreatic or biliary cancer. In addition, there are no early warning signs for these diseases.

So there's no clear and easy way at this point to diagnose these cancers early. And what that means is, these cancers do tend to present when they're more advanced, where the tumors are larger or there has been more spread of these cancers. And some of the research efforts that we have ongoing are how you figure this out, how are you going to find these tumors at an earlier stage, an earlier time in their development so they're more treatable and we can more successfully cure people from these cancers.

In terms of early diagnosis, we really have a three-pronged approach in terms of our research efforts to understand how you diagnose these cancers early. The first is that we have a large genetic screening research effort, where we're trying to understand what are the things that people inherit in their DNA that predispose them to develop either biliary or pancreatic cancer.

The second approach that we take is to use blood samples from patients, to ask what are the features or factors in their blood that we can identify that would differentiate someone who has an early pancreas or biliary cancer versus those people who do not.

And the third is imaging tests. So we have an effort to understand what new types of scans be used to find this disease early – new types of MRIs, ultrasound, PET scan imaging – ways that once you identify who's at higher risk, you actually can find the tumor.

One of the first things we usually need to determine is whether a patient is a candidate for surgery. At present, pancreas and biliary tumors are largely surgical diseases or surgery forms a cornerstone in much of that treatment. And so, the question we need to answer is: is this a patient who's suitable for surgery, and is it a tumor that's suitable for surgery? Specifically, is it a tumor that invades other structures, or can it be removed easily? And we know unfortunately that only about 20% of patients with pancreas or biliary tumors are going to be candidates for surgery when they initially present. And that's the first thing we need to decide. If a patient is a candidate for surgery, then we try to expedite that operation as soon as possible.

Across the Center, we do probably about 100 to 150 pancreatic or biliary operations a year. Removal of the head of the pancreas and duodenum – that's commonly referred to as the Whipple procedure – used to be associated with a post-operative mortality of up to 10 to 20%, even just about 20 years ago. Now we know by learning a lot more about how these tumors are treated, by concentrating treatment to high volume hospitals and high volume providers, that the mortality after surgery is down to about 3 to 4% among all specialized centers.

At Brigham and Women's Hospital, we take great pride in the fact that the morta– post-operative mortality for our surgeons, our high volume surgeons, after Whipple procedure, is at 1% or less, at or lower than any other specialized center across the country. While we hope that someday invasive procedures and surgery won't be part of cancer treatment, we know that today surgery is really the cornerstone of managing pancreatic cancer and biliary cancers.

IMPACT Clinic - Evaluating Pancreatic Cysts

One major focus of our efforts is not just on cancer, but on the wide variety of possibly premalignant lesions that we can see. And one of the biggest categories of this is cystic neoplasms of the pancreas.

Largely, these are tumors or masses that we don't need to do surgery on; they just need to be followed closely. And we're looking for a specific group of patients, patients who have specific risk factors where they might develop a pancreatic cancer in the future where we can intervene with an operation and prevent that cancer from happening.

At Brigham and Women's Hospital, we specifically have a clinic designated just for evaluation of these patients, the Interdisciplinary Pancreatic Cystic Neoplasm Clinic or IMPACT Clinic, where we have surgeons and gastroenterologists, endoscopists working side by side, just to look at patients with these types of tumors and determine who's going to need to be followed more closely, who can undergo less frequent CT scans and be followed by their home physicians.

Pancreaticobiliary Tumor Research

At the frontier of oncology is understanding how you tailor specific therapies to a patient based on the characteristics of their tumor. And there has been a large advancement in this area over the past five years or so. There are two ways in which we do that at Dana Farber/Brigham and Women's Cancer Center. One is a very clinically oriented method, which is that all patients who come through the clinic have DNA testing done on their tumors. Meaning, we screen the tumors of patients who come to the clinic to find specific mutations or alterations that we can then use to choose specific therapies.

By doing that, what we hope to do over the longer term is constantly be updating the profiling that we use in patients by using the knowledge we gain in the laboratory to then apply it to the patients we see in clinic. And the goal ultimately is to be able to clearly select the therapies that an individual patient should receive, based on the profiling of their tumor. And that manifests in having multiple clinical trials that are available for patients. These trials test new drugs and new ways to diagnose this disease, and it really gives patients the opportunity to participate in cutting-edge research.

Why Dana-Farber/Brigham and Women’s Cancer Center?

Getting one of these diagnoses involves two of the scariest things that a person can hear. Number one, that you might have cancer; and number two, that you might need a very big operation or chemotherapy to treat that disease.

One thing that I feel separates our program is that every single person across the institutions seems to recognize that, seems to understand this is what patients are going through and this is what has to motivate us to do the best we can today, as quickly as we can today, and also to continue to develop better treatments.

I think we have unparalleled breadth of experience. We can provide, I think, the best in surgery and medical oncology, but it's really that understanding and that appreciation of what patients are going, going through that I think really distinguishes us. So that really makes up our mission – to provide the best care possible today and work together towards getting the best cancer treatments for the future.

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