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No other medical center in the world treats as many patients for pancreatic cancer as the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. The Whipple procedure, the most aggressive and effective form of treatment, is a complicated surgical procedure performed more commonly here than in any other hospital in the world. We have taken the lead in the study and treatment of pancreatic cancer with the new discovery of the pancreatic cancer genes, the ongoing development of a cancer vaccine, studies of early, precancerous lesions and research into the best methods of performing pancreatic surgery.
Pancreatic Cancer Experts
Johns Hopkins experts are global leaders in the research and treatment of pancreatic cancer. Patient care and clinical research is led through Johns Hopkins' Skip Viragh Center for Pancreatic Cancer Clinical Research and Patient Care, and basic science research is coordinated through the Sol Goldman Pancreatic Cancer Research Center.
Our pancreatic cancer experts provide coordinated and compassionate care in top-rated facilities and clinical research programs. Consultations with a full spectrum of experts in various specialties are also available in a single-day clinic.
About Pancreatic Cancer
Generally 26,000 new pancreatic cancer cases are expected to be diagnosed in the United States. Most cases occur after age 50, and slightly more men than women are affected. Cigarette smoking is one of the biggest risk factors for pancreatic cancer. Five to 10 percent of all the cancers are inherited.
Johns Hopkins experts have led the research field in diagnosing pancreatic cancer. Gene mutations and molecular changes in the pancreatic duct are promising indicators of early pancreatic cancer. Cancer center physicians confirmed the accuracy of a test called ploidy analysis in assessing pancreatic cancer and discovered that the test can help to predict a patient's survival. They also found that genetic markers for pancreatic cancer can be found in routine stool specimens, suggesting the possibility of early diagnosis through routine screening.
The National Familial Pancreas Tumor Registry was established in January 1994 to track families with more than one pancreatic cancer diagnosis. It is the largest known registry of hereditary pancreatic cancer. Patients who are part of the registry undergo regular screening tests for the disease. The database provides researchers with clues to this cancer's behavioral pattern and is intended to help all family members affected by the disease for generations to come.
Like most cancers, early detection of pancreatic cancer is critical, because survival rates are highest for patients whose tumors are very small -- less than three centimeters. Our physicians and researchers are exploring new diagnostic strategies through studies funded by National Cancer Institute grants and by private donors.
The complex Whipple procedure, perfected at our cancer center, offers one of the most effective treatments for operable pancreatic cancer. A recent review, the largest single institutional experience reported to date, demonstrated that the mortality rate at Hopkins for this procedure is less than 1 percent (0.7 percent). The actuarial data for one-, three- and five-year survival rates for the 201 patients studied were 57 percent, 26 percent and 21 percent, respectively, with a median survival rate of 15.5 months. More than 150 patients have been included in the study since then, with all new data accumulated for future analysis.
A multidisciplinary team of cancer specialists, including surgeons, pathologists, medical oncologists and radiation oncologists, each of whom specializes in pancreatic cancer, is exploring new combinations of radiation and chemotherapy. The benefit of this approach is apparent in the survival rates. This team has developed special postsurgery treatment protocols to study ways to make further improvements.
New Treatment Approaches
The development of a promising pancreatic cancer vaccine is progressing at our cancer center. Because of a laboratory technique developed here, it has been possible to create enough vaccine to cause the patient's own cells to produce large amounts of an immunity-stimulating protein. The vaccine technique will be available to help eligible patients who already have the disease. Our researchers hope that a future vaccine will help family members linked to the disease by heredity face the future with confidence.
The cancer center team that discovered the pivotal genes abundant in pancreatic cancer patients also is investigating the potential for gene therapy. Studies suggest that a tumor suppressor gene, called DCP4, is either missing or inactivated in more than half of all patients with pancreatic cancer. Losing the function of both pairs of this gene is similar to losing the brakes on a car, enabling the cancer cells to multiply unchecked. Studies are under way to see whether "bystander" genes can be activated to select the cancer cells and kill them.
Pancreatic cancer survivors may create a new “normal,” as it can take time to recover. They may have permanent scars on their bodies or find it more difficult to do certain things. Treatment for those who could not have surgery may be ongoing, and side effects may continue for an extended period after treatment ends. These include:
- Changes in bowel function -- Pancreatic cancer or its treatment may result in diarrhea, as there is a decrease in the amount of enzymes being produced by the pancreas to help with digestion. Some survivors may need pancreatic enzyme supplements to manage this. Your doctor, nurse or oncology dietitian can help.
- Managing diabetes – Pancreatic cancer patients may develop diabetes from the disease or treatments, especially surgery. If this happens, it is important to be evaluated by healthcare providers specializing in diabetes management. A dietitian familiar with both diabetes and cancer can help you manage your nutritional needs.
- Altered digestion – Surgery, chemotherapy or radiation can result in altered digestion, such as poor appetite, weight loss, abdominal bloating or excess gas. An oncology dietitian can help you get the nutrition you need while managing these issues.
- Pain – Some survivors have significant pain from pancreatic cancer even when treatment is finished.
- Nervous system changes/neuropathy, pain, fatigue
Many pancreatic cancer patients, unfortunately, are never cured of their disease. Even after successful surgery, the cancer may recur. Always discuss any health concerns and symptoms with your doctor. While staying informed about your illness and treatment is essential, it also is important to try to regain a personal balance by eating healthy, exercising, reducing stress and finding sources of support. Avoid tobacco and limit alcohol intake. Keep up with screenings for other cancers, like mammographies and colonoscopies.
The Skip Viragh Center for Pancreatic Cancer and Clinical Research and Patient Care at Johns Hopkins Kimmel Cancer Center has an extensive website devoted to pancreatic cancer. The Pancreatic Cancer Action Network (PanCAN) offers information about pancreatic cancer, including survivor stories and support groups.Pancreatica offers news and information regarding pancreatic cancer fund-raising events, clinical trials and medical treatments.