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Physician Update - Teamwork Versus Pancreatic Cancer

Physician Update Fall 2009

Teamwork Versus Pancreatic Cancer

By: Ramsey Flynn
Date: October 15, 2009


Richard Schulick and Joseph Herman
Richard Schulick and Joseph Herman: “If we are going to make progress, this is the model to do it.”

The 43-year-old had been told by doctors in upstate New York that her pancreatic cancer was too extensive for removal, even after they had performed nearly 12 hours of surgery. But when the anxious woman called Richard Schulick for a second opinion in late February 2007, the chief of Johns Hopkins’ Division of Surgical Oncology said, “Why don’t you come down to Baltimore and meet with our pancreatic cancer group?”

The woman soon joined six other pancreatic cancer patients who’d arrived for a ritual that group director Joseph Herman and nearly 20 other specialists perform each Tuesday. After this team of oncologists, radiologists, gastroenterologists, geneticists, pain specialists, immunologists and surgeons review the patient histories, documents and scans in each case, they recommend a consensus plan of action. Many of the patients from that day were given new hope.

In this particular patient’s case, Schulick and the team first wanted a course of radiation and chemotherapy to reduce the tumor to a manageable size. If the tumor’s growth halted, it would raise Schulick’s confidence that surgically removing the mass would be a viable answer. After undergoing the prescribed treatment in her home state, the patient returned to Baltimore in the spring. The tumor had responded. It was smaller and potentially removable. Schulick told her it was a go.

He even addressed the issue that had dissuaded the surgical team in New York. While Schulick agreed that the tumor’s involvement with the portal vein posed a risk of provoking a serious bleed, he and his team could resect and replace that vein if necessary. 

In the operating room, Schulick and his team of seven found the patient’s pancreatic tissues typically scarred and toughened from the chemo and radiation treatments. Even so, Schulick was able to perform a Whipple procedure, completely removing the cancer and the surrounding lymph nodes without any undue bleeding. Now two years post-op, the patient remains cancer-free and has returned to work.

Schulick sees her case as but one of many examples of his group’s more aggressive attack on the pancreatic cancer problem. He says the concerted approach has helped him and other colleagues extend the lives of a growing number of pancreatic cancer patients, and he believes future outcomes data will document the progress. At 350 pancreatic resections last year, Schulick notes, Hopkins leads the nation.

Though surgical techniques have changed little in recent years, he says, “we now know how to better select those whom we can help. We live, eat and breathe the destruction of pancreatic cancer. Unless we throw everything at it, we will never beat it.”

Call 410-933-7262 to refer a patient.

To learn more about Johns Hopkins' Pancreas Multidisciplinary Cancer Clinic: http://www.hopkinskimmelcancercenter.org/index.cfm/cID/1691/centerid/37

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