Texas Health Presbyterian Hospital Dallas
Vol. 2, No. 4 — June 2012
In this Issue
Expertise to Combat Pancreatic Cancer Available at Texas Health Dallas
By Lalan Wilfong, M.D.
Pancreatic cancer has received a lot of attention recently with the deaths of two prominent members of society, Patrick Swayze and Steve Jobs. This disease affects around 44,000 people in the United States each year. Unfortunately, most of those who are diagnosed will die from the disease.
There are two main types of pancreatic cancer: adenocarcinoma and neuroendocrine carcinoma. Neuroendocrine carcinoma tends to be a more indolent disease, meaning most people can live with the disease for many years. Steve Jobs had this rare type of cancer.
Adenocarcinoma is the most common form of pancreatic cancer.
The symptoms associated with pancreatic cancer are weight loss, jaundice (turning yellow) and abdominal pain.
Patients are initially evaluated with a CT scan or an MRI scan. If the bile duct is blocked, a gastroenterologist will perform an ERCP by inserting a stent to drain the duct. A sonogram-guided biopsy of the cancer can be done at that time. Pancreatic cancer surgery, known as Whipple surgery, involves removing the pancreas and reattaching the bile duct and stomach to the small intestine. This is only done in the 10 to 15 percent of patients who present with disease localized in the pancreas. Whipple surgery requires an experienced surgeon as it is a very complicated procedure. Surgeons on the medical staff at Texas Health Presbyterian Hospital Dallas are among the nation’s most experienced in the use of this technique.
After surgery, chemotherapy is typically given with the drug gemcitabine to help prevent the cancer’s return. Radiation therapy is also sometimes used. Despite these treatments, the cancer returns in most patients. Doctors at Texas Health Dallas are actively trying to find better ways to prevent the cancer’s recurrence and have been involved in two large studies over the past few years. The most recent study involved a vaccine treatment combined with chemotherapy to target a mutation found in most pancreatic cancers.
In the 90 to 95 percent of patients where the disease has metastasized or spread to the liver or other organs, chemotherapy is the only treatment. This treatment does not cure the cancer but can help improve survival and symptoms. Gemcitabine is the chemotherapy typically given and is a well-tolerated treatment. Another regimen, Folfirinox, has a better survival rate but can cause significant side effects. Choosing a treatment requires thoughtful discussion with an oncologist.
We are also actively studying ways of improving treatment in patients with metastatic disease. Recently, we finished a study using gemcitabine with the drug Abraxane. The results of this trial are not yet available. We are also beginning a study of gemcitabine combined with a drug that targets muscle mass to help improve the symptoms of this disease.
Taking care of patients with pancreatic cancer requires a true multidisciplinary approach. Nutrition is important as most patients with this disease lose weight. Pain is another complication and must be managed aggressively. Finally, the psychological and social burdens must be addressed too. At Texas Health Dallas, we employ a team approach to address all of our patient’s needs.
If you have questions about pancreatic cancer, please discuss them with your physician. The American Cancer Society and the Pancreatic Cancer Action Network (PanCAN) are also excellent resources.
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Survivor Refuses to be Defined by Pancreatic Cancer
“Pay attention to what your body tells you. Don’t ignore any symptoms that do not seem right. Go to your doctor.” That’s the wisdom of Steve DeBonis of Allen, Texas. Now 50, DeBonis was diagnosed with stage 2 pancreatic cancer about a year and a half ago.
“I am the beneficiary of early detection and a great medical team at Texas Health Dallas. Since my surgery, chemotherapy and radiation treatments, I have had three clean scans,” he said. “If I had not met with my medical team when I did, I was told I would not have survived more than a year.”
Just prior to Thanksgiving 2010, DeBonis had a complete physical exam with blood work and levels reporting normal. Though he awoke on Thanksgiving day with flu-like symptoms, he celebrated without much worry and left for a business trip the next week.
“I excused myself from a business dinner and promptly fell asleep in my hotel room,” he said. “My laptop was beside me when I awoke the following morning. Sleeping late into the morning was unusual for me.”
Back home, DeBonis returned to his general practitioner. After two courses of antibiotics, his flu-like symptoms continued. There was suspicion of a gall bladder issue based on family history, so he had an abdominal ultrasound. After the New Year, he developed excessive itchy sensations.
“Something was triggering these sensations, so more diagnostic tests were ordered,” he said. “A CT scan identified a mass on my pancreas and an MRI performed on Jan. 14, 2011, provided a clearer view. I will never forget the day I received the call to inform me that I had a 2.4-centimeter mass that could be malignant.”
DeBonis was comforted by the reputation of his medical team that included surgeon G. Thomas Shires, III, M.D., and oncologist Lalan Wilfong, M.D., physicians on the medical staff at Texas Health Dallas. Family and friends in the medical field confirmed that there was no need to look further for treatment.
“Dr. Shires has incredible credentials and displays humility,” said DeBonis, who referred to him as Yoda among close friends. “Dr. Wilfong is a highly respected oncologist. He explained everything to me in understandable terms and put me at ease. I knew I was getting quality care.”
DeBonis underwent surgery to remove the mass. Only a few lymph nodes were found to be cancerous and no metastasis was noted. He healed quickly and received chemotherapy and radiation treatment during the following six months.
“The nursing staff in the infusion room made my experience as easy and comfortable as possible,” he said.
DeBonis feels fortunate. He returned to the golf course only four weeks after surgery and continues to be active. He works in technology sales and enjoys spending time with his family and friends.
“I have a normal life,” DeBonis said “I do let not pancreatic cancer overwhelm or incapacitate me. It’s something I have, not who I am.”
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Eating Habits and Esophageal Cancer
By Carla Hysell, R.D., C.S.O., L.D.
The esophagus, a tube, connects the mouth to the stomach. Cancer of the esophagus is the world’s eighth most common cancer. The two major types of esophageal cancer are squamous cell cancer and adenocarcinoma. Over the past several decades, adenocarcinoma has increased dramatically in the United States. The major risk factors for this type of cancer are gastroesophageal reflux disease (GERD), Barrett’s esophagus and obesity.
GERD occurs when the valve between the esophagus and stomach doesn’t work properly and allows stomach acids to flow back into the esophagus. The acids cause a feeling of heartburn. If GERD continues long term, the cells of the esophagus can become damaged. This damage is called Barrett’s esophagus.
Symptoms of GERD can be decreased by following these guidelines:
- Avoid citrus fruits and other acidic foods, chocolate, caffeine, alcohol, fatty and fried foods, peppermint, spicy foods
- Lose weight, if needed
- Eat small, frequent meals
- Avoid lying down for three hours after a meal
- Wear loose-fitting clothes
- Raise the head of the bed 6 to 8 inches
Weight loss can be especially helpful in managing reflux symptoms and in reducing the risk of becoming an esophageal-cancer statistic. People who are overweight with an apple-shape body type may have more refluxdue to body fat pressing on the abdomen.
The American Institute for Cancer Research recommends avoiding weight gain by eating a mostly plant-based diet, avoiding sugary drinks, limiting high-calorie foods and being physically active at least 30 minutes every day.
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Supporting Our Community
By Matt Schneider, Administrative Director, Oncology
Healthcare is all about people. The mission of Texas Health Presbyterian Hospital Dallas is to improve the health of the people in the communities we serve. Community involvement is an important way our staff live that mission every day.
Dadfest – June 16
Over the Father’s Day weekend, the Urology Research and Education Foundation, with sponsorship from Texas Health Dallas and others, will continue the tradition of celebrating fathers and families with a 5K run/walk at Galatyn Park in Richardson. This will be a fun-filled family event providing an ideal opportunity for men and their families to exercise during the cool morning and enjoy games, a climbing wall, a 50-yard dash for children age 8 and under, a diaper dash, a father-child look-a-like contest and fun with the many event sponsors. While there, men age 40 and over can participate in a prostate-cancer risk assessment. If the men qualify, they may receive a free prostate-cancer screening, including a digital-rectal exam and a PSA-blood test provided in the comfort of the Texas Health Wellness Motor Coach. Urologists from Texas Health Dallas will staff the screening. To register for this great event, visit dadfest.com
SUCCESSFUL RECENT EVENTS
North Dallas Relay for Life
The American Cancer Society’s Relay for Life, North Dallas, was held May 11. Staff and patients from Texas Oncology, Breast Cancer Alliance of North Texas and Texas Health Dallas united to support the fight against cancer. While the much needed rain moved the event inside, the spirit of the group wasn’t dampened as they honored survivors, caregivers and learned more about prevention and treatment. This event is part of an ongoing relationship between Texas Health Dallas and the American Cancer Society to provide information, treatment and services to the community.
Breast Cancer Survivor’s Retreat
On March 31, nearly 100 breast cancer survivors gathered at the Cancer Support Community North Texas for the annual Breast Cancer Survivors’ retreat hosted by Texas Health Dallas. The retreat is a unique event that brings together survivors and caregivers for celebration and education. The opening panel discussion gave the survivors an opportunity to question a panel that included breast surgeons, a medical oncologist, a plastic and reconstructive surgeon, a radiation oncologist and a breast radiologist. The 90-minute discussion covered topics ranging from causes of breast cancer, genetic testing and management of side effects. At the conclusion of the large group event, attendees were invited to choose from a variety of small breakout sessions for in-depth discussions in a more intimate atmosphere.
The Texas Health Dallas staff will continue to donate thousands of hours in community service at similar events. Watch for upcoming events to learn how you can become more involved in the health and wellness of your community.
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