way hello and welcome to HealthLine.

>> I'm Jennifer Bloomquist.

I'll be the host of the program this evening and I'm so glad that you joined us if you're one of our regulars I know you know the routine we're live here in the studio and we love when people call and ask questions.

We have a live guest with us tonight a surgical oncologist and the topic is pancreatic cancer.

>> So a lot of things to learn about tonight if you're new, let me kind of explain how it works.

Obviously the the phone lines are open now.

That's why we keep the number there at the bottom of the screen so call anytime now it's (969) 27 two zero.

It is still a free call if you're outside of Fort eight and some of our viewers are so just put in 866- in front of there and then you can talk to a call screener and you can ask the question live which is great because that way the doctor can ask you more questions.

Maybe it would help him to have more information to give you a better answer.

So that's your first option.

Second option is you can still talk to the call screener but you can relay your question to him and then they'll give it to me and I'll get get the question answered for you that way by asking the doctor for you and a new feature that we just started a few weeks ago is texting.

So that's a little different.

No.

And again, we're keeping that up at the bottom of the screen too.

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You can text in your question if you feel comfortable doing so.

It's always nice if you put your name and maybe what town you're from that's great but you don't have to.

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We keep all your information private.

Well, let's go ahead meet our guest.

We have a new guest this evening.

This is Dr.

Phillip about and you are a surgical oncologist and we are talking about pancreatic cancer which I've got to tell you I was talking to some friends today and they were asking what the topic was going to be this evening.

And when I told them they all said oh gosh, that's so sad.

I you know, they've they both said everybody I've known who's ever had pancreatic cancer did not beat it.

You know, we hear about people you know, I beat cancer or you know, prostate cancer but you don't hear about people beating pancreatic cancer.

>> Do you think it's fair to say that?

Yeah, unfortunately it has a very aggressive reputation.

Yeah.

And so thankfully it's not as common as some of the other cancers out there that affect people like cancer or colon cancer.

But it's certainly one of the most deadly cancers.

It's actually the third leading cause of cancer death in the US for Indiana that translates to about twelve hundred people a year dying from this cancer.

>> Is there a stereotypical description of a pancreatic cancer patient, somebody maybe with comorbidities or lifestyle age?

>> I don't know if it's more common in men than women.

Yeah, it's probably evenly distributed between men and women.

It is a cancer of older patients, older people.

So typically the patient is in their 60s to 80s but we've seen people in their 50s or even forty risk factors for this cancer aren't so well defined.

>> I mean it's associated with smoking.

All right.

Associated with long term diabetes.

There are some genetic dispositions, some families that you'll see pancreatic cancer run in along with some related cancers like skin cancer or even cancer.

>> But but most of the time we can't really pinpoint a specific factor.

Yeah, I wondered what the symptoms are because you know, both of the people that I knew it came as a complete surprise to them.

You know, they weren't really sick.

You know, it was with my grandma that's she somebody just commented to her a nurse was a customer in the store.

My grandma was still working at age eighty six.

She worked at our family's store and just comment to my grandmother you look really yellow and I really think you should go to the emergency room or be seen by a medical professional but that was it.

>> But my grandma felt fine.

>> Yeah.

So that's sort of the classic textbook presentation of somebody suddenly turns yellow.

Yeah, their eyes turn yellow, their skin turns yellow.

Maybe they have some itching but they don't have any pain or any other symptoms that would be one again the sort of classic symptom but it can be very subtle such as just unintentional weight loss over a period of three to six months, some vague pain in the upper abdomen or progressing to problems with eating and digestion.

But it can be very, very sort of low key, if you will, and attribute it to other things like aging or just you know, at the time of year that kind of thing.

>> And it can take a really astute primary doctor or family member picking up on those changes.

>> I was going to ask you you if that's something that you know, hopefully most people are going once a year to get a checkup.

So I you know, will there be anything in general that your primary care may check for or is there really even something that you mentioned if they're astute enough something may stand out?

>> Yeah.

So unfortunately there's no screening test.

I think that's important.

So unlike a mammogram for cancer or colonoscopy, there's no real recommended screening.

That being said, if you have a suggestive family history or again like I mentioned some of these subtle signs like maybe a worsening of your diabetes or if you're an older person and now you suddenly been diagnosed with diabetes, that can be a flag.

And I think the most important one that could be maybe picked up early is that subtle weight loss that you don't really otherwise have an explanation for .

>> So I'm assuming it differs depending on all sorts of factors the person's age and health situation.

But in general is there some protocol that you know, if if you suspect it, how do you even diagnose it correctly?

>> Well, certainly if somebody has that yellow jaundice then that can be confirmed with blood work.

OK, and there are some markers associated with pancreatic cancer that can be checked on the blood.

>> But really the way to diagnosis is usually with a CAT scan.

So an imaging study or an X-ray study of the CAT scan looking at that belly area where the pancreas is and that can be followed with an MRI and some other types of tests to to pinpoint where the problem is.

>> Does it tend to just be a mass in the pancreas or is it or does it change in appearance?

>> Like how would you know when you're looking at a scan of it that the cancer is present?

Well, these are what we call solid tumors so they they are usually measurable sometimes if the scan isn't done correctly you may not see it very well but at least you can see maybe some of the effects of the tumor.

OK, and then there is one other study I should mention it's a type of endoscopy.

Oh so it's where a gastroenterologist uses a specialized camera with an ultrasound to look at the pancreas and they can often see these tumors very well.

>> So where do you go from that point?

I guess it depends maybe what stage is the diagnosis comes back.

>> Yes.

So you know again a typical pathway might be one of these endoscopically procedures that can get a biopsy and then once that confirms the the the tumor, the cancer, then then it's what we call a multidisciplinary process where you might see a surgeon, you might see a medical oncologist, a cancer specialist that they can complete that workup to figure out what stage you are and what are your treatment options.

>> OK, I just want to remind people quickly, Dr.

Bo, that our phone lines are open.

We haven't heard from anybody yet so you can phone in a question.

You can ask it live.

You can have the call screener.

Let me know what your question is and I can ask it for you.

And of course don't forget now you have that texting option which is really nice.

It's really quick and simple and again it's private because we don't show your number or anything you all want to offer up your name and where you're calling from that's great but you don't have to.

We only have Dr.

Bell here for a short time just a little before eight o'clock and the show will be over.

So please take advantage of calling maybe you know somebody who has pancreatic cancer.

Maybe it runs in your family.

I'd like to find out more information about it.

You can't beat it getting free advice so please call us any time.

>> Feel free to interrupt us during our conversation at any time.

You know the two people that I knew who had pancreatic cancer one of them was my grandma.

They supposedly were not candidates for surgery.

So as wonder if you could expand upon that when would surgery maybe help the patient?

>> Yeah.

So again, just along the lines of this being such an aggressive cancer and often it might be picked up late.

Yeah, surgery would be the goal .

I mean that would be a chance to potentially get cured but maybe only about 20 percent of patients when they get diagnosed are candidates and how we decide that is whether it's spread outside the pancreas.

Yeah, that's one factor.

And then also if it's involving any of the other organs or key structures around the pancreas that can make it either safely removable or completely removable if it can't be removed under either of those circumstances safely or completely and there's very little benefit to surgery which is that when you turn to maybe something like I don't know if there's medication or if you do the chemotherapy radiation.

>> Yes.

So then your options would be for example, chemotherapy or radiation.

>> But the truth is if you're a candidate for surgery you're still going to get a recommendation typically for chemotherapy too because we want to be aggressive about treating this any way we can and then sometimes radiation as well.

>> All right.

Well, we did have somebody who texted in a question so I don't see there are there it is.

They wanted to know how to potentially prevent getting pancreatic cancer like a preventative lifestyle.

>> Any suggestions you would have?

Yeah, good question.

Unfortunately not no great solutions.

You in terms of looking at the risk factors clearly smoking cessation and obviously that has implications for lowering your risk of lung cancer too.

OK, so I would suggest smoking cessation clearly is a good one.

>> There is a relationship of chronic pancreatitis or inflammation of the pancreas and pancreatic cancer and and certainly excessive alcohol use is linked to pancreatitis which in turn can be linked to pancreatic cancer.

So I think moderate alcohol such alcohol use probably OK but certainly not alcohol abuse or excessive alcohol use and we hear that so much on this program from physicians in all different specialties that just say, you know, be reasonably you know, don't do anything to an extreme, you know, and you should be doing the best that you can.

You know, sometimes like you said, this can be hereditary.

Does that do you feel like it's when it comes to being hereditary, does it tend to affect one sex over the other?

I guess it tend to run more in the males or females or no.

I think it's still pretty evenly distributed.

>> Yeah.

Since you were mentioning that it's hard to diagnose early because there are no red flags that really that really jump out.

So you may be in a more advanced stage if somebody decides not to do anything and maybe given their age maybe it's somebody quite elderly and doesn't want to do any more treatments, does it typically can you give somebody a timeframe as to how long they may be able to live with it?

>> Yeah, it's tough.

That's a tough conversation.

So untreated, you know, completely untreated and just with supportive care measures but no chemotherapy radiation, no surgery.

>> Yeah, You really are talking about a survival that can be just on the order of a few months or six to 12 months.

>> That is the unfortunate statistic behind that.

>> You mentioned that a lot of people don't feel any discomfort.

You know, we talked about the one said classic symptom of somebody looking really yellow skin looking really yellow as it progresses.

>> So does pain become more of an issue?

Yes, it can be.

What happens is the cancer starts to irritate or infiltrate towards the back where a lot of the nerves are and then you can have more issues with pain and so certainly that is an area that can be addressed though even if you're not getting treatment for the cancer there are we have for example, a palliative care service can prescribe medications or use procedures to help manage that pain.

>> Yeah, we've we've done some programs with people who work in hospice and palliative care and you know, just to reiterate that those physicians can prescribe things that are stronger for those specifically for those kinds of of patients just just to keep them comfortable.

So Doctor, we did have somebody else text another question so somebody want to know if there's been an increase in pancreatic cancer over the last ten years or apparently there there there are suggesting that that it has been an increase and why would that be?

>> I don't know if I have a great answer.

>> I mean clearly I think with if you want to call it our epidemic, if you will of diabetes and obesity.

Yes.

In the country or worldwide, I think that's part of it.

There also are going to be links to environmental exposures, chemicals, pesticides.

I think that is applicable not only to pancreatic cancer but many of the cancers that we're seeing more frequently or in younger patients like colon cancer there may be a little bit more knowledge.

I mean certainly there are more GI specialists and so it's more being picked up.

So instead of you know, my grandmother was diagnosed with cancer but we don't know what kind of cancer and she died and so now maybe we're a little bit more specific about what that family member died of .

I was curious to know, you know, supposably is a good candidate for the camp for surgery and then doing a follow up chemotherapy.

Have you come across patients that you know still live for a fairly substantial amount of time afterward?

>> I don't know if that I I have not myself familiar with anything like that but yeah.

>> You know, the way I like to explain it to patients is, you know, unfortunately we're not necessarily hitting home runs but we do the best we can and so with best treatment, with surgery, with chemotherapy you can see a cure rate but that is on the order of maybe 10 or 20 percent.

And so when I say cure means, you know, alive with or without cancer or without cancer after about five years, OK, so it's not a great number but it's certainly not zero.

>> And so that's the best we can do at this time.

And you know, I don't we hear so much about, you know, cancer, prostate cancer, lung cancer.

I feel like there's a lot of public service announcements out about those and all kinds of walk for a cure or you know, things like that.

We dedicate like the month of October is Cancer Awareness Month.

You just don't hear a lot about pancreatic cancer.

Is it because you know, even just one person dying is too many but because compared to other cancers are there are fewer patients that way maybe there's not as much out about it or I don't know I don't know what the status of research is.

Yeah, well it's certainly an active topic of research.

I think the problem is just the success finding the right med medications better chemotherapies.

It just hasn't happened because the nature of the cancer there is Pancreatic Cancer Awareness Month I believe that's November.

OK, I'm glad you told me.

And just like cancer is the pink ribbon pancreas cancer has a purple ribbon, OK?

And there are definitely foundations and national networks and support networks that are definitely focused on pancreatic cancer research and treatment and resources for patients.

>> OK, all good to know.

I'm going to read another question that somebody texted in but I want to remind everybody you can call in your question.

You can text it in to us so please take advantage of that before the show is over.

So we got a text asking is pain on the left side a is pain on the left side after eating an indication of pancreatic cancer?

>> Yes.

Yes.

>> The potentially yes would be compatible with that but you would have to link it with other symptoms.

For example, is this happening all the time?

Is it associated with weight loss or nausea?

What might be happening, for example is if somebody eats then it activates or irritates the pancreas and in the setting of a pancreatic cancer then that might be worsened.

So certainly not the only symptom not very specific but I guess it could be compatible with that.

>> I guess if you have any concerns is a good starting point just with your primary care doctor and you're not necessarily going to a specialist right away just right.

>> Yeah, You know, if you went to your primary doctor with that kind of complaint then they may check some blood work.

>> They may recommend a CAT scan and then you go from there on the findings.

All right.

Good to know.

I wanted to ask you why that symptom you said the classic symptom about the skin and eyes turning yellow.

>> What causes that?

Yes, that's all based on on the anatomy.

So the pancreas is an organ in the in the upper abdomen.

The upper belly.

Yeah.

And the front part of the head of the pancreas is very close to the bile duct and the bile duct is a tube that connects the liver to the intestine and it carries bile which is a digestive juice.

Right.

And it happens to be green to yellow.

>> Yes.

And so when you have a cancer in the front part of the pancreas that can block that duct so that bile backs up and that's what causes the yellow jaundice if you're to that point where you're looking yellow, is it typically I don't even know if you can kind of , you know, make an estimate as to maybe how progressed it is at that point if you've got that symptom actually that might be a blessing in disguise because that might be an early sign of a cancer if the tumor is in another part of the pancreas where it doesn't cause a blockage, it may have time to grow and spread and cause just those vague or subtle symptoms before it comes to medical attention.

So actually a painless jaundice like I said might actually at least present you earlier to medical attention.

>> All right.

Maybe give you a few more options at that point.

So let's we had a couple as another text question so I'll I'll do that one first.

>> The question was why is pancreatic cancer so aggressive?

>> What is it about it?

Yeah.

Yes.

Uh, you know the term we use it has this aggressive biology and why is that different from a cancer or colon cancer?

>> Yeah, and it's just I don't know if anybody has a great handle on the why but it's how it reacts with the body around it with the tissues around it.

But somehow perhaps the best way to express that is that can evade the immune system to not have the body react to it to help control it.

It has access to the lymphatics and the blood vessels and just ends being more apt to spread in a faster time frame than perhaps other cancers.

>> All right.

And I'm to go ahead and take another text question if I can.

So somebody had written in that their father had died of pancreatic cancer was wondering what what their risk factor would be.

You know, and I guess the person saying that they're a nonsmoker so not smoking and a man.

>> Yeah.

So I think we do see pancreatic cancer run in families and so it's actually a standard recommendation now for any patient who is first diagnosed with cancer is to consider genetic testing talking with genetic counselor to get for example, blood work that can screen for a certain changes in your your cells that can be linked to cancer and so that is important to know again, we're not quite there yet with recommending, for example, earlier screening but at least genetic counseling to identify if not for example, your father.

But other family members with maybe related cancers.

And if that whole picture suggests that you might be higher risk than then definitely there are high risk programs out there that can help with screening and getting you in touch with the right people because you know, we hear so much about the genetic testing.

>> You know, I feel for women, you know, they want to know if they've if they've got the cancer, the Broca you know, a gene.

>> So I'm just wondering, you know, if you did that root for the pancreatic cancer?

I mean does it really help you you know, when you were saying once you're diagnosed, you know, a lot of times don't have a lot of options but what could that genetic testing do just allow you to catch it maybe earlier?

That's right.

I mean so even though they may not be a recommended schedule screening, there is once once you are identified as maybe a higher risk, then yes, you might be recommended to have an MRI of the pancreas every year at a certain age and so early detection can be helpful.

>> I'm going to ask your help for this.

We had somebody else a gentleman named Tom called and he wanted to know what if under Mizz I'm not sure that lation play a role in the development of pancreatic cancer.

I'm not familiar with that word or I'm not sure if it's the correct word.

>> I'm sorry I'm not either.

Yeah OK resubmit it.

Yeah if you guys want to if Tom if you're out there I'm not sure I thought maybe it was a medical term that I just wasn't familiar with.

So as Tom calls back we'll try and get that one answered so just you know we only have a minute or two left in the program and we don't have any questions right now.

We could quickly take one if you guys want to text one in or call we have two minutes left.

>> But in general, you know any any tips you can give to people because you know, I didn't even think about having any type of a screening available.

You know, maybe like my parents are older.

They're both going to be 80 this year.

I'm not sure if they're thinking about it because we've only had one person in our family with it.

What are there's what are some things that maybe I should have them advocate for when they go to the doctor?

>> Yeah, I think you just need to in some ways advocate for yourself again.

You sometimes those subtle symptoms can be ignored or attributed to other issues but if it really is persistent lasting three months, four months, five months then it really takes you know, talking or trying to talk to your doctor about it or trying to talk to your nurse practitioner about it and make sure that there is a clear explanation for why that's happening.

>> All right.

We're going to try and I'm going to try and see if we can answer this one text message really quickly.

Somebody wanted to know if a tiny spot detected the pancreas .

>> It like how often should that be monitored?

Yes, So the short answer is it depends.

>> There are certain characteristics that we look for .

There might be cysts.

There might be other findings in the pancreas and there are some clues in terms of what it looks like as to what are the chances that this could be something now or could turn to something in the future.

And so certainly if there is what we call a growth that may be associated with a future pancreatic cancer, then there are programs where we can monitor that.

So that might be for example, an annual MRI checking certain blood work to make sure it's not changing.

>> All right.

Well, Dr.

Phil Ebow, a surgical gynecologist so great to have you on.

I feel bad the show is over but we had a lot of questions tonight so this gets people thinking about it anyway.

So pleasure for being here.

Thank you.

Thank you so much and thank you to all of you for watching the program and for joining us with your questions.

We'll be back next week.

We have an orthopedic surgeon joining us next Tuesday so we'll see you then.

>> Take care.

Bye bye.