Diagnosed with pancreatic cancer: Now what?

Pancreatic cancer remains one of the deadliest of the major cancers, with a five-year survival rate of only 13%.

It's a complex and stealthy disease that is often difficult to treat and can be scary for patients and their family.

That’s why seeking out the best care is critically important for those newly diagnosed with pancreatic cancer.

“As research advances our understanding of pancreatic cancer, we’re doing better at taking care of patients. Still, given what we know about pancreatic cancer, we want to make sure we have a treatment strategy from the beginning for every patient,” said Evan Glazer, M.D., Ph.D., Clinical Director of the Pancreatic Cancer Program at University of Michigan Health and Associate Director of Clinical Research in the Rogel and Blondy Center for Pancreatic Cancer.

There are different types of pancreatic cancer. The most common is called adenocarcinoma.

Patients may also have neuroendocrine tumors and other types of cancer.

Each type is unique and requires different treatment.

We talked with Glazer about how newly diagnosed patients can get started with their care.

Why is it especially important in pancreatic cancer to find the right place to receive care?

Glazer: Because pancreatic cancer is so challenging, it’s crucial to deliver the best possible treatment for the patient as early in their diagnosis as possible.

From the beginning, we need to have a strategy in place that is flexible to the needs of the patient and responds to the changes in the tumor.

Sometimes we’ll need to pivot that strategy, and that’s OK.

That’s why we start by knowing Plan A, Plan B and Plan C.

Importantly, each plan is made up of doctors and providers with different expertise, which we refer to as multidisciplinary care.

Pancreatic cancer in and of itself can really take over the patient.

For example, a lot of patients with pancreatic cancer are malnourished. They're unable to eat well and are losing weight.

We want to make sure throughout treatment that their blood sugars are OK, that they’re eating and absorbing nutrients well.

And if they’re not, we want to address that early on. Some of that is done by surgical oncologists, some by medical oncologists, some by dieticians and some by palliative care doctors.

A number of different specialists can contribute to preventing small issues from becoming big issues.

What should you look for in a pancreatic cancer program?

Glazer: There are a number of things patients should consider.

First, look for a hospital that takes care of a lot of pancreas cancer patients.

The surgeons should specialize in pancreatic cancer and perform a high volume of pancreas surgery.

The medical oncologists should specialize in pancreatic or gastrointestinal cancers.

Second, about 10-15% of patients with pancreatic cancer will have an anomaly in their genes that caused or contributed to the cancer.

Every pancreatic cancer patient should be referred to genetic testing to check for inherited genes that contribute to cancer.

You want to be tested with the best available data, so you want to be at a place that does this routinely.

A lot of patients with pancreatic cancer experience symptoms, such as nausea or pain.

Access to experts in palliative care to help with the symptoms is an important part of treatment.

Palliative care physicians and providers specialize in helping patients manage their symptoms.

Often, people confuse palliative care with hospice.

Palliative care providers work hand-in-hand with medical and surgical oncologists to help patients undergo the best treatments for them.

National affiliations and accreditations are another way to measure expertise.

For example, the Rogel Cancer Center is a National Comprehensive Cancer Network member institution and a National Cancer Institute-designated comprehensive cancer center.

Both NCCN and NCI organizations define best cancer care practices and best cancer research programs in the United States.

What can you expect when you first come to the Rogel Cancer Center for pancreatic cancer care?

Glazer: We take a team-based approach here, even to getting you in the door.

You’ll start with one of our intake coordinators.

They’ll help you make an appointment and will also work with you to transfer any imaging tests you’ve already had or schedule any new imaging tests you’ll need.

We also have our pathologists evaluate any biopsies you’ve had as a second-look or second opinion.

From there, you’ll begin working with our clinic nurses, who are a key part of the pancreatic cancer care team.

They will help navigate you through your first visits as we evaluate you and your cancer.

You may meet with a nurse practitioner or physician’s assistant early in the process so we understand your goals, your health and your priorities.

We also provide information, education and knowledge to help you make choices about your care.

Your care team will include surgeons, oncologists, physician assistants, nurse practitioners, nurses and geneticists who specialize in pancreatic cancer.

We all work together to provide the best treatment recommendations for each individual we see.

We started that multidisciplinary approach many years ago, and in fact, we were the first program to organize this way around pancreatic cancer.

At every step of the way, we’ll find the right answer with you. We have the tools, the people and the skillset to pivot as the patient’s needs change and as the tumor responds.

How does a multidisciplinary approach to pancreatic cancer make a difference?

Glazer: It’s about treating the right patient with the right treatment at the right time for the right reason.

As patients go through their course of treatment, they’re going to change and their cancer is going to change.

Their treatment needs to change with them.

One patient’s treatment may be different from another patient’s, based on the individual and how their cancer responds to treatment.

The best example is that for patients who plan to have surgery, we often give chemotherapy beforehand to shrink the tumor.

How much chemotherapy before surgery is personalized, based on how each patient tolerates the treatment and how their cancer responds to it.

Our surgical oncologists are very involved in the chemotherapy process.

We have ongoing conversations with our medical oncologists about the best time for surgery.

It’s not an automatic regimen for all patients.

We check in: Do we want to do another cycle of chemotherapy, or can we move on to surgery? These decisions are made collectively, based on everyone’s expertise and the individual patient.

What role does research play in pancreatic cancer treatment?

Glazer: Pancreatic cancer is a big challenge.

We have a full continuum of excellence at the Rogel and Blondy Center for Pancreatic Cancer, with researchers working in laboratories side-by-side with our clinical teams to translate greater understanding of the disease’s biology into new treatments.

There’s opportunity for patients to help with this mission by participating in clinical trials testing potential new treatments.

Patients can also opt into our biorepository, which includes samples of tissue, blood and other specimens, that are used in laboratory or clinical research.

We collect these extra samples from surgery or tests that patients are already undergoing.

Our goal is that every patient is involved to the degree they want to be in clinical trials, including our biorepository.

It's altruistic, but as scientists and researchers, we certainly appreciate patients and families who help us improve options for the next generation.

Pancreatic cancer was more fatal 10 years ago than it is today.

This is a direct result of research to understand the biology of the disease, leading to clinical trials to test and develop new treatments.

Bringing new treatments to patients sooner is what research is about.

Our goal is to improve survival for patients with pancreatic cancer today and tomorrow.

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