Screening for Pancreatic Cancer

Hackensack University Medical Center recently launched an innovative surveillance program that screens individuals who are at high-risk for pancreatic cancer. Our gastroenterologists are using the first blood test on the market dedicated to the early detection of familial or hereditary pancreatic ductal adenocarcinoma (PDAC). The blood test analyzes 9 biomarkers in serum to detect PDAC, which is the most common type ofpancreatic cancer. Biomarkers assess multiple cellular processes including metabolism, inflammation and tissue damage/repair, along with CA19-9. A sample's level of each biomarker is measured and then combined through an algorithm to determine a test result which can indicate whether a patient is "High-Risk Signature Present", "Negative for High-Risk Signature", or "Borderline".

Patients who are eligible will receive both an imaging and biomarker test to measure the immune system’s response to pancreatic disease in the blood. Early detection is crucial to treatment since symptoms typically only develop with late-stage disease. The majority of pancreatic cancer is diagnosed in late stages when treatments are less effective. Identifying patients who are at risk for developing the disease or genetic mutations and family history of pancreatic cancer can be critical for finding and treating it.

Pancreas cancer screening is critical in the following high-risk groups of patients over 18 and with:

• BRCA mutation
• Cystic Fibrosis
• Familial Adenomatous Polyposis (FAP)
• Familial Atypical Multiple Mole Melanoma (FAMMM)
• Hereditary Nonpolyposis Colorectal Cancer (HNPCC) or Lynch Syndrome
• Hereditary Pancreatitis
• PALB2 mutation
• Peutz-Jeghers Syndrome
• Family history of pancreas cancer in two first-degree relatives

Pancreas Cyst Program

Hackensack University Medical Center also offers a diagnostic and longitudinal followup pancreas cyst program. This is a specialized team dedicated to the most accurate and sensitive evaluations and management of pancreatic cysts, which are common and potentially precancerous pancreas lesions. We will work with both you and your regular physician to help you both come up with an evidence-based plan to manage these oftencomplex situations. This will utilize state of the art imaging, endoscopic ultrasound, and cyst genetic/molecular analysis.

Causes of Pancreatic

Cancer Changes in your DNA result in cancer. 10% of pancreatic cancer are inherited from your parents, or result over time from smoking, obesity, or age. This can also happen at random.

First degree relatives of someone diagnosed with pancreatic cancer may have an increased risk of developing pancreatic cancer. Inherited mutations can be deciphered through genetic testing.

One’s likelihood of pancreatic cancer may be increased due to:

• Long standing diabetes
• Chronic and hereditary pancreatitis
• Smoking
• Race: African American or Ashkenazi Jew
• Over 60
• Male
• Diets high in red and processed meats
• Obesity
• Alcohol
• Chemical and heavy metal exposure
• Gum disease

Signs and Symptoms of Pancreatic Cancer

• Pain, usually in the abdomen or back
• Weight loss
• Jaundice (yellowing of the skin, eyes or both) with or without itching
• Loss of appetite
• Nausea
• Changes in stool
• Pancreatitis (swelling of the pancreas)
• Recent-onset diabetes

If you are experiencing one or more of these symptoms, we encourage you to consult your doctor and reference pancreatic cancer.

Diagnosing Hepatobiliary and Pancreatic Cancer

Accurate diagnosis is essential to treatment planning for hepatobiliary and pancreatic cancer. This also requires skill in endoscopic approaches to view, diagnose and stage your tumor. Our expert team uses the most advanced technology with accurate and prompt results.

Advanced imaging includes MRI, CT and PET scans and X-rays.

Angiography is an X-ray taken after dye or contrast medium is injected into your arteries to show an outline of your blood vessels.

Biopsy is a procedure to remove a small portion of tissue for testing, sometimes with ultrasound or MRI imaging.

Blood tests are used to check your blood for certain markers that indicate cancer.

Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and sound waves, to improve the visibility of your pancreas and bile ducts and allow your doctor to take a biopsy.

Endoscopic ultrasound uses a special probe and high-energy sound waves to diagnose, stage and treat liver, pancreatic or hepatobiliary cancer.

Liver function tests are blood tests that indicate how well your liver is working.

3D assessment of a tumor based on CT exams is used for diagnosis and treatment planning.

Advanced Surgery for Hepatobiliary and Pancreatic Cancer

Surgery offers the best chance of containing pancreatic cancer. Hepatobiliary and pancreatic surgery is a complex area of surgery that requires an experienced team. We routinely treat liver, pancreas and hepatobiliary cancers. This means you’ll find:

• Our specially trained surgeons are well versed in the full range of robotic, minimally invasive and open techniques used to treat liver, pancreas or hepatobiliary cancer.
• We carefully review each patient’s case, and based on evidence and experience, make recommendations for treatment.
• We utilize innovative surgical approaches and technologies in our commitment to superior outcomes for patients.

Robotic Surgery

Our expert surgeons use the latest da Vinci surgical robot to remove liver, pancreas and hepatobiliary cancer with great precision, fewer side effects and reduced recovery time.

Other Surgical Approaches

• Open surgery. If you are not a candidate for robotic surgery, our surgeons are skilled at performing open surgical resection to remove tumors of the pancreas, liver and surrounding organs.
• Palliative surgery. Even if your cancer is inoperable, sometimes we can perform surgery to relieve symptoms and improve your quality of life.
• Whipple surgery. The Whipple procedure (pancreaticoduodenectomy) is the primary surgery for pancreatic cancer. Surgeons remove the head of the pancreas, and parts of the small intestine, gallbladder, stomach and lymph nodes.

Minimally Invasive Tumor Removal

Interventional radiologists use minimally invasive approaches, including ablation (killing tumor tissue with intense heat) and embolization (cutting off blood supply to the tumor). These techniques may be the primary treatment, or used to reduce the size of tumors before surgery.

Treatments Available for Hepatobiliary and Pancreatic Cancer

Your team includes oncologists who develop a treatment plan for your specific type, grade and stage of cancer. Our goal is to effectively target your hepatobiliary or pancreatic cancer while reducing side effects.

Chemotherapy

Works by slowing down or stopping the growth of cancer cells. We choose chemotherapy combinations based on the latest research and your exact type of tumor, if it has spread and your overall health.

Hormone Therapy

Blocks the production or effects of hormones that can stimulate cancer growth.

Immunotherapy

Uses biological substances to boost your immune system to find and destroy cancer cells.

Targeted Therapy

We analyze your cancer to identify genetic mutations and the molecular signals driving its growth, so we can disable cancer cells from growing, dividing and spreading.

Why Choose Our Program

Our expert doctors and staff partner with patients and families at every step, offering personalized information and support. Hackensack Meridian John Theurer Cancer Center provides an innovative screening approach, which is the only center in New Jersey to offer formal screening for pancreatic cancer. The availability of this blood test and advanced imaging expertise provides patients with a newfound approach to screening for such a cancer.