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Host: One-on-One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health. Our guest today is Dr. Evan Glazer, surgical oncologist at Regional One Health Cancer Care who specializes in the treatment of pancreatic cancer. And he joins us today to talk about what patients need to know about this condition. Dr. Glazer is committed to advancing cancer care for his patients at Regional One Health and for patients everywhere. Welcome, Dr. Glazer.

Dr. Evan Glazer: Thank you so much. It really is my pleasure to be here today and discuss pancreas cancer with you.

Host: Pancreatic cancer, I've always heard it's a tricky one and it affects thousands of patients a year. Are there any lifestyle factors or other risk factors that you want patients to be aware of?

Dr. Evan Glazer: Yes, there is. There's a number of risk factors for pancreas cancer. Despite this, unfortunately, many patients still present with later disease or disease that's already spread far away from the pancreas. Some of the risk factors are chronic pancreatitis, new-onset diabetes, smoking, excessive weight gain. And these really are factors that are associated with inflammation. And that's our working understanding of pancreas cancer, is what causes the pancreas to form pancreas cancer is when the inflammation is so severe that eventually it causes these cellular changes.

Host: So what are symptoms of pancreatic cancer that patients might experience?

Dr. Evan Glazer: Some of the more common symptoms of pancreas cancer include skin turning yellow or the eyes turning yellow. This is called jaundice. Oftentimes, patients will have a dull ache in their belly, but no actual pain. They will feel that they've lost some weight. They're not eating as well. They're not gaining weight. And these are signs of a mass or a cancer growing in the pancreas. The pancreas lives next to the bile duct. And sometimes the cancer will actually push on the bile duct. And that's what causes patients to be what's called jaundiced where their skin or their eyes will have a yellow hue to them. Other times, patients will actually develop itching of their skin and will also perhaps have changes to their bowel movements or their urine that are concerning.

Host: Well, those are pretty severe clues. When is it time to get screened for pancreatic cancer?

Dr. Evan Glazer: Unfortunately, we don't have any good screening for pancreas cancer, like we do breast cancer or colon cancer. There are some patients that have a family history of pancreas cancer or family history of other cancers, such as pancreas, but also breast, ovarian, even prostate cancer. And in patients like this, we actually provide a genetic testing service and a screening program for individuals who are at high risk for pancreas cancer. So those individuals that have a family history of pancreas cancer, but they themselves don't have any known cancers, we'll actually do a series of MRI as well as endoscopic procedures, to look at the pancreas and see if there's anything concerning there. If there is, then we'll recommend the biopsy. If there's nothing concerning, then we'll actually follow these patients for many years with serial examinations of their pancreas to look for new signs of spots. And these spots or lesions as we call them can be benign or not cancer, they can be pre-cancer or, unfortunately, in some people, they are full-fledged cancer.

Host: If there is no family history and someone isn't being screened regularly, how do you diagnose for pancreatic cancer?

Dr. Evan Glazer: Often patients will present to their primary care doctor, their gastroenterologist, or even the emergency room, will present with a complaint such as yellowing of the skin or changes to their bowel or bladder habits that usually leads to a scan, which shows a lesion or a mass in the pancreas. And then, we perform a biopsy with endoscopy and that's where a gastroenterologist will put a camera into someone's stomach and put a small needle actually into this mass to get the diagnosis.

Host: As a surgical oncologist, you perform procedures to address cancer. So what becomes the treatment plan when you discover through biopsy that someone does have pancreatic cancer?

Dr. Evan Glazer: Like many cancers, after we have a diagnosis, we do what's called staging. And staging is really important. This is where we do a series of usually CT scans, sometimes MRI. And we look for where the cancer is. The cancer can be just in the pancreas. It could be in the pancreas and the lymph nodes around it, or it can spread. Pancreas cancer most commonly spreads to the liver. And so we look very carefully at the liver, but we also look at the lungs and other areas in a patient for any signs that it has spread. That's what's called staging the patient and staging the cancer.

Once we have a stage, then we talk about treatment. Treatment can be a combination of chemotherapy, surgery to remove it, radiation therapy as well as even other treatments in the very select patients. And that selection is based on characteristics of the tumor and characteristics of the patient. And so we also recommend genetic testing for those patients to really understand if they inherited something that may have caused this and testing the tumor to see if it is susceptible to any specific therapies. This occurs about 10 to 15% of patients. For most patients, after they're diagnosed with pancreas adenocarcinoma, that's the most common type of pancreas cancer, they will undergo chemotherapy. For patients who have metastatic disease, which means it's spread away from the pancreas, that usually is all their therapy, it's primarily chemotherapy. For patients where the cancer is located just in the pancreas, we usually start with chemotherapy, move on to surgery and sometimes use radiation as well if the tumor is touching blood vessels or any other way appears more aggressive than most cancers.

As you can imagine, this is a very multidisciplinary treatment approach. And that really is our preference. I work hand in hand with medical oncologists and interventional radiologists, gastroenterologists and other healthcare specialties really to provide the optimal care and the most personalized care to each individual patient. As a surgical oncologist, my tool to treat cancer is surgery, but it's just as important to get good chemotherapy and, for some patients, good radiation therapy into their tumor.

Host: And as a subspecialist in pancreatic cancer, you've also gone through additional training to have additional experience to treat this disease. So that must be something that you put to work in this multidisciplinary environment that benefits your patients as well.

Dr. Evan Glazer: That's right. In addition to being a board-certified general surgeon, I'm a board-certified complex surgical oncologist. And really what that means is I have extra training involved in not just the surgical aspects of care or surgical aspects of oncology care, but almost as importantly, I have extra training in radiation therapy, in chemotherapy and other tools that my colleagues are experts at. And we work together to identify the best treatments for the best patients at the best time. And, as you can imagine, it can be very complex. And that's why it's so important to have experts in each of these fields come together at our multidisciplinary conferences as well as interact with the patients and really understand what are the highest priorities for the patients and their families and how we can best achieve those goals. For many patients, it's understanding the cancer and helping them live as long as possible. And so we work together to optimally deliver all the care in a successful way.

Host: Now, of course, treatment plan's a little different for each patient. But in terms of recovery and outcomes, what do you see and what can patients expect? What should their expectations be in terms of those factors?

Dr. Evan Glazer: Over the last 15 years or so, we've almost tripled the survival for patients with pancreas cancer. Some of that is due to better techniques in surgery. Some of that is due to better understanding of tumor biology. Some of that is due to better chemotherapies. It's very exciting to be involved in research and clinical trials as we work to better deliver care. And while pancreas cancer can still be a very fail disease, we have more treatment options now than we did 10 or 15 years ago. And it's really important that when patients have a diagnosis of pancreas cancer, all options are on the table for initial evaluation. And so our patients are thoroughly staged, as I mentioned before, and we present all of the patients with pancreas cancer at our multidisciplinary conference to really come up with the best possible recommendations for each patient and continue to do that over the course of their treatment.

Host: Along with seeing patients, you're also actively engaged in research and improving care for pancreatic cancer. So what are some of the developments that you know of that might benefit patients in the future?

Dr. Evan Glazer: Over the last few years, immunotherapy or immune system therapy, where we give drugs to have the patient's own immune system attack the cancer has really changed the paradigm for treatment for many cancers. Unfortunately, that has not been the case for patients with pancreas cancer. One of the reasons we think is that the pancreas cancer itself is sending signals that's turning off the immune system. And so right now, a lot of research is being done to understand what those signals are and then how to block them, to allow the immune system to step up and really attack the pancreas cancer.

The other approach that I'm actively involved in research is to understand the different signals that happen inside the pancreas cancer cell itself. And so we know that pancreas cancer can take many years to form. And during that time, the cancer cell develops what's called signaling pathways, where signals are telling the pancreas cancer to grow. If we can block those successfully, we may be able to also use other therapies to attack and kill the cancer cells. And so I really think the future of the research is a multi-prong approach where we will attack pancreas cancer from different angles, including having the patient's own immune system attack the cancer.

Host: Well, you have really stayed on the cutting edge of treating this disease. I look forward to further advances in the treatment of pancreatic cancer. And meanwhile, thank you, Dr. Glazer, for an in depth look and insight into this disease.

Dr. Evan Glazer: Thank you. It's my pleasure to spend a few minutes speaking with you.

Host: You can learn more about Regional One Health Cancer Care by visiting www.regionalonehealth/oncology. And for an appointment, call 901-515-9595. Thanks for making One-on-One with Regional One Health part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow. Until then, be well.