If you or a loved one has been diagnosed with pancreatic or colon cancer, or if you've been told you're at high risk for developing the disease, City of Hope has one of the most experienced Pancreatic and Colon cancer programs in the United States It's important to learn about your options and take action right away.
Behnam Ebrahimi, MD, a City of Hope expert on Pancreatic and Colorectal Cancer, is here to explain how being "aware" of the disease process means more than being able to recognize the disease's risk factors, knowing symptoms and getting screened regularly.
Selected Podcast
Current Treatments for Colon and Pancreatic Cancer
Featured Speaker:
Dr. Ebrahimi was selected a chief fellow while at MD Anderson Cancer Center, and awarded a National Cancer Institute Fellowship Research Grant. He is an active member of the American Society of Hematology and the American Society of Clinical Oncology. His personal hobbies and interests include spending time with his family taking trips and going to the movies. Dr. Ebrahimi also keeps in shape by running and working out.
Learn more about Behnam Ebrahimi, MD
Behnam Ebrahimi, MD
As an oncologist, Behnam Ebrahimi, M.D., is especially interested gastrointestinal malignancies such as colon and pancreatic cancer, of which he has published many abstracts and articles. He also specializes in treating hematological malignancies, lung and breast cancer. He states, "I am a firm believer in enrolling my patients in clinical trials, I'm committed to researching the best possible treatments available for each patient."Dr. Ebrahimi was selected a chief fellow while at MD Anderson Cancer Center, and awarded a National Cancer Institute Fellowship Research Grant. He is an active member of the American Society of Hematology and the American Society of Clinical Oncology. His personal hobbies and interests include spending time with his family taking trips and going to the movies. Dr. Ebrahimi also keeps in shape by running and working out.
Learn more about Behnam Ebrahimi, MD
Transcription:
Current Treatments for Colon and Pancreatic Cancer
Melanie Cole (Host): If you or a loved one has been diagnosed with pancreatic or colon cancer or if you've been told you're at high risk for developing the disease, City of Hope has one of the most experienced pancreatic cancer programs in the United States and it's important to learn about your options and take action right away. My guest today is Dr. Ben Ebrahimi. He is a medical oncologist at City of Hope. Welcome to the show, Dr. Ebrahimi. Tell us a little about pancreatic cancer. Can this be found early?
Dr. Ben Ebrahimi (Guest): Pancreatic cancer is the fifth most common cancer in the United States. The organ pancreas is seated deeply in the abdomen and, unfortunately, a lot of times the symptoms are not specific--nausea, vomiting, abdominal pain, sometimes you can get jaundice--and most of the time, when we catch pancreatic cancer, it is at an advanced stage, either Stage 3 or 4.
Melanie: Are there some symptoms, some red flags, that would point to someone saying, "Well, I need to get this checked out right away"?
Dr. Ebrahimi: Right. The symptoms of pancreatic cancer are not specific but there are some symptoms. For example, unintended weight loss, abdominal pain, nausea, vomiting or jaundice, which is the yellowing of the skin. The symptoms of jaundice sometimes your stools become clay-colored and your urine will be dark. Those are some of the symptoms of pancreatic cancer. Another symptom that also sometimes happens is new onset diabetes. If you're diagnosed with new onset diabetes, sometimes it could be because of pancreatic cancer as well.
Melanie: Okay, so if somebody has some of these symptoms, things that they've noticed and they know it's just not right, how do you diagnose it? Is it difficult to diagnose?
Dr. Ebrahimi: Well, a lot of times the patients present to their primary care physician with these symptoms and eventually get a CT scan of the abdomen and there's a mass in the pancreas, and that necessitates further workup be it a biopsy, which is the most common way of diagnosing this, and there's some blood tests that support the diagnosis of pancreatic cancer.
Melanie: Then, after diagnoses, how do you stage pancreatic cancer?
Dr. Ebrahimi: So, like a lot of different cancers, pancreatic cancer comes in four stages, Stage I, II, III, IV. Stage IV is when it has spread to the outside organs and the most common is the liver and the peritoneum. Stage I and II is relatively early and localized and Stage III will be the lymph node involvement. So, in terms of staging with pancreatic cancer, we do recommend an endoscopic ultrasound where they can tell us the depth of the tumor along with a CT scan to abdomen and chest. Then, we can further refine the staging.
Melanie: So, pancreatic cancer, people hear that and right away they lose all hope. What do you tell them about the treatments that are available now for people with pancreatic cancer?
Dr. Ebrahimi: Pancreatic cancer is a tough cancer to treat but there are a lot of treatment options. For advanced staged pancreatic cancer, the cornerstone that is still chemotherapy and, in the last few years, we have some new chemotherapeutic options that we can use in a patient with pancreatic cancer. At City of Hope, of course, we have exciting clinical trials be it first line or second line of pancreatic cancer where we're using standard chemotherapy plus or minus something new in patients with pancreatic cancer. In the earlier stages, if it's discovered, the cornerstone, of course, will be surgery which is the Whipple procedure. Period. If the patient's not exactly resectable, at the beginning, we can maybe give chemotherapy plus radiation therapy to shrink down the tumor and then go on to have surgery.
Melanie: Tell us a little bit about the Whipple procedure, doctor, because this is a big surgery. So, tell us just a little bit about it and then what happens after that?
Dr. Ebrahimi: The Whipple procedure is essentially for cancers that are at the head of the pancreas. It's a pancreaticoduodenectomy, so they take the head of the pancreas along with part of the duodenum and they reconstruct the bile duct as well. These are surgeries that are not done that commonly at a community hospital, so we highly recommend for it be done at a tertiary center where they've done a high volume of these cases. So, out of 100 patients with pancreatic cancer, 20% will be a candidate for a Whipple procedure. Once that is done, if the tumor is deep involvement of other adjacent organs or if there's lymph node involvement, we do recommend chemotherapy therapy as well as radiation therapy afterwards to decrease the chances of the cancer coming back.
Melanie: So, let's speak about the cancer coming back. Do they live in fear even if they've had Whipple procedure? Is this something that, if it comes back, comes back with a vengeance? How do you keep track?
Dr. Ebrahimi: So, the pancreatic cancer in patients that have had the Whipple procedure and have had treatments afterwards, we follow very closely the first two years. There is a chance of the cancer coming back the first two years, so we see the patients every three months for that first two years. If it were to come back, of course, each patient's different, but usually it doesn't come back with a vengeance, but there are a fair number of these patients that the cancer can come back. That's why a lot of research is going on both locally and at a national level, so we can find better treatment options for our patients with pancreatic cancer.
Melanie: Can you give us some exciting things that are going on at City of Hope in terms of pancreatic cancer?
Dr. Ebrahimi: In terms of pancreatic cancer, we're looking at new target agents in combination with chemotherapy or by itself to treat these patients' pancreatic cancer. We have trials in both first line setting, second line setting, and the refractory period. One of the exciting areas of oncology in general is immunotherapy and there are trials that are being done with immunotherapy in different stages of pancreatic cancer.
Melanie: So, doctor, let's talk a little bit about colon cancers. This is also one of your specialties at City of Hope. Are there some symptoms of colon cancer? This particular cancer is also one that can be preventable. So, speak a little bit about colon cancer.
Dr. Ebrahimi: Colon cancer is, obviously, a different cancer than pancreatic cancer. We actually have a very effective screening and prevention for colon cancer. Colon cancer starts out in polyps. Polyps are a benign overgrowth which, over time, can become cancerous. That's why we have, in the absence of family history, we have screening guidelines for patients starting at age 50, who should have a colonoscopy and if it's totally normal, once every 10 years. If they have polyps, obviously, the polyps are removed and they can have one every 3-5 years. There are also some dietary factors, so it's been shown if you have a diet high in fruits and vegetables and low in red meat, that can help with cancer prevention as well as exercise that is very important both for prevention of colon cancer and colon cancer survivors. In terms of symptoms of colon cancer, a lot of times patients present with anemia. So, if you have anemia from iron deficiency, especially in a patient over 50, you always worry about colon cancer but you could have any symptoms be it constipation, you could have abdominal pain, nausea, vomiting, and the symptoms are non-specific.
Melanie: Now, if someone gets their colonoscopy on a regular basis and polyps are found, are all polyps the same? Are some a little bit more dangerous than others and, once they're removed, is there then a risk for them to regrow?
Dr. Ebrahimi: Right. There are different types of polyps. There are hyperplastic polyps--these are considered benign polyps. A tubulovillous polyp, which is how it looks under the microscope, has a special structure. Especially if they're more than two centimeters, those are risk factors for colon cancer. So, as long as you fully remove the polyps, you really decrease your chances of the colon cancer. If someone does have polyp, they'll be followed very carefully. As long as you have good removal of the polyps, that's a good way of preventing colon cancer. Now, if you're at age 40 and below and you have polyps, or if you're diagnosed with colon cancer below age 50, and especially if you have a family history of colon cancer, you do need to be screened for some of the hereditary syndromes that predispose you to colon cancer and at City of Hope, we have a very strong genetic counseling and screening programs for these particular groups of patients.
Melanie: So, tell us, in just the last few minutes, what are you doing that's very exciting there in terms of colon cancer at City of Hope?
Dr. Ebrahimi: With colon cancer, most of the trials that we have are really for advanced colon cancer, Stage IV, and we have lots of chemotherapy plus or minus targeting agents. These groups of patients, again, like I mentioned, pancreatic cancer we are looking at immunotherapy agents and, in colon cancer, there's a whole new class of medications that we're also testing to see if it's effective in colon cancer. Thirteen years ago, on average, patients lived like one year with colon cancer. Now, it's not unusual for patients to live two-and-a-half, three years and we're making a lot of advances in the treatment of colon cancer.
Melanie: Thank you so much, Dr. Ebrahimi. It's really great information. You're listening to City of Hope Radio. For more information, you can go to cityofhope.org. That's cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Current Treatments for Colon and Pancreatic Cancer
Melanie Cole (Host): If you or a loved one has been diagnosed with pancreatic or colon cancer or if you've been told you're at high risk for developing the disease, City of Hope has one of the most experienced pancreatic cancer programs in the United States and it's important to learn about your options and take action right away. My guest today is Dr. Ben Ebrahimi. He is a medical oncologist at City of Hope. Welcome to the show, Dr. Ebrahimi. Tell us a little about pancreatic cancer. Can this be found early?
Dr. Ben Ebrahimi (Guest): Pancreatic cancer is the fifth most common cancer in the United States. The organ pancreas is seated deeply in the abdomen and, unfortunately, a lot of times the symptoms are not specific--nausea, vomiting, abdominal pain, sometimes you can get jaundice--and most of the time, when we catch pancreatic cancer, it is at an advanced stage, either Stage 3 or 4.
Melanie: Are there some symptoms, some red flags, that would point to someone saying, "Well, I need to get this checked out right away"?
Dr. Ebrahimi: Right. The symptoms of pancreatic cancer are not specific but there are some symptoms. For example, unintended weight loss, abdominal pain, nausea, vomiting or jaundice, which is the yellowing of the skin. The symptoms of jaundice sometimes your stools become clay-colored and your urine will be dark. Those are some of the symptoms of pancreatic cancer. Another symptom that also sometimes happens is new onset diabetes. If you're diagnosed with new onset diabetes, sometimes it could be because of pancreatic cancer as well.
Melanie: Okay, so if somebody has some of these symptoms, things that they've noticed and they know it's just not right, how do you diagnose it? Is it difficult to diagnose?
Dr. Ebrahimi: Well, a lot of times the patients present to their primary care physician with these symptoms and eventually get a CT scan of the abdomen and there's a mass in the pancreas, and that necessitates further workup be it a biopsy, which is the most common way of diagnosing this, and there's some blood tests that support the diagnosis of pancreatic cancer.
Melanie: Then, after diagnoses, how do you stage pancreatic cancer?
Dr. Ebrahimi: So, like a lot of different cancers, pancreatic cancer comes in four stages, Stage I, II, III, IV. Stage IV is when it has spread to the outside organs and the most common is the liver and the peritoneum. Stage I and II is relatively early and localized and Stage III will be the lymph node involvement. So, in terms of staging with pancreatic cancer, we do recommend an endoscopic ultrasound where they can tell us the depth of the tumor along with a CT scan to abdomen and chest. Then, we can further refine the staging.
Melanie: So, pancreatic cancer, people hear that and right away they lose all hope. What do you tell them about the treatments that are available now for people with pancreatic cancer?
Dr. Ebrahimi: Pancreatic cancer is a tough cancer to treat but there are a lot of treatment options. For advanced staged pancreatic cancer, the cornerstone that is still chemotherapy and, in the last few years, we have some new chemotherapeutic options that we can use in a patient with pancreatic cancer. At City of Hope, of course, we have exciting clinical trials be it first line or second line of pancreatic cancer where we're using standard chemotherapy plus or minus something new in patients with pancreatic cancer. In the earlier stages, if it's discovered, the cornerstone, of course, will be surgery which is the Whipple procedure. Period. If the patient's not exactly resectable, at the beginning, we can maybe give chemotherapy plus radiation therapy to shrink down the tumor and then go on to have surgery.
Melanie: Tell us a little bit about the Whipple procedure, doctor, because this is a big surgery. So, tell us just a little bit about it and then what happens after that?
Dr. Ebrahimi: The Whipple procedure is essentially for cancers that are at the head of the pancreas. It's a pancreaticoduodenectomy, so they take the head of the pancreas along with part of the duodenum and they reconstruct the bile duct as well. These are surgeries that are not done that commonly at a community hospital, so we highly recommend for it be done at a tertiary center where they've done a high volume of these cases. So, out of 100 patients with pancreatic cancer, 20% will be a candidate for a Whipple procedure. Once that is done, if the tumor is deep involvement of other adjacent organs or if there's lymph node involvement, we do recommend chemotherapy therapy as well as radiation therapy afterwards to decrease the chances of the cancer coming back.
Melanie: So, let's speak about the cancer coming back. Do they live in fear even if they've had Whipple procedure? Is this something that, if it comes back, comes back with a vengeance? How do you keep track?
Dr. Ebrahimi: So, the pancreatic cancer in patients that have had the Whipple procedure and have had treatments afterwards, we follow very closely the first two years. There is a chance of the cancer coming back the first two years, so we see the patients every three months for that first two years. If it were to come back, of course, each patient's different, but usually it doesn't come back with a vengeance, but there are a fair number of these patients that the cancer can come back. That's why a lot of research is going on both locally and at a national level, so we can find better treatment options for our patients with pancreatic cancer.
Melanie: Can you give us some exciting things that are going on at City of Hope in terms of pancreatic cancer?
Dr. Ebrahimi: In terms of pancreatic cancer, we're looking at new target agents in combination with chemotherapy or by itself to treat these patients' pancreatic cancer. We have trials in both first line setting, second line setting, and the refractory period. One of the exciting areas of oncology in general is immunotherapy and there are trials that are being done with immunotherapy in different stages of pancreatic cancer.
Melanie: So, doctor, let's talk a little bit about colon cancers. This is also one of your specialties at City of Hope. Are there some symptoms of colon cancer? This particular cancer is also one that can be preventable. So, speak a little bit about colon cancer.
Dr. Ebrahimi: Colon cancer is, obviously, a different cancer than pancreatic cancer. We actually have a very effective screening and prevention for colon cancer. Colon cancer starts out in polyps. Polyps are a benign overgrowth which, over time, can become cancerous. That's why we have, in the absence of family history, we have screening guidelines for patients starting at age 50, who should have a colonoscopy and if it's totally normal, once every 10 years. If they have polyps, obviously, the polyps are removed and they can have one every 3-5 years. There are also some dietary factors, so it's been shown if you have a diet high in fruits and vegetables and low in red meat, that can help with cancer prevention as well as exercise that is very important both for prevention of colon cancer and colon cancer survivors. In terms of symptoms of colon cancer, a lot of times patients present with anemia. So, if you have anemia from iron deficiency, especially in a patient over 50, you always worry about colon cancer but you could have any symptoms be it constipation, you could have abdominal pain, nausea, vomiting, and the symptoms are non-specific.
Melanie: Now, if someone gets their colonoscopy on a regular basis and polyps are found, are all polyps the same? Are some a little bit more dangerous than others and, once they're removed, is there then a risk for them to regrow?
Dr. Ebrahimi: Right. There are different types of polyps. There are hyperplastic polyps--these are considered benign polyps. A tubulovillous polyp, which is how it looks under the microscope, has a special structure. Especially if they're more than two centimeters, those are risk factors for colon cancer. So, as long as you fully remove the polyps, you really decrease your chances of the colon cancer. If someone does have polyp, they'll be followed very carefully. As long as you have good removal of the polyps, that's a good way of preventing colon cancer. Now, if you're at age 40 and below and you have polyps, or if you're diagnosed with colon cancer below age 50, and especially if you have a family history of colon cancer, you do need to be screened for some of the hereditary syndromes that predispose you to colon cancer and at City of Hope, we have a very strong genetic counseling and screening programs for these particular groups of patients.
Melanie: So, tell us, in just the last few minutes, what are you doing that's very exciting there in terms of colon cancer at City of Hope?
Dr. Ebrahimi: With colon cancer, most of the trials that we have are really for advanced colon cancer, Stage IV, and we have lots of chemotherapy plus or minus targeting agents. These groups of patients, again, like I mentioned, pancreatic cancer we are looking at immunotherapy agents and, in colon cancer, there's a whole new class of medications that we're also testing to see if it's effective in colon cancer. Thirteen years ago, on average, patients lived like one year with colon cancer. Now, it's not unusual for patients to live two-and-a-half, three years and we're making a lot of advances in the treatment of colon cancer.
Melanie: Thank you so much, Dr. Ebrahimi. It's really great information. You're listening to City of Hope Radio. For more information, you can go to cityofhope.org. That's cityofhope.org. This is Melanie Cole. Thanks so much for listening.