Pancreatic Cancer

By: Daniel Gelrud, MD

The pancreas is an important organ responsible for the production of enzymes necessary for the digestion of food and insulin (a hormone that controls sugar levels in the blood). Pancreatic cancer is a disease in which malignant cells form in the pancreatic tissues. The risk factors for developing pancreatic cancer include smoking, diabetes, obesity, chronic pancreatitis and certain inherited conditions.

Symptoms

Initially pancreatic cancer tends to be silent but as it grows symptoms develop. Unfortunately, by the time symptoms develop the cancer has probably grown outside of the pancreas. The symptoms will depend on the location of the cancer. If the tumor is in the body of the pancreas, the patient will have belly or back pain and weight loss. Pancreatic cancer of the head of the pancreas tends to cause weight loss, belly or back pain, jaundice (yellow skin and eyes), dark urine, itching or light colored stool.

Is Pancreatic Cancer Increasing?

Pancreatic cancer has a poor prognosis and its incidence has been increasing over the last 15 years. Although it is not clear why this is happening, pancreatic cancer ranks 4th in cancer related deaths. By 2030 it is believed that pancreatic cancer will fall shortly behind lung cancer as the second highest cause of cancer deaths.

There are several reasons for the increase in pancreatic cancer. Firstly, there has been a rise in obesity and diabetes which are both risk factors for the disease. Secondly, the incidence of colon and breast cancer has been decreasing because of effective screening practices. The incidence of colon cancer in older adults has decreased 30% over the last decade because of the increasing use of colonoscopy as a screening tool. Thirdly, the general population has a higher life expectancy and pancreatic cancer is more common later in life.

 How is Pancreatic Cancer Diagnosed?

The pancreas is a very difficult organ to image and obtain tissue from. This makes it very difficult to diagnose. After a patient develops symptoms suggestive of pancreatic cancer, your primary doctor will obtain a full history and physical exam and then he may order a CT scan or a MRI. After that the doctor will refer the patient to see a gastroenterologist with expertise in pancreatic diseases. A biopsy will be obtained using an Endoscopic Ultrasound (EUS) or with an ERCP (an endoscopic procedure that accesses the bile and pancreatic ducts). One of the main objectives for the imaging studies and EUS is to determine whether the cancer can be removed by surgery.

Treatments

The best treatment for pancreatic cancer depends on how far it has spread, or its stage. Early stages can be treated with surgery. When the tumor has spread beyond the pancreas, then surgery is not possible. Other treatment modalities such as chemotherapy and radiation therapy can extend survival.

Summary

Pancreatic cancer is a common cause of cancer related deaths and its occurrence has been increasing over the last 15 years. Early diagnosis is crucial and it is imperative to consult with a physician who has experience with pancreatic cancer.

 

FIU College of Medicine and Gastro Health Working Hand in Hand

In 2009 FloridaInternationalUniversity opened the new Herbert Wertheim College of Medicine, the first public medical school in South Florida, with an initial class of 43 students. Two years before the first class started, the dean of the new medical school approached Gastro Health to form a partnership to develop the Gastroenterology curriculum.  Dr. Daniel Gelrud of Gastro Health was named director of the Gastrointestinal System and Nutrition course.

With the leadership of Dr. Gelrud, doctors from Gastro Health have developed the curriculum of what the new young doctors will learn about gastrointestinal diseases.  The doctors from Gastro Health give lectures and participate in innovative case conferences that help students learn basic Gastroenterology as well as the latest advances in the field.

Medical Students from FIU participate through hospital rotations with Gastro Health doctors at South Miami and BaptistHospitals, as well as their GallowayMedicalPark office located at 7500 SW 87th Avenue. The students are exposed to the latest advances and new technologies mastered by these doctors.

Several Gastro Health physicians come from academic backgrounds. Dr. Javier Parra taught medical students and Gastroenterology fellows advanced endoscopic procedures including ERCP (Endoscopic Retrograde Cholangiopancreatography) and Enteroscopy at the University of Miami. Dr. Flavia Mendes was also a professor from the University of Miami with expertise in Hepatology before joining the practice. Dr. Daniel Gelrud was an assistant professor at the Albert Einstein College of Medicine in New York.

Gastro Health is a comprehensive gastroenterology group whose physicians have expertise in many areas. FIU medical students benefit from that experience. Dr. Rothman and Dr. Mendes have special interest in liver disease. Students learn about Ulcerative colitis and Crohn’s disease from Dr. Schwartz and Dr. Leavitt. Biliary disease and complications of liver disease is taught by Dr. E. Hernandez and Dr. Leavitt. Dr. Rabassa introduces the students to important common conditions such as ulcer and reflux disease. Dr. Ruan explores the causes of diarrhea and constipation. Dr. Calleja tackles the common and important irritable bowel syndrome (IBS), while Dr. Baigorri digs into the complex issue of the obesity epidemic in the United States.

The association between the FIU School of Medicine and Gastro Health proves the commitment of providing academic level state-of-the-art care to patients. This academic environment is conducive to the practice of excellent medicine that not only benefits patients, but also the future medical doctors who rotate through Gastro Health’s facilities.

[Table 1]

FIU Faculty list

Course Director

Daniel Gelrud, MD

Teaching Faculty

Francisco Baigorri, MD

Gustavo Calleja, MD

Eugenio Hernandez, MD

James Leavitt, MD

Marc Leaderhandler, MD

Flavia Mendes, MD

Javier Parra, MD

Alfredo Rabassa, MD

Andres I. Roig, MD

Lawrence Rothman, MD

Eduardo Ruan, MD

Andrew I. Sable, MD

George A. Sanchez, MD

Howard Schwartz, MD

Stefania Vernace, MD