Eileen M. O'Reilly, MD: Diagnosing Patients With Pancreatic Cancer at an Earlier Stage

What can be done to help diagnose patients like Larry at an earlier stage?

That’s a huge challenge. I think if we’re to make a substantial impact in this disease, this is the area where it’s going to come from, in terms of early detection and being able to screen for pancreas cancer. Being able to screen is one thing, but recognizing who’s at risk for this disease is another. We do have some clues, and some lifestyle contributions contribute to the development of this disease. But perhaps several areas where opportunities exist are people with a genetic predisposition to pancreas cancer, so a subset of people who have a familial risk for this disease based on either a known genetic entity in that individual or in their family. They’re groups of people that we might want to target. Individuals who develop diabetes without lifestyle considerations, or without a family history of diabetes, that’s a red flag that there could be something underpinning this. We have some lead time there, in that diabetes may predate the identification of this disease by several years sometimes, and that could be an opportunity in terms of screening for this cancer.

Metastatic Pancreatic Cancer: Case 1

Larry D, a 62-year-old, presented to his primary care physician with persistent pain in his epigastric region, which persists throughout the night. Within the past 2 years, he has developed diabetes and experienced considerable weight loss with signs of depression.

• During his visit, jaundice was observed along with periumbilical subcutaneous metastases.
• Testing revealed an elevated CA19-9 level (2293 U/ml).
• CT scan showed a large mass on the head of the pancreas, and a subsequent biopsy showed the mass to be adenocarcinoma. Liver and local lymph note metastases were identified.

Larry went on to receive the combination of nab-paclitaxel and gemcitabine as frontline therapy for 5 months:

• Upon progression, Larry was switched to the combination of liposomal irinotecan, fluorouracil, and folinic acid. Treatment failure occurred after 2.5 months.
• Larry received FOLFOX as a third-line treatment.