Acute pancreatitis may reveal pancreatic cancer at earlier stage

Surgical intervention after 24.5 days of acute pancreatitis may be beneficial for reducing postoperative complications.

Surgical intervention after 24.5 days of acute pancreatitis may be beneficial for reducing postoperative complications.

Acute pancreatitis may be an indicator for pancreatic cancer at an earlier stage, according to a study published in Medicine.

Shaojun Li, M Med, and Bole Tian, PhD, from the West China Hospital in Sichuan, China, identified 47 consecutive patients with  pancreatic cancer who presented with acute pancreatitis between January 2009 and November 2016. Of the patients, 35 (74.5%) were men with a mean age of 52 years. Clinical features, clinicopathologic variables, postoperative complications, and follow-up evaluations of patients were recorded from the database.

Clinical features of acute pancreatitis include abdominal pain, jaundice, and weight loss. The timing of surgery was identified by receiver operating characteristic (ROC) curve. Preoperative, intraoperative, and postoperative parameters were collected to determine operative timing of surgical intervention. Survival curves were plotted using the Kaplan—Meier method, and survival data were analyzed using the log-rank test.

Of the 47 patients included, acute pancreatitis was clinically mild in 45 (95.7%) and severe in 2 (4.3%). Radical surgery was performed in 32 (68.1%) of cases, palliative surgery in 7 (14.9%), and biopsies in 8 (17.0%). A total of 2 (8.0%) patients were needed for vascular resection and reconstruction. The diagnosis of pancreatic cancer occurred at a median of 101 days, and 27 (57.4%) patients were diagnosed in less than 2 months after acute pancreatitis diagnosis.

The timing of surgery was calculated from the date of the first attack of acute pancreatitis to the surgery. The best cutoff point was 24.5 days according to the ROC curve. A total of 25 (64.1%) patients received surgery at or before 24.5 days from diagnosis of pancreatic cancer. Postoperative complications occurred in 12 (30.8%) patients. The median follow-up for patients was 24 months with a patient survival rate at 1 year of 23.4%. The median survival in patients with vascular resection and reconstruction was 18 months, compared with 10 months in patients without vascular resection.

According to the authors, “this retrospective study supports the assumption that acute pancreatitis is the early presenting clinical symptom of pancreatic cancer.”

By Madeline Moore at Clinical Advisor

Dr. Oliver McDonald, of NMF’s Medical Board, Publishes New Study

Oliver McDonald, M.D., Ph.D., Kimberly Stauffer, left, Anna Word and colleagues are studying how metastatic pancreatic cancer changes its metabolism to become more malignant. (photo by Joe Howell)

Oliver McDonald, M.D., Ph.D., Kimberly Stauffer, left, Anna Word and colleagues are studying how metastatic pancreatic cancer changes its metabolism to become more malignant. (photo by Joe Howell)

Metastatic pancreatic cancer — cancer that has spread from the pancreas to other tissues and is responsible for most patient deaths — changes its metabolism and is “reprogrammed” for optimal malignancy, according to new findings reported Jan. 16 in Nature Genetics.

It may be possible to reverse the malignant reprogramming to treat metastatic pancreatic cancer, said Oliver McDonald, M.D., Ph.D., assistant professor of Pathology, Microbiology and Immunology at Vanderbilt, and lead author of the study.

The researchers have identified a compound that reverses the reprogramming and prevents tumor formation in model systems.

“We are not aware of other agents that selectively act on aggressive, distant metastatic disease, so this was a huge surprise to us,” McDonald said. “We’re very excited about developing more selective compounds for pre-clinical studies.”

McDonald and close collaborators from Memorial Sloan Kettering Cancer Center and Johns Hopkins University School of Medicine sought to understand how pancreatic cancer progresses from a primary tumor in the pancreas to metastatic disease in distant tissues.

The prevailing theory of cancer progression — that it’s driven by the accumulation of genetic mutations that increase tumorigenic “fitness” — holds true for the early stages of cancer progression, but metastases seem to find new ways to increase their fitness, McDonald said.

“Intensive DNA sequencing efforts to find the genetic ‘drivers’ of metastasis, which is what kills patients in up to 80 percent of cases, have thus far been disappointing, to say the least,” he said.

Instead of looking for genetic changes during cancer progression, McDonald and his colleagues examined epigenetics — modifications of chromosomal DNA and proteins that control gene function.

“Epigenetics can be thought of as the software that programs function into the DNA hardware,” McDonald said.

The researchers studied a unique set of matched primary and metastatic pancreatic cancer samples collected (by rapid autopsy) from patients who died from aggressive, widely metastatic disease.

Christine Iacobuzio-Donahue, M.D., Ph.D., now at Memorial Sloan Kettering, began collecting the patient samples and studying the primary and metastatic tumors when she was a faculty member at Johns Hopkins.

She and her colleagues sequenced genomic DNA in the tumor samples but did not find any new driver gene mutations in the metastatic samples compared to the primary tumor samples, said McDonald, who completed clinical training under Iacobuzio-Donahue at Johns Hopkins.

After moving to Vanderbilt, McDonald continued working with Iacobuzio-Donahue and Andrew Feinberg, M.D., MPH, who is also at Johns Hopkins and is a recognized pioneer in the field of cancer epigenetics.

“It was an incredibly productive collaboration that brought together Chris’s genetics expertise and amazing patient samples, Andy’s expertise and world-class sequencing facilities, and our experimental work and data analysis at Vanderbilt,” McDonald said.

The researchers were surprised to find massive epigenetic changes across the genome of distant metastases (those resulting from spread of cancer cells through the bloodstream), compared to matched primary tumor cells and peritoneal “carcinomatosis,” a localized form of intra-abdominal metastasis that is not thought to spread through the bloodstream.

The genome-wide epigenetic changes clustered in certain chromatin domains and controlled “gene expression changes that specify different malignant traits, including the ability to form tumors,” McDonald said. “Much of the epigenome gets reprogrammed right at the point of metastasis.”

To further explore the reprogramming, McDonald performed metabolic studies on the samples, with collaborators at Duke University. By painstakingly analyzing long lists of metabolites, McDonald and Vanderbilt undergraduate student Anna Word discovered that distant metastases altered their metabolism by consuming excess amounts of glucose and directing it through the pentose phosphate metabolic pathway. A particular enzyme in the pathway — phosphogluconate dehydrogenase (PGD) – turned out to be key, enabling the conversion of glucose to metabolites that “can directly fuel tumor growth,” McDonald said.

The researchers demonstrated that blocking the PGD enzyme genetically or with a pharmacologic inhibitor reversed the epigenetic reprogramming and malignant gene expression changes detected in distant metastases, and also strongly inhibited their tumor-forming capacity, with no effect on normal cells or peritoneal pancreatic cancer controls. Kimberly Stauffer, a graduate student at Vanderbilt, played an important role in uncovering the inhibitor effects.

The findings may help explain a clinical enigma — the observation that metastatic tumors often seem to progress very rapidly compared to primary tumors.

The current research suggests that pancreatic cancer cells that spread to organs that receive a blood supply rich in glucose and other nutrients, such as the liver and lungs, acquire metabolic adaptations to use these “natural resources” to increase their tumorigenic fitness.

“Our laboratory findings on Chris’s autopsy patient samples suggest that metastatic cells in these patients evolved an incredibly aggressive combination of metabolic, epigenetic and gene expression changes that allowed them to form numerous tumors in a short amount of time,” McDonald said. “However, if you hit the PGD enzyme, at least in the experimental setting, then you block their ability to do that.”

McDonald is working with medicinal chemists at Vanderbilt to develop more selective and potent PGD inhibitors for testing in animal models, with the ultimate goal of moving these inhibitors into clinical trials for pancreatic cancer patients.

This research was supported by grants from the National Institutes of Health (CA038548, CA140599, CA179991, CA180682), and by the AACR Pancreatic Cancer Action Network, Vanderbilt GI SPORE and Vanderbilt-Ingram Cancer Center.

by Leigh MacMillan for Vanderbilt University Research News | Jan. 19, 2017

Nutrition’s Role In Managing Pancreatic Cancer Symptoms

imagesDecember 12, 2016

Nutrition, though often overlooked, plays a key role in mitigating the symptom burden of patients with pancreatic cancer. 

When diagnosed with pancreatic cancer, one of the last things on a patient’s mind may be diet and nutrition, yet these are two key components that medical experts say can affect the outcome of treatment.

Patients with pancreatic cancer often experience weight loss, loss of appetite, fatigue, nausea, as well as back and belly pain. The cancer itself plays a large role in preventing patients from having a normal diet and nutrition.

During a live broadcast of CURE Connections, held during the Seventh Annual Ruesch Center Symposium: Fighting a Smarter War on Cancer on Dec. 3 in Washington, D.C., a panel that included an oncologist, a nurse, an oncology dietitian and a patient advocate discussed the importance of nutrition when trying to manage a long list of symptoms.

“These cancers are well-known to release hormones that we don’t fully understand that rob a patient of their appetite,” said Michael Pishvaian, M.D., director, Phase 1 Clinical Trials Program, Division of Hematology/Oncology, Georgetown Lombardi Comprehensive Cancer Center. “It makes them feel like they don’t want to eat or drink anything. It robs them of their calories even if they are very conscientious about getting enough nutrition in. It can even cause changes to taste, so a patient with pancreatic cancer will often complain about an abnormal taste sensation long before they even start chemotherapy.”

Pishvaian explained that the pancreas creates digestive enzymes that help digest food properly. When the cancer invades the pancreas, this disrupts proper digestion. The lack of digestion also leads to bacterial overgrowth lower down into the gastrointestinal (GI) tract and can cause a lot of discomfort, gassiness, bloating and diarrhea, he added.

There are ways to try to manage these symptoms before, during and after the cancer journey. The panel recommended patients make it a priority to meet with a dietician one-on-one. Some cancer centers already have a dietician in place.

“Often pancreatic cancer patients will undergo a surgery called a Whipple Procedure (pancreaticoduodenectomy), which can impair a patient’s ability to digest certain foods like fats, carbohydrates and proteins – particularly in fats,” said Rachel Wong, R.D., oncology dietician, Georgetown Lombardi Comprehensive Cancer Center.

She added, that this is where digestive enzymes, which help break down fats, proteins and carbohydrates, should be consumed with meals and snacks.

Patients should consume energy-dense nutritious foods such as quinoa, oatmeal and avocado, which all have healthy fats. As far as sugars go, they should continue to eat fruits, but stay away from simple sugars like candy bars.

It is also recommended that patients with pancreatic cancer eat small, frequent meals, eat slowly and also keep a diary of everything they are eating and drinking each day.

Patricia Reilly, a holistic health counselor, nutrition expert and patient advocate, says the best way a caregiver can be there for a loved one with pancreatic cancer is to help with nutrition. She became that person for her husband, who had pancreatic cancer.

“We recognized that he wanted to feel good every day. As a caregiver, I looked at the foods,” Reilly said. “I want my doctor to know about those clinical trials. I want him to be on top of that and let me create a team to support my husband in terms of what he’s eating for breakfast, lunch and dinner, again looking for nutrient-dense foods that will support him to be stronger so he will get to that clinical trial.”

The panel also opened up the discussion on marijuana and if there is a benefit there for patients with pancreatic cancer, which they agreed there is.

“We are seeing that their appetite goes up, their sense of well-being is greater and their pain levels are reduced,” said Pishvaian. “It is not a treatment for their cancer, but universally makes them feel better. Try things, see what works and stick with it.”

By Katie Kosko for Curetoday.com

Coping with Cancer During the Holidays

1419370395896Holidays are traditionally viewed as a time to celebrate. Many people enjoy reuniting with family and friends, giving and receiving gifts, and celebrating religious traditions during this time. However, sometimes people with cancer and their loved ones feel “out of step” from the rest of the world during the holidays. In fact, the holiday season can prompt new questions, such as: How do I take care of the holiday rush and myself at the same time? How can I celebrate when I have so many other things on my mind? What will my life be like next year? Sharing these concerns with the people you love and who love you can help you feel more connected.

Here are some additional tips for coping with cancer during the holidays:

Make plans to get together with friends, family or co-workers over the holidays. Trying to celebrate alone can be very difficult, so accept some invitations from others, or join an organized group activity through your local YMCA, YWCA, church or synagogue. Find the right balance between celebrating with family and friends and spending the time you may need on your own. Give yourself permission to pace your activities and to decline an invitation or two so that you have the energy to enjoy the gatherings that are most important to you.

Create a new holiday season tradition that makes the most of your energy.Change your usual holiday activities so you relieve yourself of some of the pressures of entertaining. Have a “pot luck,” with family members each bringing a dish for the meal, have someone else host the meal, or suggest eating out at a favorite restaurant.

Enjoy special moments. Try to focus on new traditions that have been established, rather than dwelling on how cancer has changed a holiday or special occasion.

Talk to your health care team about upcoming special events. They may be flexible about appointments in order to accommodate travel or other needs.

Be an innovative shopper or gift giver. Use mail order catalogues, shop over the telephone, or try online shopping this year. You can also make a gift of sharing your thoughts and feelings. Write a short note or make a phone call to let others know that you are thinking about them.

Express your feelings in ways that help you receive the support of the important people in your life. Tears can bring a sense of relief. Laughter can be relaxing. Sharing can be comforting. It is common to experience a mixture of anticipation, excitement and apprehension about the future. Let your feelings breathe, and talk them over with a loved one, friend or professional counselor.

Celebrate strengths you and your loved ones have developed. Many families who face the day-to-day challenges of cancer discover strengths and courage they didn’t know they had. Reflect on the strengths you have developed, and build on them during the holidays.

Article reposted from cancercare.org

Weight loss: When cancer immunotherapies are rendered ineffective

A pair of female feet standing on a bathroom scale

Nov 10, 2016

According to a new study, a weight loss condition that affects cancer patients could make immunotherapy ineffective. It explains why the approach of boosting a patient’s immune system to treat the disease fails in a lot of people.

Cancer immunotherapies involve activating a patient’s immune cells to recognize and destroy cancer cells. They have shown great promise in some cancers, but so far have only been effective in a minority of patients with cancer. The reasons behind these limitations are not clear.

Researchers at the University of Cambridge have found evidence that the mechanism behind a weight loss condition which affects patients with cancer could also be making immunotherapies ineffective. The condition, known as cancer cachexia, causes loss of appetite, weight loss and wasting in most patients with cancer towards the end of their lives.

However, cachexia often starts to affect patients with certain cancers, such as pancreatic cancer, much earlier in the course of their disease. Scientists found that that even at the early stages of cancer development in mice, before cachexia is apparent, a protein released by the cancer changes the way the body, in particular the liver, processes its own nutrient stores.

“The consequences of this alteration are revealed at times of reduced food intake, where this messaging protein renders the liver incapable of generating sources of energy that the rest of the body can use,” said Thomas Flint, from the University of Cambridge’s School of Clinical Medicine.

“This inability to generate energy sources triggers a second messaging process in the body — a hormonal response — that suppresses the immune cell reaction to cancers, and causes failure of anti-cancer immunotherapies,” Flint said. “Cancer immunotherapy might completely transform how we treat cancer in the future — if we can make it work for more patients,” said Tobias Janowitz, from University of Cambridge.

“Our work suggests that a combination therapy that either involves correction of the metabolic abnormalities, or that targets the resulting hormonal response, may protect the patient’s immune system and help make effective immunotherapy a reality for more patients,” said Janowitz. “If the phenomenon that we have described helps us to divide patients into likely responders and non-responders to immunotherapy, then we can use those findings in early stage clinical trials to get better information on the use of new immunotherapies,” said Duncan Jodrell, from the Cambridge Cancer Centre.

“Understanding the complicated biological processes at the heart of cancer is crucial for tackling the disease — and this study sheds light on why many cancer patients suffer from both loss of weight and appetite, and how their immune systems are affected by this process,” said Nell Barrie, from Cancer Research UK.

The research was published in the journal Cell Metabolism.

Thanksgiving Meals for patients and their families

l-ncjbmzrwlnsfcfjz-copyBeing from Texas, Nikki chose to go home for Christmas and stay in Nashville for Thanksgiving. She started a tradition for her friends with a home cooked meal for “Friendsgiving”. It was one of her favorite things to do and her friends who had family out of town had a warm, inviting place to go. Having pancreatic cancer, going to treatments and feeling sick didn’t stop her from this tradition. She made sure there was a Friendsgiving meal for everyone.

This year we are doing the same thing for cancer patients –  Nikki’s foundation is providing a “Friendsgiving Meal” for PC patients and those living with them. NMF is asking you to donate to the Bridge of Wings program. In addition to helping cancer patients with their daily living expenses, we’re providing holiday meals for them and their families.

MATCHING DONATIONS – A loyal supporter of NMF who has been impacted by pancreatic cancer has pledged to match donations up to $2500! 

To donate to our Bridge of Wings program for Thanksgiving meals, click here and to learn more about BOW, check it out here.

PC Symptoms and Jamie’s Story

image2Symptoms of pancreatic cancer can be weight loss, abdominal or back pain, diabetes, or jaundice. Physical symptoms are not very specific to the disease and are often mistaken for something else. Patients can even be asymptomatic. The bottom line is pancreatic cancer is hard to diagnose and even harder to treat. Nikki Mitchell Foundation is working hard to prevent, detect and cure pancreatic cancer.

Jamie Thornton, a friend of NMF, shares the story of her father’s journey:
My father, James Drury, was a Vietnam veteran (a captain and platoon leader), a general manager, and a great leader and father. He loved life, outdoors, people and food. He was a heavy-set guy and we were excited at first when he started to lose weight, but when he started having severe pain in his stomach, he finally went to the doctor. The doctor was positive about his weight loss and encouraged him to keep cutting back on food.

Around November, a few months after the initial pain and losing 50 pounds, he started hurting a little more when he ate and I talked him into going back to the doctor twice. By the end of the week we had a diagnoses of a tumor in his pancreas. After a slew of hospital visits and tests, we found out he had two pancreatic tumors, with one on a lymph node, liver tumors, and spots in his lungs. The oncologist recommended he start chemotherapy and also participate in an additional clinical trial that might decrease the spread of the tumors from the lymph node.

Throughout all of this, Dad was very positive and strong in his faith and believed that with any outcome he was a winner because he either got to stay with us on earth or go to heaven.

We scheduled the chemo and he made it through only two treatments. After the second round was over, Dad could barely stand up. He had an adverse reaction to the drugs, wound up in the hospital twice, and then we were told he only had a few weeks to two months to live. We were sent home with hospice care.

We were blessed that Daddy came out of hospital feeling better this time and over the next month, as the chemo left his body, he was able to return to some fun activities that he enjoyed like fishing, shooting and visiting with friends he hadn’t seen in years. He actually had a full pain-free week once and felt like maybe he was cured. Then, at the end of May, and after watching my daughter graduate from middle school, he started declining rapidly. A week and half later he was gone. I believe he is a winner in that he is in heaven and he has left a wonderful legacy to his kids, grandkids, friends and family. He maintained a wonderful outlook throughout the whole experience.

We experienced some difficulties, like doctors not being clear about survival rates and honestly explaining to us what to expect. I also wish we had known earlier that weight loss is a major indication that something is wrong and that maybe he could have had a chance of beating the disease.

“Doctor Targets Gene Mutations for Cancer Care”

By Lauren Dunn/June 8, 2016/NBC News

160607-bcra-research-mn-1710_aa5ca7cce7c619057a3bfe298e4ef2ac.nbcnews-fp-1240-520

A researcher works at the University of California San Francisco’s Center for BRCA Research.

As more is learned about what causes cancer, scientists are discovering it can be less important where the disease is located and more crucial to know if it has a certain genetic mutation.

At the annual meeting of the American Society of Clinical Oncologists (ASCO) in Chicago this week, the world’s leading cancer doctors focused on one of the most promising new avenues: the genes that cause cancer. Vice-President Joe Biden considers it a cornerstone of his Cancer Moonshot Initiative.

By targeting specific genetic mutations, one California doctor is already bringing this future of cancer care to her patients.

Oncologist Dr. Pamela Munster is not only a leading BRCA mutation researcher, she’s also a breast cancer survivor. Munster started the University of California San Francisco’s Center for BRCA Research after learning that she carried the BRCA mutation and being diagnosed with the disease.

BRCA1 and BRCA2 are well known for increasing the risk of breast and ovarian cancer in women — it’s the mutation made famous by Angelina Jolie.

After surgery, Munster realized she would also need a lifetime of pancreatic screenings and screenings for skin cancer because her BRCA mutation — which has now been linked to not just breast and ovarian cancer, but prostate, pancreatic and skin cancers.

“I was really stuck with the fact that I had to find four doctors for myself and for screening,” Munster said.

Munster was shocked at how overwhelming it was.

“If this was difficult for me, I thought this must be very erroneous for someone who doesn’t live and breathe cancer like I do,” she said.

The BRCA Clinic, the second of its kind in the United States along with one at the University of Pennsylvania, provides care for people affected by mutations in those two particular genes.

Targeting mutated genes marks a shift in cancer research: The San Francisco clinic offers a unique model of care for cancer patients with hereditary cancers due to BRCA — and strives to provide on stop shopping for screenings, prevention education, and treatment for both patients and their families affected by genetic mutations.

Dr. Pamela Munster and her father both carry BRCA mutations.

160607-pamela-munster-bcra-mn-1705_e737c117b65fbc7df1f2b3b7cb08ee26.nbcnews-ux-600-480

“There needs to be a place where the family members can go,” Munster told NBC News. “If we have the opportunity to diagnose risk early we have a better opportunity to prevent cancers.”

It was her unique knowledge of BRCA, combined with her personal experience, that led Munster to have her own father tested when he was diagnosed with advance pancreatic cancer at age 78. Pancreatic cancer is especially deadly, with a 5-year survival rate of only 6 percent.

He tested positive for BRCA and when conventional chemotherapy was not working, his doctors were able to target treatment specifically designed for his mutation.

Three years later, he has beaten the odds and is still alive.

160607-bcra-bochnowski-mn-1700_d1b20b84495ef7e195a0b944250c676b.nbcnews-ux-600-480

Lauren Bochnowski of San Ramon, California also has a BRCA mutation, but she’s healthy and cancer-free. The 36-year-old was tested after her sister was diagnosed with a rare form of breast cancer and is now a patient at Munster’s San Francisco clinic.

“It’s really nice to know I can call one person and get all the answers that I need,” she said.

While testing positive for a BRCA-1 mutation was not happy news for Bochnowski, being able to rely on the BRCA clinic, gives her more confidence in her future.

Lauren Bochnowski, left, a patient at the University of California San Francisco’s Center for BRCA Research center, with her sister. Courtesy of Lauren Bochnowski

 

Living Every Day

dana and nikki

Dana Zieman and Nikki Mitchell

Dana Zieman wrote candidly about her battle with pancreatic cancer in Georgia’s Rome News-Tribune for a year until her death in April of 2016. On August 6, 2015, she wrote: “In beginning this series of columns, I hope to express some of the emotions, reactions and ideas we cancer patients experience on our journey through this disease.” From the outset, her writing demonstrates a robust fighting spirit as Dana frankly discusses how it feels to be told that the cancer you thought you had beaten had returned.

Dana describes the highs and lows she experienced as the “most extreme roller coaster ride of [her] psychological life.” Dana’s strength and positivity mirrors that of Nikki Mitchell herself, who kept an online journal to chronicle her thoughts as she battled her own diagnosis. There are many parallels between these two extraordinary women. Their insights can aid, inspire, and encourage both patients living with cancer and the friends and family that rally against them.

As Dana wrote, “I didn’t understand the wily, teasing and ultimately maleficent nature of this ugly disease. It was determined to have the last laugh … but here’s how we tough, bald, eyebrow-less, often emaciated and physically weak patients respond: ‘We’ll see about that.’”

PART I

ACCEPTING HELP:

“No matter how informed we are, getting a diagnosis of cancer shocks. It strikes fear and denial and emotional paralysis into even the most intrepid souls. We all know that cancer is a leading cause of death. But we never believe we will be the ones to get that particular call from the doctor … There are any number of ways to get the news. And once you hear it, life is never the same.”

Dana writes about how accepting help can sometimes be difficult, especially as a woman who values her independence: “My advice to cancer patients is to remain independent when you can. It’s good for you. When you can’t, however, let the people who love you help. Their doing so benefits you both … My advice to friends and family: Don’t always take the patient at his/her word. Sometimes you need to override their decisions and take charge in a very concrete, unobtrusive way…No matter how independent we have been, we now need assistance, all kinds of it. We must allow ourselves to accept it, even to ask for it.” Allowing friends and family to help is immensely valuable, as many people don’t know what to say or do when a loved one is diagnosed. Proactively helping out with basic tasks, like mowing the grass, running errands, cooking meals, or hiring a house cleaner can be a huge help to patients with cancer.

NMF president Rhonda Miles was Nikki’s caretaker for the 31 months she battled pancreatic cancer and was at every doctor’s appointment, procedure, and hospital stay. Nikki said, “This is not something you beat alone and I am sending you a hug for staying with me! I am close to a time that I can resurface to the place I once knew to visit and ‘come out and play’ again. A special place in my heart to those of you who have shown the depth of your friendship even when I was unable.”

LIVE EACH DAY TO THE FULLEST:

From the start, all of Nikki’s blog posts were overwhelmingly positive. Even when faced with recurrence, she focused on the positive:  “I am EXTREMELY grateful that I am able to grow forward from all of this. I am not sure I would have learned what I have any other way…One of the main (of hundreds) of things I have learned through all of this is…Why waste a moment worrying about something that may never be? And if something does unfold, then worry is not an option. It does nothing but weaken the spirit and spin your wheels in mud.” In keeping with her positive outlook, Nikki said, “One of the amazing ‘up sides’ to all this is that I know now without a doubt – I have felt the power and the healing of this incredible gift you each have given me…In other words, it can always be worse so grab the saddle horn and bring it on…for the better good, of course!”

Dana also felt that living each day to the fullest was incredibly important. She issued “a plea to say what you should, now and every day … We shouldn’t look at the people we love with the thought that they might not be here tomorrow. Or for that matter, that we may not be here tomorrow. We couldn’t enjoy our lives and the many joys we share if we always anticipated the darkness.” Her thoughts on how to do this were to “make our small gestures of kindness a reflex.” She believed it was important to not dwell on mortality and to just focus on the day ahead and that attitude and outlook play a critical role in the healing process.

The attitudes, values, and positivity embodied in Dana and Nikki’s writings can aid patients living with cancer and their caregivers alike. Dana says  “Begin the day with this mantra: be kind, be expressive; find something positive to say to others; love your family and friends.” Living Dana’s mantra and embracing Nikki’s positivity can change everyone’s world for the better.

Read Dana’s full articles here.

“In this cancer hospital, there’s more than one way to kill a tumor”

By Anne A. Jambora /July 19, 2016 / Philippine Daily Enquirer

t0719fuda-1

Suite at Fuda Cancer Hospital

Broadcast journalist-turned-political analyst Ferdie Ramos was celebrating his 71st birthday in China when he felt a pain in the chest. He feared it was a heart attack but kept quiet about it, not wanting to ruin the merrymaking.

When he flew back home the next day, he went straight to the hospital. As it turned out, Ramos had pancreatic cancer. He was advised to undergo a Whipple procedure immediately, open surgery first performed in 1935 by an American surgeon named Dr. Allen Whipple.

Whipple surgery involves removal of a part of the pancreas’ head, said Ramos, and part of the small intestine, a portion of the bile duct, gallbladder and stomach. There are so many organs attached to the pancreas that performing surgery can sometimes take up to 12 hours.

But when he learned there was a 30-percent risk of failure during surgery—one of 10 surgeries ends in death—he started to look for other solutions.

dr

Dr. Ning “Carl” Yu

Just when he was about to give up, one of his friends told him about Fuda Cancer Hospital in Guangzhou, China. The hospital also happens to have a consultation office at Century Medical Makati at Century City in Makati.

He dropped by for a consultation and was advised by Dr. Ning “Carl” Yu, a medical oncologist/surgeon at Fuda and consultant doctor, to undergo the latest FDA-approved procedure, the irreversible electroporation (NanoKnife) for tumor ablation.

Zap tumor cells

The NanoKnife procedure does not require open surgery. Approved in 2012 by the FDA, it’s a minimally invasive, probe-based technology that involves inserting two electrodes that release high-voltage pulses of up to 10,000 volts to zap tumor cells in an instant.

For patients with locally advanced pancreatic cancer, the NanoKnife can double their survival time. Instead of a two-year survival rate, for example, patients can now look forward to four years or more.

What NanoKnife offers is a promising treatment for tumors in the pancreas that cannot be surgically removed.

“Other important structures near the pancreas will not be harmed. With the CT scan guiding the surgeons, there is real-time monitoring of the process,” said Yu in an interview. “One session is enough if the tumor is about 3 centimeters. If it’s bigger then we have to use bigger needles.”

While open surgery takes up to 12 hours, the NanoKnife procedure takes only 20 minutes. Preparing the patient for surgery, however, can take up to two hours. Still, that’s a remarkable difference between both procedures.

“Quality of life begins right after the surgery,” said Segundo Cruz III, Fuda supervisor for the international affairs department.

Ramos, for example, was already walking and eating less than 24 hours after the procedure.

Other advantages of NanoKnife include less damage to surrounding nerves, especially for body parts with dense motor nerves, such as the neck, groin and pelvis; and fewer side effects.

Disadvantages include the cost of the  procedure ($30,000), and the fact that it requires precise insertion of electrodes. At Fuda, for example, only one doctor is qualified to perform the procedure.

Pancreatic cancer has often been referred to as the “King of Cancers” because the pancreas is deep in the abdomen, with symptoms of incredible pain and jaundice; it disrupts the urge to eat and weakens patients who are no longer receiving proper nutrition, Cruz said.

“The NanoKnife procedure is 80- to 90-percent effective. Many of them can eat and talk after the treatment. There are hardly any post-operation side effects. They can feel a little pain from the needle insertion but that’s about it,” Yu said.

NanoKnife is also used for liver, lung and breast cancer.

Another procedure offered at Fuda Cancer Hospital is argon-helium knife cryosurgery (cryosurgical ablation) for breast cancer, a minimally invasive procedure that uses minus 150-degree Centigrade super-freeze to destroy the tumor, prevent it from spreading, and allow patients to return to normal activity a few days after the treatment.

Effective and inexpensive

American Laura Ross-Paul was one of the first people in the world to undergo cryoablation 13 years ago and is  cancer-free to this day. She is also the co-author of the book “They’re Mine and I’m Keeping Them.”

“Cryoablation is effective and inexpensive, $10,000-$20,000 per patient, versus the gold-standard treatment of mastectomy and rebuilding that’s around $100,000,” Ross-Paul said in her presentation. It is the low potential return of investment, she continued, that keeps investors from getting the approximately $10 million needed to get an FDA approval. To this day, she said, cryoablation is still considered experimental in the United States.

(Cryoablation is approved only in certain states in the United States. In China, it is FDA-approved.)

During the procedure, a knife head that uses argon and rapidly lowers its temperature to minus 150°C is inserted into the tumor. The surrounding tissues will then begin to freeze, creating multiple ice balls that eventually turn into one big ice ball.

By turning off the argon and turning on the helium, the temperature of the necrotic area will quickly rise to 40°C. In three to five minutes, the whole freeze-thaw cycle will repeat, until the tumor is completely destroyed.

It’s a convenient operation. The knife can be directly inserted into the small tumor from any angle, since there are no other vital structures or organs surrounding it. For bigger tumors, more knives are needed.

“Women are aware of the need for early detection, and in many cases, something suspicious is seen in the early mammogram. It is too small for biopsy and may not be cancer at all. So the current practice is to wait six months and have another mammogram. I can assure you, this is not what women want. They want to do something as soon as possible to prevent a tumor from forming,” Ross-Paul said.

She suggests cryoablation early on, when tumor formation is suspected, to avoid months of anxiety.

“If the protocol is adopted, cryoablation will prove itself because a statistical pool  will show that a lower percentage of women are diagnosed with breast cancer if they detect and freeze versus detect and wait… This is what women, and medicine, need,” she said.

Meantime, Ramos is back in China for a follow-up. He looks forward to returning home to be with family and friends.