Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. Usually detected at only the most advanced stages and with median survival time of only three to six months, it leaves little time for treatment or cure. This abysmal clinical outlook has fueled a great deal of research into the nature of pancreatic cancer, as well as key patient factors that place some people at increased risk of the disease.
According to Gail Matters, Ph.D., associate professor of biochemistry and molecular biology at Penn State Hershey Medical Center, Penn State College of Medicine, “The link between patient factors like obesity, chronic pancreatitis, and a family history of pancreatic cancer have provided clues about underlying cellular and molecular pathologies. We know that certain normally-occurring peptides, like cholecystokinin (CCK), are found in elevated concentrations in mice that have been fed a high-fat diet. These peptides have a growth-factor-like effect on pancreatic tumor cells.” Continue reading
Cancer of the pancreas remains one of the greatest clinical challenges in oncology. With no reliable screening tests and a poor prognosis following identification, the need for novel approaches toward this disease remains largely unmet.
In recent years, however, pre-malignant pancreatic cystic lesions have been increasingly discovered in patients undergoing cross-sectional imaging for unrelated reasons. While over half of pancreatic cystic lesions have little to no malignant potential, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs) can carry a high potential for progression into pancreatic cancer.
Discovering a pancreatic cyst poses a new set of difficulties. According to Matthew T. Moyer, M.D. M.S., associate professor of medicine, Penn State Hershey Medical Center, “Either serial radiographic surveillance or surgical resection is generally recommended for these cysts, both of which have significant limitations. Surveillance is inconvenient and expensive with no therapeutic aspect, while surgical resection is associated with a significant risk of morbidity (20 to 40 percent) and mortality (1 to 2 percent).” Continue reading
Inflammatory bowel disease (ulcerative colitis and Crohn’s disease) is associated with an increased risk of thromboembolism. Andrew Tinsley M.D., M.S., associate director of clinical research and quality at Penn State Hershey Medical Center’s Inflammatory Bowel Disease Center explains, “While thromboembolic events are rare, they can be potentially life-threatening. Until one of your patients experiences one of these disease-related complications, or perhaps even dies from one, it’s difficult to appreciate how important of an issue this is.” The risk of thrombosis in the hospital can be significantly reduced with the use of daily medications such as heparin.
As a member of the Crohn’s and Colitis Foundation of America’s Quality of Care Committee, Tinsley is one of the first physicians to conduct research to explore the current state of thromboembolism prevention in hospitalized inflammatory bowel disease (IBD) patients. An initial nationwide survey of gastroenterologists was published by Tinsley and colleagues, and suggested that many providers were not routinely giving heparin for thromboembolism prophylaxis. Following on from this study, Tinsley recently looked at the actual rates of heparin use for preventing thrombosis in patients admitted with ulcerative colitis (UC). His findings, which recently appeared in the Journal of Crohn’s and Colitis, revealed that only around 50 percent of inpatients with active UC received prophylactic anti-thrombotic medication. Furthermore, when the medications were ordered, medical patients failed to receive one-third of their doses. Continue reading
Deborah Bethards, M.D.
Most gastroenterologists have encountered patients who complain of chronic constipation. Colonoscopy shows no anatomical abnormalities. Nonetheless, conservative treatment with laxatives and bulking agents brings only temporary, minor relief. After several failed treatment attempts, the patient is distressed, uncomfortable and anxious; the gastroenterologist is frustrated. Deborah Bethards, M.D., a gastroenterologist at Penn State Hershey Medical Center’s Neurogastroenterology and Motility Clinic explains, “Failure of conservative treatment to resolve constipation should be a red flag. With no other detectable abnormality, the possibility of a chronic pelvic floor disorder that primarily affects women—known as dyssynergic defecation—should be considered.”
With this disorder, the rectosigmoid area does not function properly so that during attempted defecation, paradoxical anal contraction occurs, and pelvic floor muscles fail to relax. The result is that stool is retained in the rectum. If left untreated, complications such as fecal impaction, rectocele, megacolon, and fecal incontinence may occur. Continue reading
The Penn State Hershey Cancer Genetics Program was developed in 1998 to provide genetic counseling services to individuals concerned about a personal or family history of cancer. New patient appointments typically involve the development of a three- or four-generation family pedigree, education about various risk factors for developing cancer, and discussion regarding risks, benefits, and limitations of genetic testing, if appropriate. Options to manage one’s increased risk for cancer are reviewed, including dietary and lifestyle changes, as well as enhanced surveillance, chemoprevention, and prophylactic surgery.
Over the past fourteen years, nearly 300 patients have been identified to carry a genetic predisposition to cancer. Hereditary gastrointestinal cancer syndromes identified include not only the more common ones such as Lynch syndrome, FAP, and MYH-Associated Polyposis (MAP), but also the more rare conditions such as Cowden syndrome (or PTEN Hamartoma Tumor syndrome), Peutz-Jeghers syndrome, and Hereditary Diffuse Gastric Cancer syndrome. Continue reading
Gastrointestinal (GI) cancers are among the most complex malignancies to treat; often, patients present with advanced disease and survival rates tend to be low. In 2005, a small group of hepatobiliary surgeons at Penn State Hershey Medical Center came together and formed the Liver, Pancreas, and Foregut Tumor Program to deliver state-of-the-art, multidisciplinary care for this difficult to treat patient population. The group has grown over the years to include four hepatobiliary surgeons: Kevin Staveley O’Carroll, M.D., Ph.D., director of the Liver, Foregut and Pancreas Program; Niraj J. Gusani, M.D., M.S., F.A.C.S.; Jussuf T. Kaifi, M.D., Ph.D.; and Eric T. Kimchi, M.D., F.A.C.S.
The multidisciplinary and coordinated nature of the program is unique to the central Pennsylvania region. Patients admitted into the program receive coordinated care from a team of surgeons, gastroenterologists, hepatologists, medical oncologists, radiation oncologists, radiologists, geneticists, and psychiatrists. Diagnostic questions are optimally clarified by modalities such as endoscopic ultrasound and computed tomography, with expert gastrointestinal pathologists providing immediate interpretation when biopsy procedures are necessary, resulting in high diagnostic accuracy with less repeat procedures. Such facets of the program allow surgeons to optimally address the challenges of tumor removal in these cases. Continue reading