Gastrointestinal Cancer

Pancreatic Cancer

Pancreatic cancer has often grown to an advanced stage and spread to other organs by the time it is diagnosed and is challenging to treat successfully. The care of people with pancreatic cancer is, therefore, best handled by a multidisciplinary team of specialists with expertise in diagnosing and treating this disease and relieving symptoms. This is the approach we take at NewYork-Presbyterian.

We offer the latest advanced endoscopic techniques, minimally invasive and complex surgical approaches, chemotherapy, and radiation therapy. We have published the best survival rates for locally advanced pancreatic cancer. Our teams are also conducting clinical trials of promising new therapies to extend the lives of people with pancreatic cancer and to provide hope to individuals suffering from this disease.

A Team of Pancreatic Cancer Specialists

Through a collaborative approach, our cancer surgeons, gastroenterologists, radiation oncologists, medical oncologists, and other specialists are known for providing leading medical, surgical, and supportive care for people with pancreatic cancer. They meet weekly to discuss each patient and design the optimal plan of care. We will assemble the team of healthcare professionals you need. When planning your treatment, our physicians consider the type, location, and stage of your cancer, as well as your age and physical health to personalize your treatment.

Two Renowned Pancreatic Care Programs

NewYork-Presbyterian is home to two of the world’s most accomplished pancreatic programs: the Pancreas Center at NewYork-Presbyterian/Columbia University Medical Center and the Pancreas Program in the Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell Medical Center. Both programs feature multidisciplinary teams of pancreatic cancer experts, provide comprehensive care for every stage of the disease, and are among the handful of programs in the nation designated as National Pancreas Foundation Centers for the treatment and care of patients with pancreatic cancer.

Advanced Diagnostic and Staging Techniques

While your initial assessment may include CT scanning and magnetic resonance imaging (MRI), we use more advanced tools to confirm your pancreatic cancer diagnosis and to determine its extent—a process called staging. These tools include:

• Confocal endomicroscopy. NewYork-Presbyterian is one of the few centers in the country offering confocal endomicroscopy of the pancreas, which can aid in the detection and staging of cancer. We use a small microscope to analyze cells to determine if they are normal or precancerous. Cancerous tissue may be immediately removed through an endoscope for further examination.
• Endoscopic ultrasound (EUS). EUS involves the use of a special endoscope with high-energy sound waves ("echoendoscope") to visualize your digestive tract and nearby organs. It is particularly useful for evaluating the pancreas, and we often use it for fine-needle aspiration and biopsy.
• SPYGLASS. This novel technology provides a direct view of the bile duct system, enabling our doctors to visualize lesions and narrowed areas (strictures) in the ducts and to biopsy them to see if they are cancerous. This approach ensures highly accurate sampling of the area in question. It is an excellent tool to use with confocal endomicroscopy.
• Endoscopic retrograde cholangiopancreatography (ERCP). This procedure combines x-rays and the use of an endoscope. We may use it to obtain a tissue sample.
• Pancreatoscopy. Here we use a small camera to visualize the pancreatic duct.

Minimally Invasive Therapies

We use ERCP not only to diagnose but also to treat abnormalities in the bile ducts and pancreas. Using ERCP, your doctor, an interventional endoscopist, can open up blocked ducts, drain bile ducts, and remove tissue to be biopsied. We sometimes treat pancreatic cancer by combining ERCP with:

• Radiofrequency ablation. This image-guided technique heats and destroys cancer cells in people with inoperable pancreatic cancer. Our specialists use imaging techniques such as ultrasound or computed tomography to help guide a needle electrode into the tumor. They then pass high-frequency electrical currents through the electrode, creating heat that destroys the abnormal cells. This palliative therapy is useful for improving the quality of life in people who have few other treatment options.
• Insertion of a stent. An advanced interventional endoscopist performs this technique to open a narrowed bile duct and improve the quality of life in patients with advanced pancreatic cancer.
• Other minimally invasive treatments. Our doctors also perform celiac plexus neurolysis to relieve abdominal pain and insert stents in the duodenum of the intestine to treat obstructions.

Experience with the Most Advanced Pancreatic Cancer Surgery

If we can remove your pancreatic cancer through surgery, you might have the Whipple procedure (removal of the head of the pancreas, part of the small intestine, the gall bladder, part of the stomach, and lymph nodes near the head of the pancreas). This complex surgery is best handled by a surgical team with extensive experience. NewYork-Presbyterian’s pancreatic surgeons are among the most experienced in the world performing the Whipple approach. In fact, Allen O. Whipple, MD, who pioneered the Whipple procedure in 1935, was former chairman of the Department of Surgery at Columbia University.

Some people have just the pancreas removed (total pancreatectomy), just the tail and body of the pancreas (distal pancreatectomy), or only the body of the pancreas (central pancreatectomy). The choice of operation depends on the location of your tumor, the stage of cancer, and your overall health.

Chemotherapy and Radiation Therapy

In some patients, surgery is not possible because the pancreatic cancer has grown around vital structures, such as blood vessels. If your cancer is inoperable, you may benefit from chemotherapy (such as the drugs gemcitabine and nab-paclitaxel) and radiation therapy.

• Some patients receive these treatments after surgery to delay or reduce the risk of cancer recurrence.
• Chemotherapy and radiation therapy can sometimes shrink an inoperable tumor enough to make it surgically removable.
• In some cases, you may receive chemotherapy and radiation therapy during the same period (chemoradiation).

We offer these treatments in our comfortable and modern infusion suites and radiation therapy centers.

Treating All of You

To support your quality of life, we offer palliative care, which includes services such as pain management. Our nutritionists, social workers, palliative care experts, and others will help you and your loved ones address the effects of cancer and its treatment—physical, emotional, and spiritual. We understand the burden cancer can place on your life and the lives of your loved ones, and we do whatever we can to lessen that burden.

Clinical Trials for Pancreatic Cancer

Progress against pancreatic cancer requires intensive research efforts to understand this disease better and clinical trials to assess new treatments. At New York Presbyterian, we actively support clinical trial participation in pancreatic cancer patients and have many active studies to provide improved options for all patients. Your care team will let you know if you can participate in a clinical trial of a promising new therapy.