Pancreatic cancer is one of the deadliest types of cancers. Survival rates are low because it's very hard to detect in its early stages. Now, Jupiter Medical Center is performing what they call a life saving procedure, hoping to provide the best possible outcomes for patients. Let's go on the record from Wpbf 25. This is on the record with Natalie Pozo. Welcome on this Morning. We're talking about pancreatic cancer and the advances being made in the field. This morning we have Doctor Chanel bag wenton from Jupiter Medical Center to talk more about this. Doctor, you are the very long titles here. Medical director of gastrointestinal surgical oncology program. And also the program director of the National Pancreas Foundation Pancreatic Cancer Center program. So you have a lot of experience and in this field. So first let's talk a little bit about how does pancreatic cancer form. Yeah. Thank you for having me. First of all I mean this is a very interesting diagnosis in terms of how we're learning about it, and especially with regards to being commonly a disease of older age. Pancreas cancer really refers to, the, change in the cells within the pancreas that primarily function to help with how the pancreas can digest a lot of the foods that we eat. A lot of people know the pancreas serves to function with regards to insulin production and diabetes. So there are different types of pancreatic cancer, but the one that we fear most is known as pancreatic ductal adenocarcinoma, which specifically refers to some sort of derangement in those cells where they can detect or develop a mutation and over time develop into pancreas cancer. And unfortunately, you don't really start to feel symptoms until you're later on. A different stage of the cancer. Yeah. That is the aggressive nature of this disease. Is that especially as it gets diagnosed, sometimes it can be invisible to the body, where it can hide. And as a result of that, it can grow unchecked. And usually once patients start to develop symptoms back pain, loss of appetite, even jaundice, yellowing of the eyes and skin, those are symptoms that sometimes present at a much later stage where we find it, and that survival usually mirrors that in terms of being a lot poorer when it's detected late. Is there anything that people can do to prevent this? Can they do any sort of tests? Yeah. So there are as far as just talking about the day to day changes that we can all do in terms of, of, of our overall cancer care. Smoking is the most common modifiable risk factor with pancreatic cancer. Having, well-balanced diet, high in fruits, vegetables, less, fatty foods, red meat, things like that. Similarly, we're seeing a trend where there's an increase in pancreas cancer secondary to the increase in obesity and diabetes, particularly among younger patients. So as a result of that, we are seeing that trend in terms of increase. But going back to your point about earlier tests of screening, that is one of the advancements that we are, you know, seeing a push in that direction where, this is a diagnosis that we don't have a clear cut way to detect it before it becomes pancreas cancer. But there are earlier blood tests and, what we call liquid biopsies or cancer screening that, can be performed with higher sensitivity and specificity for this type of cancer that can be detected at earlier stages before patients start to develop those symptoms. I was telling you that unfortunately, my father in law died, of pancreatic cancer. Is this something that runs in the family? It absolutely can. We do see a genetic predisposition somewhere between 10 to 12%, depending on the type of cancer. But that is a known risk factor with regards to pancreas cancer. So much so that we do encourage and that our center, recommend genetic counseling for all patients just to see if there is, in fact, a genetic predisposition that would allow us to learn about that cancer, but also potentially even treat additional cancers that they may be at risk for. And we're going to talk a little bit about that a little bit later on in the show. So talk to me about this, procedure at Jupiter Medical Center that you guys are doing that. That's really just giving a lot of hope to to patients. Yeah. So this is what's known as, robotic Whipple. It specifically refers to an operation where you're removing the head of the pancreas. The pancreas is an organ that's deeply nestled towards the back of the body, but it's almost at the crossroads of very critical blood vessels. It oftentimes requires you to remove the head of the pancreas, the intestine, the bile duct, multiple organs to do a very complex reconstruction for cancers in that area. We are talking about the precision of millimeters, where changes in technique can absolutely lend themselves to different outcomes, as well as, patients being able to have surgery because the majority of the time patients are not candidates for surgery. Over the past year, we've been able to utilize a robotic approach to treat cancers in that location. And what we've demonstrated is that patients have been able to have a faster recovery back to their functional baseline, less pain, increased sort of organ, function after surgery and where that translates, particularly with patients dealing with cancer, is that they can get back to their treatment a lot earlier. And who qualifies for this kind of, procedure? You know, patient selection is key. A lot of it with regards to the decision making is largely based on experience. So it's not so much about, you know, doing the most volume, but a lot of it is really just the understanding with the patient to know that this could translate to faster outcomes. And with that, back to living normally, but going back to the decision making in terms of patient selection, the majority of patients with a pancreas cancer, as long as they don't have the specific blood vessel involvement where we may need to do a blood vessel reconstruction, if they have a mass that would allow for them, especially with regards to the robotic surgery and using small incisions to approach the pancreas, is that we want to make sure that we're approaching it in a very safe, meticulous way so that we can be precise with the dissection. So if someone is diagnosed with with stage four pancreatic cancer, could they possibly be a candidate for this? Yeah. Stage four unfortunately, isn't a candidate for pancreas cancer. Thank you for making that distinction. Is that the majority of our patients have cancer that's localized to the pancreas or the nearby lymph node, certainly with involvement of those blood vessels around the pancreas, we can approach that surgery in a way to resect and or do a surgery to remove and reconstruct the blood vessels. But once a cancer has metastasized or spread, which implies stage four, it's less likely that surgery is going to be of benefit. Even if, let's say, the theoretical disease that has metastasized could have a surgery to remove it there. Usually that doesn't track to the improved survival that we want with this disease because of how aggressive it is. All right, Doctor Penguin, a thank you so much for being here with us this morning. And talk to us about this. Just very, very important topic here. Coming up, we're going to sit down with a pancreatic cancer patient and her journey since being diagnosed. You're watching on the record. On Wpbf 25. We continue our conversation this morning on pancreatic cancer. Nicole Locher is a pancreatic cancer patient here to share her story to raise awareness. Thanks so much for being here with us, Nicole. So happy to see you. Talk to us about just the day you were told that you had pancreatic cancer. It was a call it 3:00 in the afternoon, and it was, the gastroenterologist that had done the biopsy, because they had seen on MRI that there was a mass, and he just said, you know, this is a dental carcinoma. And you need to see a, an oncologist immediately. He had a referral for me. I was in the oncologist office on Friday. Well, I had my port put in the following Wednesday. Started chemo the Tuesday after that. And it was my oncologist that recommended Doctor Bhagwan. And, he also gave me other options, like Mayo Clinic, Miami, Moffitt Center. But he was very, very confident that the right choice would be doctor. But London, especially because he was local. Yeah, absolutely. So yeah. And and we were talking about the procedure they have at Jupiter Medical Center. I know you had a different procedure done than what we were speaking about with the doctor. Can you tell us about that? It it was, I would say similar to having my gallbladder removed. So it was all laparoscopic. So I had a few incisions and then after surgery, I did have a drain. That I had to take care of for a couple weeks with the help of home care, but I would say probably four days, five days after surgery, I was up and about and able to do most everything that that I was approved to do. I mean, you seem like such a strong, strong woman. You what? Just kind of went through your mind when when you were told about that diagnosis? I immediately, of course, thought of Alex Trebek and, you know, Patrick Swayze in the, you know, the ones that you hear about that are diagnosed at stage four. So I was I was very scared. But once I met with my medical oncologist and then doctor began and, I had a lot of hope and just figured, all right, let's go. Yeah. Were you feeling any symptoms? What made you want to go to the doctor? So I in late April, I had, lower quadrant pain on my right. And it kept getting it kept getting worse and worse. It took about two weeks, and I finally went to the doctor, and they, are to the emergency room, and they did a CT, and thought it was pancreatitis. It matched with my blood work. But after discharge, I was I was inpatient for a few days, and after discharge, I still didn't feel right. So I scheduled a follow up with a gastroenterologist, and she, took me very seriously, which I appreciated. Oh, goodness, you did that. You trusted your miss your instincts and wanting to make that appointment. Yeah. And she she started with, some imaging that had contrast in it. She said it would help see better and some cancer blood markers and and she that's a procedure. We went down and got the official diagnosis. So it took, I'd say about a month with all the diagnostics and waiting on the age where you diagnosed with, to be, I believe. Okay. Yeah. Yeah. I mean, when you heard two, though, that must have caused a little bit of relief. Yes, yes, absolutely, absolutely. And I've had an amazing support system. My medical team is incredible. You know, I couldn't have more confidence in them. I also see someone behind the camera here who seems like it's an incredible support system to you. Yes. That is John, and it's my significant other. It's that John was giving you a big hug right before you came out here. Yeah, I saw that. That was very, very sweet. John. Nicole, what would you say to people who are in a similar situation to you, you know, who maybe have just been diagnosed, or maybe to a family member who has a loved one that has been diagnosed to advocate for yourself. It's like if you feel like something's wrong, go with it. You know? And if if someone tells you that, yeah, let's not try again, you know, or if the treatment that, that they tried is, you know, isn't making you feel better, talk to them. It's scary, but. And it changes a lot. It does, you know, like I haven't I've been out of work now for a while. But just, you know, try to keep on living your life. Well, yeah. We. When my first with my first round of chemo, we went to, North Carolina to see Pearl jam and to Missouri, Saint Augustine, you know, we we tried to get out when we could. Yeah. So, and how does your recovery look? From now on. What is your what a doctor's telling you? That as of right now, I'm cancer free. Thank you. I started my second half of chemo yesterday. Which is why I have my pump. And then after, I think five rounds of that, then I'll meet with a radiation oncologist. Well, I know you said that. Then things obviously change for you and and that you're out of work right now. But you're here with us. Yes. And that's the most important thing. Yes, absolutely. Well, for sharing your story with us. Thank you. Next, we're going to learn more about genetic testing and how it can help identify people at an elevated risk for cancer. Welcome back. Connie Murphy is a board certified nurse practitioner who is a certified in cancer genetics risk testing, risk assessment, testing. At Jupiter Medical Center. Connie, thanks so much for being here with us this morning. We spoke with Doctor Bandwidth earlier on in the show, and he was mentioning how we're seeing an increased risk in pancreatic cancer. Cancer and also younger patients. Yes, absolutely. There are about 646,000 cases diagnosed last year. Some of it is attributed to attributed to their lifestyle, smoking, obesity. As Doctor Greg London was referring to alcohol use. But we do see a definite increase in the incidence. And why do you think we're seeing it now in younger patients as well? That's an unknown. I you know, we do talk about cancer, genetic testing for hereditary cancer syndromes, meaning that someone has inherited a faulty gene from a parent that can elevate their risk for cancers, including pancreatic cancer. And those are the patients we want to find early, because we do have screening tools now that we can use to detect their pancreas cancer. So what kind of screening tools do you have? And is it for all sorts of cancers that are specific kinds of cancer? Well, that's the piece about genetic testing. When we identify a family or a person who is at risk for cancers, and every gene that we test, we do panels of 40 to 77 genes, routinely. So when we identify someone who has a faulty gene that elevates their risk, each of these genes is associated with a different type of cancer and with a different level of risk. So there is a lot of crossover among the genes. Our goal is once we've identified these families as to offer them high risk surveillance, to offer them risk reducing medications, risk reducing surgery, and certainly talk about lifestyle modifications. So that's big to to mitigate the risk. I was, telling a doctor bang one death about my my father in law, he passed away from pancreatic cancer. So should my husband. Should his siblings be doing these kinds of testing? Should I do this on my children as well? So absolutely, any person diagnosed with pancreatic cancer should be offered genetic testing early on because it can inform their planning, their treatment planning the medications that we use. And then once we've identified a person with a faulty gene, all of their biologic relatives need testing. So my role isn't just about patient. It becomes the family. And the current guidelines say that if the person with pancreatic cancer was not offered genetic testing because there aren't programs like ours at Jupiter Medical Center or every cancer center, I think that's the case with my father in law. I don't think he was ever offered that. Yeah, and that saddens me because it is a national guideline. It is it is a societal guideline. It is a gold standard to get them and then get them tested right away. And then we move on to testing their family members all first degree relatives, that sibling or child of your father in law should be offered appropriate genetic counseling and test. What if he didn't have that test on? Is there still something you can do for, let's say, my husband and his siblings? Oh, that's absolutely. Well, okay. Yeah. If the person that was affected did not have genetic testing, then we move on to their site. Their children and your and their children. If someone is positive, then they can pass on the genetic defect. So anyone who is positive their children should be age appropriately tested. And what does this test look like? It's it's actually it's just a blood test. Okay. I use blood almost exclusively because we can then analyze DNA and RNA, which has a bigger yield, for these genetic variants that increase cancer risk. We we spent about an hour with our patient discussing what we're going to do. Potential results. Positive, negative, uncertain. It's very important for patients to understand they can have an uncertain result, where we find a variation on a gene that we don't understand yet and we don't act on it. And that is something they have to get their head around, because that can be anxiety producing. Connie, do you have a story that sticks out to you? From a patient or from a family member of the patient? I have, yes, I have a I'm sure you have so many I do. I have several families that, I've become very close with over the years because one of the things we offer in our program is high risk surveillance. So we don't just test you, tell you you're positive and send you on your way. You know, we're going to develop an individualized care plan, and we have the benefit of an EMR electronic medical record called my Gene Council through the courtesy of a generous donor that provided us with that which provides our patients and their families with a living lab report. That means any time there's an update about their gene, about their cancer risks, about how we provide them surveillance, about what surgeries we do, they get an email. It's a lot faster than me trying to keep up with my 3000 patients. Right. So they're offered an email. And so that's something that makes us unique. I have families that come in like sisters will come together. Mothers, daughters, fathers. You know, men are included in this. It's it's everybody inherits a gene from your parents. So if you have a parent with a faulty gene, male or female, you should undergo genetic counseling. Okay? So people that want to do this, what do we want to tell them? If you have a strong family history of cancer or if you've been diagnosed with cancer yourself, at our center, we actually take every prospective cancer case and and have a tumor conference where we discuss the case and the care, and I'm there, or my genetic counselor associate Robin Urban, is there to tell the our team who meets criteria for testing. And so if you have a strong family history of cancer, you want to talk with your health care provider to see if it's compelling enough to warrant genetic testing. All right, Connie, anything else you want to add before we wrap up? I think it's really important for people to be aware we've moved way beyond BRCA one and BRCA two genes. There are multiple cancer genes out there that if those genes are faulty, we're at risk. We need to know our family history. That's ideal. Absolutely. I mean there's been to so many advances also just in medicine. I'm going to take advantage of that. Right. All right. Thank you so much. We'll be right back. Thank you for making us a part of your morning. As always, we encourage you to be part of our discussion each and every Sunday, right here at 10 a.m.. Until then, you can watch this morning's on the Record and every episode on our website, wpbf.com, and our free Wpbf 25 news app. Have a wonderful Sunday. We'll see you again next weekend. For.