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Early diagnosis remains key for those who treat cancer patients

Dr. Ahsan Bhatti addresses an audience Monday during a symposium at Willmar Holiday Inn and Conference Center, where he discussed the techniques of detecting and diagnosing a variety of cancer. Tribune photo by Gary Miller

WILLMAR -- If the outlook for pancreatic and liver cancer is to improve, earlier diagnosis needs to be one of the main strategies, say physicians who treat these patients.

"That's where we can do some major changes in survival and life expectancy," said Dr. Ahsan Bhatti, a gastroenterologist at Affiliated Community Medical Centers in Willmar.

How to manage these two formidable cancers was the focus this week of the annual cancer symposium, hosted by the Willmar Regional Cancer Center.

More than 100 people spent a day hearing presentations and touring the exhibit hall. The event Tuesday also included a panel discussion on family caregiving for people with cancer, and a speaker on the therapeutic value of humor.

Progress that has been made in successfully treating many of the most common cancers, such as breast, prostate and colon cancer, has not extended to cancer of the pancreas or liver. Although five-year survival after a diagnosis of pancreatic cancer is not unheard of, overall survival rates have budged little since the 1970s, said Dr. Timothy Sielaff, an oncologist and president and medical director of the Virginia Piper Cancer Institute at Abbott Northwestern Hospital in Minneapolis.

He called it "one of the toughest diseases we deal with."

The challenge for clinicians, said Bhatti, is detecting liver and pancreatic cancer sooner, while the tumor is still localized and small enough to treat effectively.

"The problem is that many of these tumors are very difficult to identify in the early stages," he said. Early diagnosis also is hampered by the fact that cancers of the liver and pancreas have few, if any, symptoms in their earliest phases.

New imaging technologies are helping, however, Bhatti said.

One of the latest is the so-called spyglass direct visualization system, which combines endoscopy and ultrasound to view pancreatic ducts and bile ducts within the liver, where small localized cancers -- too small to pick up on a CT scan -- can be hiding.

Willmar is one of fewer than half a dozen sites in Minnesota where endoscopic ultrasound is available. Bhatti has been doing the imaging procedure here since 2004.

The slender scope is only 3 millimeters wide, allowing it to be threaded into the ducts of the liver and pancreas and even snip off small tissue samples for further examination, Bhatti said. "You can physically see the tumor. You can do directed biopsy of the tissue."

Although endoscopic ultrasound is still relatively new, it has been found to be highly accurate, especially for very small tumors that don't show up with CT imaging, said Sielaff. He called the technology "a critical part of the evaluation of patients."

Surgery works best for pancreatic tumors that are small and localized, he said.

Along with better imaging technology, pancreatic surgery techniques also have made strides in the past decade and now include robotic surgery, Sielaff said.

Improving the survival rate for pancreatic cancer rests on research and the development of novel therapies, he said.

"Research is critical in pancreatic cancer. Every patient should be considered for a clinical trial," Sielaff said.

No reliable screening method exists yet to pick up pancreatic or liver cancer in their earliest stages. This means physicians need to be alert to potential signs of the disease among their patients, Bhatti said.

Jaundice, or yellowing of the skin, and itching, weight loss, lack of appetite, and abdominal and upper back pain are the most common symptoms.

Patients can help by making a doctor's appointment promptly if they develop symptoms that might signal pancreatic or liver cancer, Bhatti said.

It's also important to be aware of the risk factors. For pancreatic cancer, these include a history of diabetes, insulin resistance or chronic pancreatitis, along with lifestyle factors such as smoking, obesity and physical inactivity. Cirrhosis of the liver and being a carrier of hepatitis B or having chronic hepatitis C are among the risk factors for liver cancer.

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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