'Killing Fields' Photographer Squares Off Against Cancer

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"Sixty [percent] to 70 percent of pancreatic cancers are diagnosed in the most advanced stage -- when it has spread to other organs -- and we have, at best, minimally effective therapies for advanced pancreatic cancer," said William Blackstock, professor of radiation oncology at the Wake Forest University Comprehensive Cancer Center in Winston-Salem, N.C.

"In most cases we don't even get a chance to cure it; at the time of presentation and the clinical manifestation of the symptoms, the cat's already out of the bag," said Andrew Warshaw, surgeon-in-chief at the Massachusetts General Hospital Cancer Center in Boston.

"For 80-plus percent, maybe even 90 percent of people at the time the diagnosis is first made, there is nothing beyond palliative care to help them," he says.

The numbers only get worse from there. Of the 20 percent of patients who are eligible for treatment, only about 20 percent are still alive after five years, Warshaw says, adding, "we're getting down to some small numbers."

Fighting an Impervious Foe

Oncologists say the usual treatment plan for the disease combines both chemotherapy and surgery.

"If the patient's medical status is good -- no liver or kidney abnormalities and a functional patient -- treatment would likely consist of chemotherapy," said Harold Frucht of the Pancreatic Cancer Prevention & Genetics Program at Columbia University in New York. "If there is a response, this would indicate a good short-term prognosis."

If the cancer has not already spread to other organs, Frucht says the best approach would be to try to use chemotherapy to shrink the tumor, allowing for a less dangerous surgery to remove the cancerous tissue. However, if the cancer has already spread, chemotherapy is the best bet for keeping it in check.

The best bet, however, is not always a great bet. Neither chemotherapy nor radiation has been reliably shown effective in dealing with pancreatic cancer, even in the best of circumstances.

And new experimental approaches to treat the disease are "unfortunately, not very promising," said David Patrick Ryan, clinical director of the Tucker Gosnell Center for Gastrointestinal Cancers at Massachusetts General Hospital. "The latest trials of [cancer drugs] Avastin and Cetuximab -- for which we had a lot of hope -- were negative."

Aditionally, surgery for pancreatic cancer is a risky proposal. Frucht says few surgeons in the country even possess the expertise needed to perform the operation.

Hope for the Future

Facing such odds, patients -- and even their doctors -- often view palliative care as the best course of action.

"There is a sense of nihilism among many treating physicians that says, 'why even subject these patients to surgery?'" Warshaw said. "Fifty percent of these patients don't get full treatment, which furthers this self-fulfilling prophecy."

This is bad news for the estimated 37,680 people the National Cancer Institute says will be diagnosed with the disease this year. And the institute projects that in 2008, 34,290 will die from the disease.

But trials on experimental treatments continue. And Mark Talamonti, division chief of surgical oncology at the Northwestern Medical Faculty Foundation in Chicago, says that with this research comes hope for many whose lives will be touched by this dreadful disease.

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