Sunday, October 20, 2002

UC center caseload growing

Pancreatic disease facility factor in tripled demand

By Tim Bonfield
The Cincinnati Enquirer

The recently formed Pancreatic Disease Center at the University of Cincinnati Medical Center has tripled the number of patients coming to the city for specialized treatment for some of medicine's hardest-to-treat conditions.

As the center has grown, so have calls for pumping more research money into the field, especially to battle pancreatic cancer - the nation's deadliest solid tumor cancer.

Pancreatic cancer strikes about 30,300 people a year, according to the American Cancer Society. That's far fewerthan the 205,000 people who get breast cancer each year. But just 4 percent of people with pancreatic cancer survive five years, compared with the 86 percent who live at least five years with breast cancer.

"Pancreatic cancer doesn't have a high incidence rate. But because the mortality rate is so high, it is the fifth-leading cause of cancer death," said Dr. Andrew Lowy, co-director of the center.

However, research funding pales in comparison with other life-threatening illness.

Each year, the National Institutes of Health devotes about $38,000 in research funds for every American death caused by AIDS. It spends about $9,000 per breast cancer death. It spends about $300 per pancreatic cancer death.

"It's pretty staggering. Pancreatic cancer needs more direct research support. It's one of the most aggressive neoplasms there is," said Dr. Jeffrey Matthews, the recently appointed chairman of surgery for the UC College of Medicine, who is a leading specialist in pancreatic disease.

There are no screening tests for pancreatic cancer, such as there are for breast and prostate cancer, . Nor have there been many breakthroughs in treatment, although several potentially valuable ideas are being studied.

Besides helping the patients themselves, progress made in fighting such a deadly form of cancer would have possible implications for many other kinds of cancer, Dr. Matthews said.

Growing center

UC's pancreatic disease center started in 2000 with three doctors seeing about 20 patients a week for complex diagnostic and surgical procedures. Since then, the center has grown to include 10 doctors and several support staff serving about 60 patients a week.

Patients have traveled from as far as Montana, Idaho, Kansas and Florida to be treated at the new center.

In many ways, the center is a smaller version of UC's Neuroscience Institute, which has concentrated experts from several brain-related fields, has added cutting-edge medical equipment and has recently attracted several million dollars in new research grants.

Besides cancer, the center focuses on diagnosing and treating pancreatitis, a painful and often misunderstood condition.

The pancreas is a small but crucial organ located near the liver that produces insulin and several other enzymes the body uses to digest food. Pancreatitis is an inflammation of the organ often caused by its enzymes "digesting" the organ.

The disease strikes 50,000 to 80,000 people a year, according to the National Pancreas Foundation, based in Boston.

Victims can suffer severe abdominal pain, fever and nausea, making them unable to eat or handle many daily functions. Weight loss and illnesses related to malnutrition can occur. And in cases where the pancreas completely fails to function, insulin-dependent diabetes follows.

In most cases, the cause is unknown. Known causes include gallstones, viruses, alcoholism, and reactions to acetaminophen and other medications.

"Pancreatitis is hard to diagnose and hard to treat," said Dr. Stephen Martin, co-director of UC's center. "But recently, new technology has allowed better imaging."

Dr. Martin is an expert in endoscopic diagnosis and treatment of pancreatic disease. Instead of open surgery, Dr. Martin passes a flexible tube called an endoscope through the mouth and through the stomach to ducts that connect to the liver and pancreas.

The endoscope allows doctors to use ultrasound or X-rays in combination with contrast agents to analyze the pancreas. Doctors also can use the procedure to gather biopsy material and to inject nerve-blocking medications to treat chronic pain.

In extreme cases, surgeons remove the pancreas to treat the pain. UC, with its recruitment in 2000 of Dr. Horacio Rilo, is emerging as a Midwest leader at performing islet cell transplantation for these patients to prevent the onset of diabetes.

The new center also is involved in several clinical trials of new treatments, including a "smart drug" designed to target a protein linked to the growth of pancreatic cancer tumors. Other studies are testing medicines designed to replace the enzymes not produced by a damaged pancreas.

"This is one of the times when having a medical center in a community is a real benefit," Dr. Matthews said.


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