Understanding Pancreatic Cancer
- Toni Bravo was a a 20-year-old college student studying at The University of Notre Dame in Indiana when was diagnosed with pancreatic cancer after initially suspecting her fast heart rate and feeling of tightness in her chest were due to anxiety. Now, 21, she’s sharing her story to encourage others to get checked when something feels off with their bodies.
- She is cancer-free after undergoing a Whipple procedure, an invasive surgery, to get the tumor removed. She didn’t need chemotherapy.
- Pancreatic cancer is a type of cancer that forms in the pancreas. It is more challenging to treat because symptoms usually don’t present themselves until the cancer has spread or metastasized. Symptoms may include weight gain, back pain, and jaundice.
- Early-stage pancreatic cancer tumors don’t appear on imaging scans, and people typically don’t experience symptoms until the disease has progressed. The pancreas’ location in the abdomen makes it harder to find tumors.
- Treatment options for pancreatic cancer may include surgery, radiation, chemotherapy, and targeted therapy.
Now, the resilient 21-year-old woman, Toni Bravo, who is cancer-free after undergoing surgery to have her tumor removed, has shared her story with People, in hopes to inspire others get see a doctor when something doesn’t feel right.
Read More
However, just days before her finals in December 2023, she thought she was experiencing a “really bad anxiety attack” that didn’t go away after a good night’s rest.
She recounted to People, “Just walking 10 steps to the bathroom would increase my heart rate to the point where I was really uncomfortable. I called my mom and I was like, ‘I can’t get rid of my anxiety today. I don’t know what’s going on.'”
Her mom suggest she go to the nearest emergency room, where a CT scan saw something concerning, prompting her to need a CT scan of her abdomen.
She then learned she has a “really rare tumor” on her pancreas that needed to be surgically removed.
After finishing up the semester, she returned home to Los Angeles and went to City of Hope to undergo further testing and confirming she had a rare form of pancreatic cancer, which could be removed with surgery.
She chose to finish up her Spring 2024 semester before undergoing “robotic Whipple surgery” on June 4, 2024, which she explains, “The Robotic Whipple procedure involves removing the head of the pancreas, part of the small intestine, gall bladder and bile duct. The robotic surgery allows a smaller incision and quicker recovery.”
Johns Hopkins Medicine explains that the Whipple procedure, also known as a pancreaticoduodenectomy, “is the primary surgical treatment for pancreatic cancer that occurs within the head of the gland.”
“During this procedure, surgeons remove the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct, the gallbladder and associated lymph nodes,” Johns Hopkins explains. “In some cases, the surgeon may remove the body of the pancreas, the entire duodenum and a portion of the stomach. On average, the surgery takes six hours to complete. Most patients stay in the hospital for one to two weeks following the Whipple procedure.”
RELATED: Detecting Pancreatic Cancer Early Is Crucial
Bravo told People that surgery was enough to remove the cancer, so chemotherapy wasn’t needed.
She also doesn’t no why she was diagnosed with the disease as she has no family history of it, but she suspects maybe it’s because it’s “more common in minority communities” and she’s of Mexican decent.
Bravo then noted, “As new cancer data has come out, younger people are getting diagnosed. The age range that people are getting cancer is getting younger, and we need to have a way for people to find out. That’s why it’s super important for early detection tests for pancreatic cancer.”
She hopes her cancer journey will inspire others to get checked when something seems off with their body and she now considers herseld an advocate for being proactive.
“I got lucky that I decided to take myself to the emergency room that day because of my anxiety. Otherwise, I don’t know when the doctors would’ve found it. And potentially, I would’ve had the same luck that a lot of pancreatic cancer patients have: They catch it late and it’s harder to deal with it,” she concluded.
Coping With a Pancreatic Cancer Diagnosis
Pancreatic cancer is a type of cancer that forms in the pancreas. It is more challenging to treat because symptoms usually don’t present themselves until the cancer has spread or metastasized. Symptoms may include weight gain, back pain, and jaundice.
Pancreatic cancer often comes with a slim chance of survival due to difficulty detecting it when it is more treatable.
Although pancreatic cancer survival rates have been improving, it’s still considered to be largely incurable. An exception to this is if the tumor is still small enough and localized enough to be operated on.
WATCH: Pancreatic cancer and early detection.
In a previous interview with SurvivorNet, Dr. Anirban Maitra, the co-leader of the Pancreatic Cancer Moon Shot at MD Anderson Cancer Center, explains what he typically sees when patients develop this disease.
“Because the pancreas is inside the abdomen often doesn’t have symptoms that would tell you that something is wrong with your pancreas,” he says.
“By the time individuals walk into the clinic with symptoms like jaundice, weight loss, back pain or diabetes, it’s often very late in the stage of the disease.”
Expert Resources On Pancreatic Cancer
- Big News for PARP Inhibitors: They Can Work in Pancreatic Cancer, Too
- Detecting Pancreatic Cancer Early Is Crucial
- If You’re A First Degree Relative of Someone With Pancreatic Cancer, Screening and Surveillance Could Save Your Life; Here’s Why
- Immunotherapy Offers New Hope for Fighting Pancreatic Cancer
- Pancreatic Cancer Rates are Rising In Women Aged 15 to 34, According to New Research; How To Recognize Symptoms
- Pancreatic Cancer Treatment Just Became a Lot More Accessible; New Platform Is Designed to Test Multiple Therapies at the Same Time
- Prevention For Pancreatic Cancer That Took Alex Trebek? New Data Shows GLP-1 Drugs, Like Ozempic, Linked to 53% Drop
Meanwhile, parents, siblings and children of someone with pancreatic cancer are considered high risk for developing the disease because they are first-degree relatives of the individual. PGVs (pathogenic germline variants) are changes in reproductive cells (sperm or egg) that become part of the DNA in the cells of the offspring. Germline variants are passed from parents to their children, and are associated with increased risks of several cancer types, including pancreatic, ovarian and breast cancers. Germline mutations in ATM, BRCA1, BRCA2, CKDN2A, PALB2, PRSS1, STK11 and TP53 are associated with increased risk of pancreatic cancer.
Jessica Everett, a genetic counselor at NYU Langone’s Perlmutter Cancer Center, encourages people in this category to look into possible screening options.
“If you’re concerned about pancreatic cancer in your family, start by talking to a genetic counselor to learn more about your risk and what options you have,” Everett told SurvivorNet in an earlier interview.
Additionally, note that up to ten percent of pancreatic cancer cases are caused by inherited genetic syndromes. So, if two or more members of your family have had pancreatic cancer, or if you have pancreatic cysts, it’s worth asking your doctor to check for pancreatic cancer since you’re at high risk.
The National Cancer Institute identifies pancreatic cancer symptoms to include:
- Dark urine
- Pain in the abdomen
- Unexplained weight loss
- Light-colored stools
- Loss of appetite and fatigue
Treatment options for pancreatic cancer may include surgery, radiation, chemotherapy, and targeted therapy.
Progress in Pancreatic Cancer
Progress has been made over the last few years in the world of pancreatic cancer treatments. One clinical trial recently found that the drug Onivyde, in combination with chemotherapy in the so-called Nalirifox regimen, helped patients live longer compared with chemotherapy in previously untreated patients with metastatic pancreatic ductal adenocarcinoma (mPDAC), according to Ipsen, the pharmaceutical company that bought the drug.
“The prognosis for people diagnosed with pancreatic cancer is extremely poor and we plan to submit these new findings to the regulatory authority as, if approved, we believe this regimen could offer up an important new treatment option for people living with an aggressive and hard-to-treat cancer,” Howard Mayer, Executive Vice President and Head of Research and Development for Ipsen, previously said. “We thank the patients who participated in the study, their families and their healthcare teams.”
The drug is currently approved in the U.S., Europe, and Asia in combination with fluorouracil and leucovorin as a treatment for mPDAC after disease progression and following gemcitabine-based therapy.
Another example of progress being made comes in the form of immunotherapy, a type of cancer treatment that uses your own immune system to fight cancer.
“Up until now, immunotherapy hasn’t had a big role,” Dr. Allyson Ocean, a medical oncologist at Weill Cornell Medical Center, previously told SurvivorNet.
Dr. Allyson Ocean explains why pancreatic cancer is so hard to treat.
A clinical trial led by researchers at the Perelman School of Medicine at the University of Pennsylvania, and sponsored by the Parker Institute for Cancer Immunotherapy, found “combination of chemotherapy with an immunotherapy meant to unleash the anticancer capacity of the immune system was effective against one of the hardest targets in cancer care, pancreatic cancer,” said Penn Medicine.
“The researchers found that in 34 patients with advanced pancreatic cancer randomized to receive the immunotherapy nivolumab with two chemotherapy drugs, nab-paclitaxel and gemcitabine, had a one-year survival rate of 57.7 percent, significantly greater than the historical average of 35 percent with chemotherapy alone,” the institution said.
Dr. Benjamin Musher, the director of medical oncology at the Dan L Duncan Comprehensive Cancer at Baylor St. Luke’s Medical Center, recently said there were currently multiple “home-grown clinical trials testing novel immunotherapies in all stages of pancreatic cancer studies underway at Baylor St. Luke’s.” But only about 5 percent of patients with pancreatic cancer participate in such studies.
“We know that we are not going to improve outcomes without more patients enrolling,” Musher said.
In addition, there are immunotherapy clinical trial innovations being made to allow for multiple immunotherapeutic approaches to be tested and compared to one or several standard-of-care options within trials. In other words, “investigational treatments can be added or dropped from the trial over time, depending on preclinical and clinical evidence.”
“We’re encouraged by the trend toward more innovative clinical trial designs to improve the drug development process and ultimately lead to better patient outcomes,” PanCAN Chief Science Officer Lynn Matrisian said in a recent article from the Pancreatic Cancer Action Network.
Clinical trials, in general, are research studies that compare the most effective known treatment for a specific type or stage of a disease with a new approach.
Dr. Beth Karlan, a gynecologic oncologist with UCLA Health, previously told SurvivorNet that clinical trials can play an important role for some patients’ treatment, but they also serve a larger purpose.
“Clinical trials hopefully can benefit you, but it’s also providing very, very vital information to the whole scientific community about the effectiveness of these treatments,” Dr. Karlan said. “We need everyone to be partners with us if we’re ever going to truly cure cancer or prevent people from having to die from cancer.”
That being said, there is no guarantee you’ll receive more effective treatment than the standard of care, and clinical trials certainly aren’t right for everyone. You should always talk with your doctor(s) before getting involved in one. Some risks to consider are:
- The risk of harm and/or side effects due to experimental treatments
- Researchers may be unaware of some potential side effects for experimental treatments
- The treatment may not work for you, even if it has worked for others
But if you’ve already decided that a clinical trial is right for you or you’re just beginning to explore your treatment options, you should know that SurvivorNet has a tool for you. The SurvivorNet Clinical Trial Finder: an A.I. driven tool for patients to find clinical trial options for treatment.
The tool is built on top of clinicaltrials.gov, a database maintained by the U.S. government that compiles privately and publicly funded clinical trials conducted around the world, and gives access to more than 100,000+ individual clinical trials, updated daily.
“Clinical trials are critical to the development of new therapies, and as we live through this extraordinary revolution in genomics, immunotherapy and targeted therapy, it’s clear that one of the most pressing needs for patients, clinical trials sponsors, and researchers is simply a better way to find patients,” SurvivorNet CEO Steve Alperin said.
“Even one percent more people successfully enrolled in clinical trials can change the world.”
Being Proactive About Your Health
It’s always a good idea to get into see your doctor if you have any concerning lingering symptoms that may be bothering you for more than a couple of weeks.
It’s also imperative to get regular checkups and screenings even when you are seemingly in perfect health. The more proactive you are about your health, the more of a chance you can stay ahead of a potential diagnosis. In general, the earlier you catch your cancer, the better the prognosis.
“Don’t just leave it to the doctors to tell you what’s going to happen … yes you have to listen to them, but take your health into your own hands,” survivor Amy Armstrong previously shared with SurvivorNet.
Questions for Your Doctor
If you are facing a pancreatic cancer diagnosis, you may have questions but are unsure how to get the answers you need. SurvivorNet suggests asking your doctor the following to kickstart your journey to more solid answers.
- What type of pancreatic cancer do I have?
- Has my cancer spread beyond my pancreas? If so, where has it spread, and what is the stage of the disease?
- What is my prognosis?
- What are my treatment options?
- What side effects should I expect after undergoing treatment?
- Will insurance cover my recommended treatment?
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
