Dr. Sanjay Reddy, surgical oncologist and the Co-Director at the Marvin & Concetta Greenberg Pancreatic Cancer Institute, joins "Forbes Newsroom" to discuss pancreatic cancer following Rep. Sheila Jackson Lee's (D-TX) announcement that she has been diagnosed with the disease.
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NewsTranscript
00:00 (upbeat music)
00:02 - Hi everyone, I'm Maggie McGrath, Senior Editor at Forbes.
00:07 Over the weekend, Congresswoman Sheila Jackson Lee
00:10 announced that she has been diagnosed
00:11 with pancreatic cancer.
00:13 The news is trending today,
00:14 and so we wanted to sit down with an oncologist
00:17 who can explain more about the disease.
00:19 Joining us now is Dr. Sanjay Reddy,
00:22 a surgical oncologist
00:24 with Fox Chase Cancer Center in Philadelphia.
00:27 He is also the co-director of Fox Chase's
00:30 Pancreatic Cancer Institute.
00:32 Dr. Reddy, thank you so much for joining us.
00:34 - Thank you, Maggie.
00:35 - Representative Lee is the latest
00:37 in a string of high profile leaders
00:40 to receive this diagnosis.
00:42 Within the past few years,
00:43 we have seen cases with Justice Ruth Bader Ginsburg,
00:47 Congressman John Lewis, Apple co-founder Tim Cook.
00:51 And so I want to start by asking,
00:53 how common is pancreatic cancer in the United States?
00:57 - So pancreatic cancer is becoming more common,
01:00 mostly because of people coming out
01:04 and talking about their diagnosis, right?
01:06 We are much more proactive than in years past,
01:10 instead of being reactive.
01:11 And I think that by being proactive,
01:14 we're looking for signs, we're looking for symptoms,
01:16 we're trying to engage the disease process
01:19 at an earlier time point in time.
01:21 And you'll see sort of time and time again,
01:23 that if we can catch it at an earlier stage,
01:26 it usually portends a better prognosis.
01:30 - Now, Representative Lee, as far as I have seen,
01:34 has not indicated what stage of cancer she has.
01:38 Is that correct?
01:39 What do you know about her case?
01:41 - That's correct.
01:42 So from what I understand, no stage has been assigned,
01:46 but she has begun treatment.
01:49 Now, it's interesting because treatment generally starts
01:52 with chemotherapy.
01:54 Whether pancreatic cancer tumors are either,
01:57 I always say it in my clinic,
01:59 within the box or out of the box,
02:02 generally speaking, in a lot of cases,
02:04 it starts with systemic chemotherapy.
02:06 And the reason is, is that this disease
02:08 is really a systemic disease at the onset of diagnosis.
02:12 So it's really imperative that treatment
02:15 to be started as soon as possible.
02:17 The difference though, between the in the box
02:19 and the out of the box scenario,
02:21 is that if it is metastatic disease,
02:24 it is technically incurable disease.
02:26 And the chemotherapy is a way to keep the disease
02:28 at bay as best we can.
02:30 But for the other group of patients
02:33 that have potentially resectable or removable disease,
02:38 systemic chemotherapy is an adjunct,
02:40 meaning that after that, depending on how they do,
02:43 the ultimate goal is to make a patient
02:46 to the operating room for surgery.
02:48 - So just to break that down a little more,
02:51 in the box means it has not metastasized
02:54 and out of the box means that the disease
02:56 is prevalent in the body and therefore,
02:58 lifetime chance of remission is very low?
03:02 - That's correct.
03:03 That's correct.
03:04 And we know that if we can tackle the disease
03:06 at an earlier time point,
03:08 we have better chances for survival.
03:12 - Why is it that this disease is so out of the box
03:17 in typical cases?
03:18 I feel like most of the headlines we see
03:20 or talking to friends and family,
03:23 this is usually diagnosed, again, anecdotally,
03:26 in the later stages.
03:28 Do we have an explanation for that?
03:30 - Yeah, that's a good question.
03:31 I think there's not a great explanation.
03:33 I think the real sort of problem is that
03:36 it's so insidious, this process, right?
03:39 So the symptoms may not be as wide,
03:44 if you have a colon cancer, you have rectal bleeding.
03:47 In pancreas, by the time you become jaundiced,
03:49 if the tumor is causing a blockage of your bile duct,
03:52 a lot of the time, the disease has already sort of laid
03:55 its roots in the ground and those little seedlings
03:58 are already there sort of germinating.
03:59 I think that's the problem with this disease in particular,
04:02 that it's just an aggressive disease.
04:04 But this is also where we've been become much better
04:07 about being more attentive to symptoms, right?
04:10 So new onset diabetes, weight loss, nausea, vomiting,
04:15 the other typical things that we see.
04:18 But this disease is one that is just an insidious process
04:21 that just sort of lurks under the radar
04:23 until it becomes more obvious.
04:26 - So just to highlight those symptoms you said there,
04:28 weight loss, nausea, vomiting,
04:31 those can be relatively common symptoms
04:33 for myriad diseases.
04:36 So what should someone know about their own bodies
04:39 and when to call a doctor and what to do?
04:42 - Yeah, I mean, I think, first of all,
04:44 prevention is the best medicine, right?
04:45 And I think going to your primary care,
04:47 getting your routine blood work,
04:49 subtle signs and symptoms, for example, again,
04:52 you know, new onset diabetes in an older patient
04:54 is something that should be a trigger, an alarm.
04:57 If you have now, you know, chalky stools,
05:00 maybe you're having some pancreatic insufficiency
05:02 where your pancreas is just not working
05:05 on all eight cylinders, that could also be a time point
05:09 that you may wanna intervene.
05:10 So again, it's good primary care physicians
05:13 that really sort of intervene at an earlier time point
05:17 that hopefully identify these patients earlier.
05:19 - You said nuance at diabetes.
05:23 I am not a physician.
05:24 Can you break down what that means?
05:26 - Yeah, so if a patient now all of a sudden
05:28 has increasing problems controlling their blood sugars,
05:33 that should alarm something as to sort of, oh, why is that?
05:35 Is there some dysfunction going on in the pancreas
05:38 due to a mass or due to some other process?
05:40 And I think those are, again,
05:42 some things that we can identify.
05:45 The pancreas has sort of two functions, right?
05:48 There's the endocrine function,
05:50 which regulates your diabetes.
05:51 And then there's the exocrine function,
05:53 which helps with your digestion.
05:55 So if one of those is off,
05:57 it could be a trigger that something more is going on.
06:01 - What are the treatment options
06:03 for pancreatic cancer in 2024?
06:05 You alluded to chemotherapy and then decisions
06:09 that can be made after a cycle or several of chemo.
06:14 But we sit here in 2024
06:16 when there have been so many medical innovations
06:19 across not just cancer, but heart disease and diabetes
06:23 and so much more.
06:24 Have the treatment options improved for patients?
06:28 - Yeah, I would say yes.
06:29 I mean, if you look at the five-year survival rate,
06:32 every year we are upticking in the percentage.
06:35 I mean, right now the five-year survival rate
06:37 for pancreatic cancer across the board is 13%.
06:41 But when I started my practice now 12 years ago,
06:43 I think it was 7%.
06:45 So we've seen sort of these increases over time
06:49 with the disease.
06:51 But the advances we're making is really multifactorial
06:55 in the sense that it's a team approach, right?
06:58 We really lean on each other as a multidisciplinary team
07:02 with medical oncologists, radiation oncologists, surgeons,
07:06 our GI doctors, and really our scientists, right?
07:09 Because they're the ones that are also making
07:11 some groundbreaking discoveries with this disease.
07:14 And we've learned that it's the combination of therapies,
07:17 chemotherapy, radiation at times, and surgery
07:20 seem to be that secret sauce
07:23 to get sort of everything kind of working again.
07:26 But I think that is the advances that I see
07:30 is that we're working more collaboratively than ever
07:33 to treat patients with this disease.
07:35 - Now, when I named the high profile people
07:39 who have been public with diagnoses
07:42 or have succumbed to the disease, I named men and women.
07:46 But is there a gender breakdown in patients
07:49 in who is more likely to get diagnosed
07:52 with pancreatic cancer?
07:53 - General, I see a pretty even split
07:57 anecdotally just in practice.
08:00 But again, I think one of the biggest things now
08:02 is a family history, right?
08:04 That seems to be another way
08:08 that you sort of become more proactive and not reactive,
08:10 right?
08:11 If you have a family history of pancreatic cancer,
08:13 then perhaps you need to pay extra mind
08:16 and extra attention to those sorts of things.
08:18 Genetic testing is offered for high-risk individuals
08:21 at times as well.
08:22 Now, every pancreatic cancer patient we see,
08:24 they get genetic testing for the reasons of a lot,
08:28 some of the times there could be mutations
08:30 that are causing this cancer diagnosis.
08:32 So for example, if you have breast cancer
08:35 and you test positive for the BRCA mutation,
08:38 that's another trigger that we use in pancreatic cancer
08:42 to see if certain therapies work better than others.
08:45 - And what about age breakdown?
08:48 Representative Lee is 74,
08:50 but Tim Cook was roughly 49 when he announced his diagnosis.
08:55 Is this an equal opportunity cancer when it comes to age?
09:00 - Yeah, I mean, the number you quoted
09:02 was pretty spot on in terms of the average,
09:05 but we see patients in their 30s,
09:08 and it's really across the spectrum.
09:11 Age is not necessarily a right-defining denominator here.
09:16 I think every patient is an individual.
09:19 When it's genetic predisposed to cancer,
09:22 especially when you see a young patient,
09:25 the first thing you think about is,
09:25 "Oh my God, did you have a family history?
09:28 Is this why this developed here?"
09:30 And at times that is the cause,
09:31 but I think age, we're seeing a wider array of ages.
09:36 And I think it's partly because, again,
09:38 we are much more proactive
09:42 about trying to identify the process of the disease.
09:46 - I'm glad you mentioned the wider array of ages
09:49 because we are speaking at a moment
09:51 when the average age for the first recommended mammogram
09:54 has been lowered to 40 years old from 50 years old.
09:58 And also we've seen the recommended average age
10:03 for first colonoscopy, that's been brought down to 45.
10:06 What is going on here with cancer rates among young people?
10:10 Should we be worried, or is it, as you say,
10:13 a cause of increased awareness?
10:15 - Yeah, I mean, that's a really tough question.
10:18 And again, I'm sure there's multiple layers to that answer,
10:22 but I do think in part,
10:24 we are doing a better job of being more aware
10:27 of our symptoms in our bodies, right?
10:30 And again, I think, I can't say this enough,
10:32 but preventative care is the best care
10:34 and being proactive about seeing your primary care
10:37 and reaching out to physicians
10:40 that could potentially intervene sooner rather than later,
10:42 I think is really important in the cancer world.
10:45 - Preventative care is the best care.
10:46 Obviously seeing your general practitioner
10:49 going for your well visits,
10:50 but is there anything else people should be doing
10:53 when it comes to eating, sleeping, exercising?
10:56 Obviously they should be doing all of the above,
10:58 but anything specific?
11:00 - Yeah, I mean, I think anything in life,
11:02 anything well-balanced, right?
11:04 I think a combination of healthy eating habits, exercise,
11:08 those are things that seem trivial and just sort of ordinary
11:12 but I do think that makes a big difference
11:15 both in, again, being healthy in general,
11:18 but trying to decrease some of those risk factors.
11:22 - Well, we've talked about symptoms,
11:26 causes, prevention, Dr. Reddy,
11:27 is there anything else we need to know
11:29 about this disease today as it trends
11:31 because of the news from Representative Lee?
11:34 - Yeah, and I think, you know,
11:35 the biggest thing I can say is
11:37 every patient starts with the same starting line
11:40 and it should be a situation where efforts put forth
11:44 in whatever way that we can.
11:46 And, you know, can we get people through treatment
11:49 into surgery following chemo?
11:50 Yes, we can.
11:51 But if we can't, is that a failure?
11:54 No, absolutely not
11:55 'cause there's treatment options available.
11:57 And if the best we can do is sort of control the process
11:59 and keep it at bay, we can do that.
12:01 But I think a true team is really sort of the,
12:06 one of the most important factors
12:07 for the patient in their journey.
12:08 And I can't stress that enough.
12:10 It's not just an individual treating the patient,
12:11 it's really a team.
12:12 - Dr. Reddy, thank you so much for your time today.
12:15 We really appreciate it.
12:16 - Thank you.
12:17 (silence)
12:19 (silence)
12:22 (silence)
12:24 [BLANK_AUDIO]