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Pancreatic Cancer Team

Pancreatic cancer is a devastating diagnosis that affects over 35,000 people in the United States each year.  Thankfully, recent advances and new treatment options for patients with the disease have led to a more promising outlook. The Gastrointestinal Cancers Program at Smilow Cancer Hospital offers patients easy access to specialized care for pancreatic cancer, including new approaches to the treatment of the disease. As a multispecialty program, we are dedicated to providing our patients with cutting-edge technology for the evaluation, diagnosis, and treatment of their pancreatic cancer.
 
Our program includes experts in diagnostic imaging, pathology, gastroenterology, surgical, medical, and radiation oncology, and cancer genetics.  Members of the team meet regularly to discuss every case and to develop a unique, comprehensive treatment plan for each patient, in consultation with the patient’s referring physician.
 
In addition to providing an expert approach to standard treatments, the Gastrointestinal Cancers Program offers innovative treatment options, including clinical trials for the treatment of advanced and metastatic pancreatic cancer and cutting-edge surgical techniques.
 
 
Diagnosing Pancreatic Cancer
Pancreatic cancer often causes symptoms such as abdominal pain, weight loss, and jaundice.  Newly onset diabetes and the presence of the BRCA1 or BRCA2 breast cancer gene have also been identified as risk factors for the disease.  If pancreatic cancer is suspected, patients may be referred for blood tests, a CT scan, and/or an endoscopic ultrasound (EUS) to diagnose their disease.  
 
Interventional Endoscopy/Gastroenterology
Yale gastroenterologists perform the most endoscopic ultrasounds in Connecticut and have dedicated expertise in evaluating the pancreas and performing fine needle aspiration (FNA) biopsies of pancreatic tumors.  The combination of EUS and FNA offers patients at Yale the state-of-the-art method of pancreatic biopsies with greater accuracy and lower risk of tumor spread than a biopsy through the skin.  The interventional endoscopy team also has expertise in the performance of ERCP, an endoscopic procedure that evaluates the pancreas and bile ducts. ERCP can also be used to alleviate jaundice by placing a stent in the bile duct or to eliminate a blockage of the intestinal tract using a stent in the small intestine.
 
Yale gastroenterologists are developing and utilizing the newest techniques in imaging of the bile and pancreas duct using small cameras (cholangioscopy), some of which can give cellular level views providing a “virtual biopsy.” Pain resulting from pancreatic cancer can also be improved with the performance of EUS-guided blocking of the nerves that transmit pain (celiac plexus neurolysis).
 
Following a biopsy procedure, Yale Cytopathology provides skilled evaluation of pancreatic tissue biopsies to determine if a tumor exists, the type of tumor present, and to assist in the staging of the disease in conjunction with the findings of specialized CT scans and EUS.  Yale’s expert cytologists are present at the time of EUS-guided biopsies to ensure that optimal tissue sampling is achieved. 
 
Surgical Oncology
Smilow Cancer Hospital is a regional referral center for patients in need of surgery for pancreatic cancer.  Several operative procedures exist and the choice of surgery is tailored to the individual patient after reviewing the details of the tumor. The Whipple procedure is the most frequent operation and is used for tumors in the pancreatic head. Distal pancreatectomy, often done laparoscopically, is used for tumors of the pancreatic body and tail, and rarely, there is a need for a total pancreatectomy. Our surgeons have in excess of 30 years of experience in pancreatic surgery and are the highest volume center for pancreatic surgery in Connecticut, performing approximately 100 pancreatic resections each year. Current operative techniques and careful attention to the postoperative management in and outside of the hospital optimizes the opportunity for our patient’s complete recovery. 
 
Medical Oncology
Chemotherapy is often recommended following surgical removal of a pancreatic tumor to prevent the disease from returning or to delay its return.  Chemotherapy is also prescribed to treat patients with advanced or metastatic disease.  Yale Cancer Center oncologists provide experience and knowledge of innovative treatment options and investigational therapies for pancreatic cancer. 
 
Yale Cancer Center is a major national research center for the development of novel therapies for late stage pancreatic cancer and provides our patients with access to the newest therapies available.  Our medical oncologists are also searching for novel combinations of chemotherapy and targeted therapies to further improve the treatment of pancreatic cancer.
 
Radiation Oncology
Radiation therapy is often used to treat patients who are not eligible for surgery or to shrink the pancreatic tumor prior to surgery in combination with chemotherapy.  Three-dimensional conformal radiation delivery techniques and four-dimensional CT simulation are used to decrease toxicity while improving tumor targeting.  Stereotactic body radiotherapy is also available.  Patients who are cared for through the Yale Cancer Center Gastrointestinal Cancers Program and need radiation oncology as a component of their prescribed treatment can feel confident that they are receiving the highest quality care from the most experienced team of radiation oncologists in Connecticut.
 
Pancreatic Cancer Research
Yale Cancer Center emphasizes the importance of clinical trials and continually strives to provide our patients with the most current therapies to treat pancreatic cancer.  In close collaboration with basic scientists, clinical research is focused on developing innovative strategies to help eliminate, control, and palliate pancreatic tumors in patients. Clinical trial participation is offered for treatment of advanced stage and metastatic pancreatic cancer using chemotherapy and other novel therapies for the disease. Many of these drugs are exploring new types of therapy that are not currently offered in the community.

Patient Support Services
Yale Cancer Center places great emphasis on taking care of all of our patients’ needs with the best medical care available and a network of supportive care services. Advanced practice nurses with dedicated knowledge and skills related to the treatment of pancreatic cancer are available to care for patients through the continuum of their illness.  Patients and their families are also provided with access to social workers to ensure psychosocial support during their treatment.  Other available resources for our patients and/or families include nutritional counseling, physical therapy, art therapy, and pastoral support.   
 
Appointment Information
The Yale Cancer Center Gastrointestinal Cancers Program provides efficient appointments, rapid diagnosis and treatment, and access to the most up-to-date technology and research protocols.  Most importantly, patients receive personal, friendly, confidential care that is designed to meet the needs of the whole patient, not just the disease.  A patient care coordinator helps to arrange appointments so that patients can be evaluated expeditiously by the most appropriate specialists.
 
Before your first visit, our team will need to review all available physician’s referral and office notes, results of diagnostic imaging studies, pathology reports and slides, and the results of any other pertinent tests or consultations. The patient care coordinators at Yale Cancer Center will be glad to help patients organize this so the physicians will have everything needed to ensure efficient and prompt management of their medical care.  Please call our intake coordinators at (203) 200-4422 for assistance.

Team Members:
 
Interventional Endoscopy Program
·          Harry Aslanian, MD
·          Priya Jamidar, MD
·          Uzma Siddiqui, MD
 
Medical Oncology
·          Howard Hochster, MD
·          Stacey Stein, MD
 
Surgical Oncology
·          Ronald Salem, MD
 
Therapeutic Radiology
·          Bryan Chang, MD
 
Pathology
·          Marie Robert, MD
·          Dhanpat Jain, MD
 
Cytopathology
·          David Chhieng, MD
·          Guoping Cai, MD
 
Cancer Genetics
·          Ellen Matloff, MS