Nov. 25, 2019

This paid piece is sponsored by Avera.

Three years and counting. After a diagnosis of pancreatic cancer, this much lifespan is often not hoped for.

But for Dr. Richard Holm of Brookings, surgery and treatments have allowed him more years to spend with family, to continue taping his “On Call With the Prairie Doc” show on South Dakota Public Television and even to write a book about the end of life – “Life’s Final Season.”

November is Pancreatic Cancer Awareness Month.

Pancreatic cancer is a challenging diagnosis. Over 56,000 cases are diagnosed each year in the U.S., and incidence is increasing by 1 percent per year.

For all stages combined, the five-year survival rate is 9 percent, according to the American Cancer Society.

“While the statistics demonstrate the seriousness of this disease, treatments exist to prolong life and/or address symptoms so patients can enjoy a higher quality of life,” said Dr. Mark Huber, Avera Medical Group medical oncologist.

Holm was diagnosed at age 67 in October 2016 after experiencing belly pain and a yellowing of his skin.

“As a family physician, I tried to model healthy lifestyle – moving more, eating less and connecting with people more,” Holm said. “We thought at first it was gallbladder.”

During gallbladder surgery, however, pancreatic cancer was found, blocking his bile duct.

“I’ve had chemotherapy, radiation therapy and Whipple surgery,” Holm said. After lesions were found in his liver, he had liver resection surgery and is now trying an outside-the-box therapy – immunotherapy.

Pancreatic cancer usually progresses symptomless. When symptoms such as jaundice, abdominal pain, difficulty eating and weight loss do appear, the disease is often advanced.

Pancreatic cancer easily spreads because of the proximity to the stomach, small intestine, liver and major blood vessels, as well as the interaction between digestive organs. These are the reasons behind its poor prognosis, Huber said.

“However, for certain patients, surgery, chemotherapy or radiation may add years to their life and relieve pain or other symptoms.”

While not everyone is a candidate, surgery provides the best opportunity for remission or curative treatment, said Dr. Michael Person, a surgeon with the Surgical Institute who performs Whipple procedures at Avera McKennan Hospital & University Health Center – recognized as a high-volume center for the Whipple procedure.

Pancreatic tumors most often appear in the head of the pancreas. The Whipple procedure involves removal of the head of the pancreas, part of the stomach, the duodenum of the small intestine, a portion of the bile duct and the gallbladder.

Then, the remaining parts of these organs are reconnected to the small intestine. This procedure is needed rather than simply removing the affected part of the pancreas because of the involvement of the nearby organs, lymphatic system and major blood vessels, Person said.

Neuroendocrine pancreatic tumors are more likely to appear in the tail of the pancreas, and in those cases, the tail portion of the pancreas can be removed, with or without the spleen, Person said.

Unlike mammography for breast cancer or colonoscopy for colorectal cancer, no good overall screening tool exists for pancreatic cancer.

“Research is ongoing to find that screening tool, such as a test to find biomarkers in the blood,” Huber said.

You may be at greater risk of pancreatic cancer if you have longstanding diabetes, a history of chronic pancreatitis, a history of smoking, obesity or a diet high in red and processed meats.

Be sure to talk with your medical provider about any new symptoms such as abdominal pain, unexplained weight loss, loss of appetite, changes in the stool or a yellowing of the eyes or skin.

While Holm has sought out treatment to experience a longer life and higher quality of life, he recognizes the seriousness of his stage IV pancreatic cancer.

“For all of us, our lives are limited,” he said.

A diagnosis of cancer or other serious illness is an opportunity to rethink priorities.

“If this were the last day of my life, what would I do? Maybe I would savor every day a little more,” Holm said. “I’ve come to the conclusion that fearing death is dangerous to your health.”