Ronald Chamberlain, M.D., surgeon-in-chief and chairman of the Department of Surgery at Saint Barnabas Medical Center, doesn't sugar-coat what happened to Elizabeth Sprague of Maplewood: "She is that 'one in a million' who survives pancreatic cancer," he says.
This cancer is particularly deadly because there are no screening tests to find it early. By the time any symptoms show up, it has almost always spread to the lymph nodes and other areas of the gastrointestinal tract. The actual survival rate of patients with node-positive pancreatic cancer is about 5 percent, Dr. Chamberlain says. So while "one in a million" is a bit hyperbolic, five in 100 are still odds no one would bet on.
Yet the odds are improving, thanks to advances in surgical, chemotherapy and radiation treatments. And the future holds even more promise, with genetic testing that will be able to help oncologists target specific tumors with the treatments most likely to be successful.
Sprague, who was diagnosed in November 2007, didn't have those options yet. The retired airline employee, who will admit to being "over 39," and her husband, David, a retired engineer, have three grown children and eight grandchildren. While she was undergoing endoscopic testing for gastroesophageal reflux disease (GERD) and for noncancerous colon polyps, her physician noticed a small tumor on her pancreas. "He said, 'Do me a favor, please have another imaging test,'" Sprague says. "That one found cancer."
Her reaction, she admits, was a bit odd. "I went home and cleaned my closets," she recalls with a laugh. "That's how I dealt with it."
In truth, Sprague tackles most things with clear-headedness and humor. "I knew it was serious, but I didn't dwell on it," she says. "That wouldn't make it go away. I told my children that this was not a morbid situation; we just had to take care of it."
She was referred to Dr. Chamberlain. "I immediately felt comfortable with him," she says. "He calmly explained what he would do, and I said OK, let's go." He scheduled surgery for Jan. 3, 2008, because she wanted to wait until after the holidays.
Pancreatic cancer requires a difficult operation called the Whipple procedure. "It's very complex and involves removing parts of five different organs—the pancreas, small intestine, bile duct, gallbladder and stomach," Dr. Chamberlain says. Then the remaining pieces must be reconnected into a functioning system. "The operation used to take 20 hours, but now we can do it in about four," he says.
Dr. Chamberlain did not offer a prognosis, Sprague says. "But he did say to my husband, 'If I am out in 45 minutes, it isn't good. The longer I am in there, the better the situation," she says. "He didn't come out for quite a while, so that was promising."
Sprague spent about two weeks in the hospital. Recovery was not bad, she says. "I have a scar that is now disappearing, but I don't wear a bikini anyway, so it doesn't matter if it completely disappears." She has fond words for the staff at the hospital. "The attitude of the people I encountered in the cancer ward was extremely nice—not morbid, very pleasant and caring," she says. "They had someone come in and play the harp, and the first time I thought, 'Oh no, that's the music they play when you go to Never-Never Land!" she says with a chuckle. "But I found it very relaxing."
Chemotherapy and radiation followed, but Sprague suffered no side effects, thanks to improvements in the therapies. And now, "I feel great," Sprague says. "I am a very lucky person." Someone in her position today is luckier still, says Dr. Chamberlain. "Medicine is in the middle of a revolution, from disease specific care to patient-specific care," he explains. Until now everyone has been treated essentially the same way. "Now they are treated differently, based on genetic aspects of their particular tumor. Today I would send a tumor like hers for bio genomic profiling," he says. "That can tell us what drugs it might respond to and what drugs it might not." For example, African- Americans tend to respond poorly to a certain drug because they typically possess an enzyme, which Caucasians don't have, that breaks the drug down. "Other genes may reveal a certain growth factor, which would make a particular drug a great choice," he says. These changes are helping to push pancreatic cancer survival rates into the 15 to 30 percent range.
"That is by no stretch a home run, but it is a substantial improvement," says the doctor. Only a reliable screening test similar to colonoscopy or mammography will bring those numbers up to the levels now seen in other cancers, but that is still year's away, he cautions.
Until then, Sprague is helping others newly diagnosed with pancreatic cancer to prepare for the daunting road ahead. "She brings a tremendous ability to look at it in a positive light and has talked to or met with 30 to 40 different patients about the Whipple surgery," Dr. Chamberlain says. "She steps in and explains that it's not the 1960s anymore. It's 2013, and medicine is advancing."