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Pet Imaging Guides Treatment for Pancreatic Cancer Patients

Pancreatic cancer is the fourth leading cause of cancer death in the U.S. Each year, approximately 33,000 Americans develop cancer of the pancreas. If it is confined to the pancreas and hasn't spread to surrounding organs or lymph nodes, the cancer can sometimes be cured through surgery. But because it is difficult to diagnose, the disease is frequently undetected in its earliest stage, and has already spread, or metastasized, by the time it is diagnosed. Once pancreatic cancer has spread to the liver, median survival for patients is five to six months. At NewYork-Presbyterian/Columbia, new treatments developed in the laboratory have doubled this survival period in initial studies.

PET and fused PET/CT
Top (cross-sectional view): PET and fused PET/CT show a "hot spot" in the pancreas of a patient with obstructive jaundice. The kidneys also appear as hot spots because of their high metabolic activity, although they are not cancerous. Bottom (frontal view): PET and fused PET/CT show stents placed in the patient's bile ducts (to relieve the obstruction) and the tumor, with no evidence that it has spread beyond the pancreas.

The Columbia University Pancreas Center, nationally known for its superior surgical procedures, innovative chemotherapy treatment, and pioneering prevention program, routinely relies on PET imaging (positron emission tomography), to guide treatment decisions. For tracking pancreatic cancer and its metastases to other organs, say Columbia faculty, PET's sensitivity is often superior to any other type of imaging procedure.


Columbia's Robert Fine, MD, Herbert Irving Associate Professor of Medicine and Director of the Experimental Therapeutics Program, is an oncologist who works with the Pancreas Center to treat its patients. Dr. Fine says PET is able to identify changes that are not detectable with CT (computed tomography), the routine imaging method for observing tumors. While CT scans show anatomical structures including tumors, PET visualizes the chemical activity of cells (their metabolism). Cancer cells, which metabolize more sugars than normal cells, appear on a PET scan as bright "hot spots." Dr. Fine says that when chemotherapy has begun to work, the tumor does not physically shrink right away, and improvement cannot therefore be detected by a CT scan. "But PET can detect a response two or three months earlier than a CT scan, by indicating that the tumor's metabolic activity has been slowed by treatment, or that the tumor is dying or dead." The opposite is true as well, he says. "PET can detect relapse months before it appears on a CT scan."


Beth Schrope, MD, PhD, Assistant Professor of Surgery, who performs pancreatic surgery, also relies on PET in her treatment of pancreatic cancer. For many patients, she uses PET imaging post-operatively to find out if a pancreatic cancer has recurred, or if it has metastasized. "We first follow up surgery with periodic blood testing. If tumor markers are elevated in the tests, we move to imaging, including PET," she says. Any kind of previous surgery leaves behind scar and fibrosis that are difficult to distinguish from cancer with a CT scan, she says. "But unlike cancer, a scar is not metabolically active, so on a PET scan we can tell if it's cancer or not."

Dr. Schrope also uses PET to determine whether to operate or not. The presence of metastasis is a key factor in deciding whether a patient is a candidate for surgery. A dilated bile duct in the liver can look like a metastasis on a CT scan. "A dilated bile duct viewed on a PET scan won't light up, whereas a metastasis in the liver will," she says. If the cancer has metastasized to other organs, surgery is not indicated — surgical resection has not been shown to have a survival benefit under these circumstances. "Pancreas operations are complex, so we really want to make sure there's no metastasis before we operate," she says.

"PET/CT imaging is adding a new dimension to the care and treatment of patients with pancreatic cancer," says Ronald L. Van Heertum, MD, Professor of Radiology and Director, Columbia Kreitchman PET Center. "We are very pleased with the additional information that this technology offers our patients and physicians."

If you are a physician and would like to refer a patient for an oncology PET scan, please call the Columbia Kreitchman PET Center at 212.923.1555.

If you are a patient and would like to get a PET scan, please discuss a referral with your physician.


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