Pancreatic Disease Program Tackles Tough Tumor
October 15, 2015
By Emily Turk
Last spring, when 58-year-old Kathy Rusenko began having digestive problems, she thought her discomfort was just the result of a bothersome gallbladder. But when her symptoms persisted, she saw a local gastroenterologist who ordered an imaging test.
The result was inconclusive, but Kathy and her husband, Jack, wisely continued to pursue the problem. Her doctor ordered a second MRI, which revealed the frightening diagnosis: pancreatic cancer. A tumor was partially blocking the bile duct that branched out from the pancreas. By then, her skin had the yellow cast of jaundice, and tests indicated elevated tumor markers in her blood.
Her doctor performed a procedure to open up the duct—and immediately referred her to MedStar Georgetown University Hospital.
By July, Kathy’s treatment was in the able hands of experts at the unique Pancreatic Disease Program at MedStar Georgetown. This multidisciplinary team of physicians has special training and years of experience treating patients with pancreatic diseases, including cancer. Their level of expertise is unmatched in the region—offering hope to patients with often difficult-to-treat pancreatic tumors.
“Mrs. Rusenko met with each of us,” explains oncologist Brandon Smaglo, MD. The team, which also included surgeon Lynt Johnson, MD, and radiation oncologist Keith Unger, MD, worked in tandem to evaluate her condition. “Together, we made recommendations for next steps. It’s a collaborative approach to care that helps increase the chance for a good result,” says Dr. Smaglo.
Many patients with pancreatic cancer are diagnosed in the late stages of the disease when it has already spread to other organs. “It is often too late for surgery, and this cancer doesn’t respond as well to treatment as other tumors do,” says Dr. Smaglo. “It’s very aggressive.”
Beating the Odds
“Only ten percent of patients with pancreatic tumors are candidates for surgery,” Dr. Johnson explains. “And of these people, an even smaller number have good results.” Kathy was one of the lucky few. Dr. Johnson believed he could remove the tumor surgically. But when he performed an initial exploratory procedure, a complication was revealed. The tumor had wrapped itself around a blood vessel, and removing it could prove dangerous.
“We regrouped,” says Dr. Smaglo. “We knew that, to ensure the best result for Mrs. Rusenko, we needed to take another approach.”
Taking the path less followed—and more tailored to each individual—is the future of cancer treatment. “At MedStar Georgetown, because we have so much experience treating this type of cancer, we feel confident about tailoring treatment protocols and trying newer therapies to improve results for our patients,” says Dr. Unger.
The group’s recommendation was a rare approach to the treatment of pancreatic cancer: neoadjuvant therapy (treatment given as a first step before main treatment). They would use chemotherapy and radiation before surgery to shrink the tumor to a manageable size for removal.
It was an unexpected turn of events, but Kathy and Jack Rusenko stayed positive. “My strong faith in God, prayers from friends around the world, and my family saw me through,” says Kathy.
Kathy began a rigorous schedule of chemotherapy and radiation. “The chemotherapy helps to provide systemic control of the cancer,” explains Dr. Smaglo.
On an alternate week, Kathy underwent CyberKnife therapy, which targets radiation directly at the tumor. “The technique, which we have perfected at MedStar Georgetown, allows us to use higher doses for a shorter period of time, while sparing surrounding tissue,” explains Dr. Unger.
“By December, the tumor had shrunk dramatically, and her tumor markers had improved significantly,” Dr. Johnson says. Surgery was the logical next step in Kathy’s months-long treatment process.
Crazy Good Results
During a six-hour surgery, known as the Whipple procedure, Dr. Johnson removed part of Rusenko’s pancreas, the first portion of her small bowel, the bile duct and her gallbladder—then reconnected them.
Following surgery, the tissue removed by Dr. Johnson was examined by a pathologist. The startling result? No evidence of cancer.
“Immediately after the procedure, Dr. Johnson told me that he couldn’t guarantee anything,” says Kathy. “Later, during the first follow-up appointment, I could tell he was excited. Then he said, ‘The results are crazy good!’”
Months later, Kathy’s life has returned to normal. She has completed a round of oral chemotherapy, and additional follow-up imaging shows no evidence of a tumor.
“I can’t praise the doctors, the technicians and the whole medical team enough,” says Kathy. “They were patient with me and Jack, explained everything, every step of the way. What can I say? God—and the doctors at MedStar Georgetown—are an unbeatable team!”
Recognized for Expertise in Treatment of Pancreatic Diseases
By Marianne Worley
One of 30 centers in the United States and the only facility in the Washington, D.C. area, MedStar Georgetown University Hospital has been recognized for the care of people with pancreatic diseases by the National Pancreas Foundation (NPF).
The NPF is a non-profit organization that awards the designation after rigorous review, recognizing multidisciplinary treatment of the whole person with a focus on the best outcomes and quality of life.
“We are honored to receive the NPF designation,” says Nadim Haddad, MD, chief of Gastroenterology at MedStar Georgetown. “Patients with pancreatic diseases often present with complicated symptoms that require a high level of expertise to correctly diagnose and treat. In addition to meeting clinical and patient experience criteria, designated centers also seek to advance research and raise awareness of pancreatitis and related conditions among community physicians, allied health professionals, patients, families and the general public.
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