Pancreatic Cancer Q&A with Dr. Stauffer, Mayo Surgeon: May 29

Allow me to introduce you to Dr. John Stauffer, a hepatobiliary and pancreas surgical oncologist at Mayo Clinic in Florida, one of the country's highest-volume surgical programs for advanced pancreatic cancer.

On Thursday, May 29 from 1:30-2:30pm ET, Dr. Stauffer will host a Q&A about surgical management of pancreatic cancer.

After a pancreatic cancer diagnosis, many people have questions about treatment options, including surgical and nonsurgical approaches. You may also want to know how an integrated team – including surgical oncology, medical oncology, radiation oncology and gastroenterology specialists – works together to prevent further cancer complications and preserve your quality of life.

Please note that this hour-long Q&A is for informational purposes only, and any concerns you have should be addressed to your treating physician. If you would like to learn about pancreas cancer care at our integrated program in Florida, please visit this page for information.

Submit your questions in advance in the comments below and Dr. Stauffer will reply during the hour-long Q&A event. See you back here on May 29.

Go ahead, ask away!

Interested in more discussions like this? Go to the Pancreatic Cancer Support Group.

@mnewland99

Sorry, but I have another question, I had surgery (distal) in 2022 and liver lesion in 2023 that I got chemo for and then SBRT. 6 months after SBRT a new liver lesion, very small, occurred and my CA19-9 is about 284 now. My drs fear I might also have it elsewhere (abdominal, only) since they think my number is too high for just that one about 1.2cm. Would it be appropriate to do a ERCP to find other areas? My dr at HOPE in Irvine, CA says no, but I’m not sure about that, what’s your opinion?

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I recommend a high quality MRI which is the best modality (although also imperfect) to identify liver disease. While I agree that there is likely additional disease, close follow up while on systemic therapy is warranted and aggressive treatment of single isolated lesions can be justified if no further sites of disease are identified.

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@mnewland99

Hello Dr.,
What percentage of the time does chemo actually obliterate an existing tumor or lesion, rather than just shrink it? So many of us are told we are “cancer free”, only a few months later to be told a “new” tumor or lesion has been identified on a scan. It makes for quite a roller coaster ride on this disease. If you don’t have the BRCA related genes, then our recurrence for disease is very high and I wish (after having been in that situation for just about 3 years now) that drs would just stop with “cancer free” and at least order the CA19-9 every 2 weeks for patients during this period.

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Without surgical resection, the chances of chemotherapy causing a cure is around 1-2%. Surgery increases that chance to greater than 25%, maybe closer to 35-40% depending on the stage. If a definitive surgery is performed and the margins are negative and the surveillance scans are clean, we tell patients that they are "cancer free" and will do so until we have evidence to the contrary.

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We at Mayo Clinic Florida use IRE for unresectable PDAC in combination with systemic chemotherapy and radiation treatment. This modality is not widely used or have available trials due to the lack of efficacy against cancer when compared to standard treatment. It is employed occasionally for patients who are not candidates for standard treatment. IRE should only be used for patients that have no other options based on sound evidence, not for theoretical benefits touted by the manufacturer or those who stand to gain financially from its use.

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@colleenyoung

- A Study to Evaluate the NanoKnife SYstem for Stage 3 Pancreatic Cancer https://www.mayo.edu/research/clinical-trials/cls-20509963

Dr. Stauffer, what can you share with us about your study and use of nanoknife for the treatment of pancreatic cancer?

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Thank you, this study is ongoing, we are careful to use this modality. Intentionally when it makes sense but use discretion due to its limited efficacy.

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What is the mortality rate at Mayo for ire? How many do you perform a year? And the complete response rate? Thank you!

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Do you integrate holistic care if it is desired?

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@johnstauffermd

We at Mayo Clinic in Florida use IRE for unresectable PDAC in combination with systemic chemotherapy and radiation treatment. This modality is not widely used or have available trials due to the lack of efficacy against cancer when compared to standard treatment. It is employed occasionally for patients who are not candidates for standard treatment. IRE should only be used for patients that have no other options based on sound evidence, not for theoretical benefits touted by the manufacturer or those who stand to gain financially from its use.

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@utravelone8671, see Dr. Stauffer's answer to your question about Irreversible Electrporation here https://connect.mayoclinic.org/comment/1315824/

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@kjc12

Was wondering your thoughts/opinion on recent articles suggesting the use of Ivermectin and Fenbendazole in cancer therapy. Thank you for taking the time to respond to all our inquiries, much appreciated.

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@kjc12, you may find this article helpful.

- Separating fact from fiction: repurposed drugs in cancer treatment https://www.anticancerfund.org/en/blog/separating-fact-fiction-repurposed-drugs-cancer-treatment

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@mmaxfield

Do you integrate holistic care if it is desired?

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@mmaxfield, I can answer that question.

More and more cancer centers and oncology specialists are open to discussing and integrating complementary medicine in programs called Integrative Medicine or Integrative Oncology. Integrative medicince is offered at all Mayo Clinic locations.

Here's a link to more information about Mayo Clinic's Integrative Medicine programs
– Integrative Medicine and Health https://www.mayoclinic.org/departments-centers/integrative-medicine-health/sections/overview/ovc-20464567

In this Mayo Clinic Q & A Podcast. Dr. D'Andre talks about how integrative oncology can be incorporated into conventional cancer care at Mayo Clinic.

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@johnstauffermd

I have found PET to be imperfect when identifying recurrent cancer within the abdomen. There are many cases of nebulous results which can be due to inflammation, infection, or some other cause of hypermetabolism and not due to recurrent cancer. At MCF, we use very high-quality MRI to better detect whether there is recurrent PDAC or not but even then, it is not entirely accurate.

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So how does one know if it is cancer? A biopsy?

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