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You might say that cancer runs in my family, but not with what I¡¯d call any consistency. There¡¯s been a random case of bladder cancer here,?colon cancer there, or melanoma somewhere else. But overall, my extended family has been pretty healthy. So, I was surprised to be diagnosed with pancreatic cancer in 2017.

I went to MD Anderson for my treatment at the recommendation of one of my office staff. Her son-in-law did a fellowship there under , a surgical oncologist who specializes in gastrointestinal tumors.

My pancreatic cancer treatment was really tough. But I¡¯m cancer-free today. I¡¯m feeling good and back to ranching full-time. If I hadn¡¯t gone to MD Anderson, I wouldn¡¯t be here today. So, if I had to do it all over again, I would.

My pancreatic cancer symptoms

I¡¯ve had problems with ulcers and irritable bowel syndrome for most of my adult life. So, I initially chalked up the abdominal pain I felt for a couple of weeks before my diagnosis to one of those. Then, my doctor prescribed an antibiotic, and I had what I thought was an allergic reaction to it. I started itching all over real bad.?

My wife was putting calamine lotion on my back to soothe the itching one day when she noticed that my skin was turning yellow. I called the doctor. He told me I must have a blockage somewhere and to be there in an hour. Scans revealed a tumor on my pancreas. It was about the size of a man¡¯s thumbnail and looked like a tiny soda can.

My doctor said that pancreatic tumors were rarely benign, but that I might be a candidate for surgery since the tumor was fairly small and didn¡¯t appear to be attached to any blood vessels. I just needed to go someplace with experts who could treat it properly.

My wife and I called MD Anderson and made an appointment.

My pancreatic cancer treatment

At MD Anderson, I had a stent endoscopically installed to unblock my bile duct. The tumor happened to be sitting on it, which caused my symptoms to show up early. Pancreatic cancer doesn¡¯t usually cause symptoms in its early stages. So, to that extent, I guess, I kind of lucked out.

Once I had the stent installed, I started chemotherapy to shrink the tumor under the supervision of gastrointestinal oncology specialist , then had a Whipple procedure under Dr. Tzeng to remove it. Afterward, I had more chemotherapy to kill any potential microscopic cancer cells that might still be floating around, undetected by scans.

I trusted Dr. Tzeng, but I was really worried about the Whipple procedure. My late grandfather had had his stomach removed at another hospital years before and barely survived the operation. I¡¯d heard family stories for years about how hard that experience was for him and how much it changed his life for the worse. I knew my only chance at survival was to have the surgery, but it still took everything I had to go through with it.

The hardest parts of my pancreatic cancer treatment

Dr. Tzeng performed my Whipple procedure on Oct. 9, 2017. It took me quite a while to start feeling normal again afterward. Even now, my digestive system can be fickle. But I¡¯m adapting, and I can eat about anything I want to in moderation. Now, instead of having one or two bad days a week, I¡¯ll only have them about once every six months, which is probably no different from a person who hasn¡¯t had intestinal surgery.

Chemotherapy turned out to be the hardest part of my cancer treatment. I was so sick that some days I couldn¡¯t get out of bed until 3 p.m. Even then, I¡¯d just lie there on the couch and breathe. I was too sick to do anything else, even watch TV. I came close to wanting to give up. But then I¡¯d think, ¡°What if the next round is the one that cures me?¡± So, I¡¯d gather my strength and go back for another.

Hold onto hope

Nobody knows how you¡¯re going to respond to cancer treatment, or what¡¯s going to happen to you in the end. The main thing is not to give up hope. It¡¯s easy to feel low when the whole thing starts. You find out you¡¯re sick, and the news always seems to be bad.?

But today, I¡¯m 69 and back to managing our ranch full-time. We have about 400 head of cattle now. We also have two grandkids, both born after my diagnosis. That¡¯s way cool. It took about three years, but now I¡¯m not just alive, but living.

I always wanted a custom-made saddle, but never felt like I could afford it. Then, a few months before my cancer diagnosis, I had a little extra money in my pocket from a business I¡¯d sold. I decided to splurge and ordered one built. Then I found out I had cancer, and I thought, ¡°I¡¯ll never get a chance to use it.¡±

Today, that saddle has a lot of wear on it. And two years ago, I took out a 20-year mortgage to buy another piece of land. That¡¯s not something I ever thought I¡¯d do again. So, hold on to hope. It¡¯s out there.

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The most common symptoms of pancreatic cancer are pain in your abdomen or back, weight loss and jaundice.??

But these issues can also be caused by other conditions, such as gallstones, hepatitis or even heavy drinking. So, when should you see a doctor about them??

¡°Most people with abdominal pain won¡¯t have pancreatic cancer,¡± says pancreatic cancer surgeon ¡°But any pain that persists beyond a couple of weeks should still get checked out. And, if you¡¯re experiencing rapid weight loss without trying, you should mention it to your doctor as soon as you notice it. Anyone whose skin or eyes turn yellow should be evaluated immediately.¡±?

Here¡¯s how some patients knew they had pancreatic cancer, in their own words.??

Abdominal pain that radiates to your back?

¡°I had a little dull pain start just below my left breast in September of 2016,¡± adds Reneata Benjamin, a retired elementary school librarian who was 53 when she was diagnosed with stage III pancreatic cancer. ¡°I was rubbing it so much that people started asking me what was wrong. Finally, my daughter told me I needed to see a doctor because it just kept getting worse.¡±?

Sometimes, the combination of back and abdominal pain can make pancreatic cancer patients feel like there¡¯s a belt of pain wrapped around their middle. ¡°The classic presentation is to have abdominal pain that radiates to the back,¡± explains Katz.?

Jaundice?

Jaundice, or yellowing of the skin or eyes, is another telltale sign of pancreatic cancer.?

¡°My wife noticed my skin turning yellow while putting calamine lotion on my back to soothe some itching,¡± remembers Steven Adami, a Wyoming rancher who was 62 when he was diagnosed with stage II pancreatic cancer. ¡°I called the doctor, and he was so concerned that he told me to be at his office in an hour.¡±?

Unexplained weight loss?

Unintentional weight loss is a common symptom of many gastrointestinal cancers, including pancreatic cancer.?

This weight loss could be due to:?

• inflammatory proteins secreted by the cancer?
• jaundice, pain or other symptoms?
• physical obstructions in the gastrointestinal tract??

All of these can limit a person¡¯s appetite and ability to get enough nourishment.?

If you experience rapid, unintentional weight loss, it¡¯s important to tell your doctor. So, what counts as rapid weight loss???

¡°Losing 5% or more of your body weight in a month would be very concerning,¡± says Katz. ¡°But losing anything over 10 pounds, even if it¡¯s over an extended period, such as 3 to 6 months, should be investigated if it can¡¯t be explained by a change in diet, activity level or medications.¡±?

Don¡¯t dismiss non-specific symptoms?

Other symptoms of pancreatic cancer include:?

• Dark urine or light-colored stools?
• Bloating, or a feeling of fullness?
• Nausea, vomiting or indigestion?
• Fatigue?
• Lack of appetite?
• Sudden-onset diabetes?

Unfortunately, pancreatic cancer doesn¡¯t often produce symptoms in its earliest stages. So, by the time they start appearing, the disease is often advanced, when it¡¯s harder to treat. That¡¯s why Katz says you shouldn¡¯t dismiss even vague symptoms.??

¡°I can¡¯t tell you the number of patients I¡¯ve seen who had aches and pains or diarrhea for months and just didn¡¯t think it was worth mentioning to their doctor,¡± Katz says. ¡°Don¡¯t dismiss these symptoms, particularly if they¡¯re persistent or in the elderly. While they may turn out to be caused by something other than pancreatic cancer, they¡¯re worth evaluating.¡±?

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Helene Andrews-Polymenis finds hope in cancer research.

Like many cancer survivors, she often feels some anxiety when she thinks about the future. Her diagnosis, pancreatic ductal adenocarcinoma, is difficult to treat, and while Helene currently shows no evidence of disease, she worries about the possibility of another recurrence.

But she finds peace in the idea that right now scientists, physicians and other researchers are working together to develop new treatments ¨C ones that could even double her life expectancy.

¡°We¡¯re at such a watershed moment,¡± she says. ¡°It¡¯s really kind of amazing what could happen.¡±

Preventing pancreatic cancer recurrence with PARP inhibitors

Recent treatment advances have given Helene more than four years since she was diagnosed with pancreatic cancer.

¡°I wouldn¡¯t be alive today if it wasn¡¯t for PARP inhibitors,¡± she says.

PARP inhibitors are a type of targeted therapy commonly used to treat breast and ovarian cancers. But in some cases, like Helene¡¯s, they¡¯re used to treat pancreatic cancer, too. They work by blocking DNA repair, killing cancer cells, and keeping the cancer from spreading. They¡¯re known to treat cancers caused by the BRCA 1 and 2 genetic mutation, but scientists have found that they could also have some potential in treating cancers impacted by another mutation: RAD51D. Genetic testing showed that Helene had this specific mutation, and she began PARP inhibitors to help keep her cancer from recurring in April 2022.

¡°I¡¯m hopeful because two years ago there were only a handful of PARP inhibitors,¡± she says. ¡°Now there are others in development, plus other drugs, vaccines and new clinical trials that could benefit pancreatic cancer patients.¡±

Undergoing pancreatic cancer treatment

Helene¡¯s career and background have given her a deeper understanding of her treatment and the research that helped develop it. A microbiologist and veterinarian by training, she researches infectious diseases at the intersection of animal, human and public health.

¡°Being a scientist is kind of a double-edged sword,¡± she says. ¡°Sometimes, it¡¯s hard to know a lot, but it gives me tools to help better understand my own disease, and I¡¯m not afraid to ask my doctors and others in the field questions.¡±?

Helene was first diagnosed in May 2019. She had been experiencing abdominal pain and fatigue, when routine blood work showed that something was off. Her hometown doctors thought it might be a gallbladder problem, and Helene began to prepare for surgery to have her gallbladder removed. But when a pre-surgery ultrasound showed a mass, Helene knew something else was wrong. She needed a CT scan that day. It revealed a 4 cm mass. While no one used the word ¡°cancer,¡± Helene knew there was little else it could be.

After starting chemotherapy, Helene came to MD Anderson, about 90 minutes from her home in College Station, to discuss a complex surgery called a Whipple procedure with

After successful chemotherapy, Helene underwent five weeks of radiation therapy at MD Anderson. At that point, she was ready for a Whipple procedure. During this long and complex surgery used to treat pancreatic cancer in some patients, the pancreas, distal bile duct, gallbladder regional lymph nodes and the duodenum ¡ª a part of the small intestine that connects to the stomach ¡ª are removed.

But when Helene woke up from her procedure after just a few hours, she knew something was wrong. Katz explained that early in the surgery, he spotted a metastasis on Helene¡¯s liver that wasn¡¯t detected by prior scans. It made it impossible to perform the Whipple successfully. She and Katz shared their complete and utter disappointment. But they agreed on a path forward: more chemotherapy with the potential to try the Whipple procedure again.

From April to October, Helene underwent more chemotherapy. The cancer responded well, and she was able to undergo a successful Whipple procedure in November. She spent a few days in the hospital and was grateful for the care and comfort she received from her care team, including advance practice registered nurse Morgan Bruno, advance practice provider Justin Folloder and Katz before recovering at home. With the Whipple behind her, she resumed chemotherapy, with routine scans every three months.

Helene was able to take a few months off from treatment, but in August 2021, her scans showed a liver metastasis. This time, she had a biopsy followed by stereotactic body radiation therapy (SBRT), and additional chemotherapy. Genetic testing revealed a mutation in a gene called Rad51D, which made Helene ?a strong candidate for PARP inhibitor treatment. She started this treatment in April 2022, and continues it today.

The future of pancreatic cancer treatment

Helene isn¡¯t sure what the future holds. She knows the cancer could come back again someday, and she¡¯s counting on researchers to develop new treatments to help her live a longer, healthier life. She finds comfort in knowing that MD Anderson is a leader in cancer research.

As a researcher and a patient, Helene has connected with several MD Anderson researchers through social media, including .; .; and These friendships and contacts have given her unique insights into the research community at MD Anderson. She knows that at MD Anderson clinicians work hand-in-hand with scientists to seamlessly bring new treatments from the lab straight to the clinic and back to the lab for more improvements.

In the past year, more than 9,000 patients were enrolled in over 1,500 clinical trials, and MD Anderson contributed to the development of nearly 60% of cancer drugs approved by the Food and Drug Administration (FDA) last year.??

¡°The great thing about MD Anderson is it¡¯s a site for so much research and so many cutting-edge trials,¡± she says. ¡°I feel really fortunate to be close to that.¡±

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When retired geologist and author David Allard was diagnosed with stage IV pancreatic cancer in August 2020, his local doctor told him he had less than six months to live.???

¡°I was only 62 at the time,¡± David recalls. ¡°I hadn¡¯t had any symptoms. And I¡¯d always been very fit and active. So, I couldn¡¯t accept that prognosis.¡±??

The Texas Hill Country resident sought a second opinion at MD Anderson. Gastroenterologist ; gastrointestinal medical oncologist ; and gastrointestinal radiation oncologist devised a treatment protocol. But some unchecked internal bleeding threatened to derail the whole plan.???

That¡¯s when they referred David to interventional radiologist And that¡¯s why David is still here, five years later.?

Unconventional problem calls for unconventional solution?

David¡¯s internal bleeding was due to a condition called portal and splenic vein thrombosis, blood clots in the main vessels that carry blood from the intestines to the liver. In David¡¯s case, they were caused by a lime-sized pancreatic tumor pressing up against both of those veins. That, in turn, was causing varices to develop in his stomach. They were under so much pressure, they¡¯d begun to bleed. ??

As with all deep-tissue blood clots, David¡¯s thrombosis was potentially fatal on its own. But it also posed a serious roadblock to his healing.?

¡°David¡¯s internal bleeding was unresponsive to any conventional treatments, such as endoscopic cauterization,¡± explains Habibollahi. ¡°He was also losing so much blood that it was becoming life-threatening. As a result, David was unable to continue receiving cancer therapy.¡±?

Shunt installed during complex surgery still working, five years later??

To resolve the problem, Habibollahi proposed a pair of procedures:???

1. An image-guided recanalization of the portal and splenic veins???
2. A trans-jugular intrahepatic portosystemic shunt, also known as ¡°TIPS¡±???

The first procedure would create a new pathway for blood to flow through and decompress the varices that were bleeding. The second would protect the new connection with a shunt to ensure it remained open and functional. ??

¡°Dr. Habibollahi said he couldn¡¯t guarantee it would work, but there was a pretty good chance that it would,¡± David recalls. ¡°He had done this surgery about 20 times before, and was successful in 75% of those cases.¡±?

David decided to take a chance. He had the complex, eight-hour surgery on Dec. 7, 2020, and stayed in the hospital for five days to recover.?

¡°I¡¯m really grateful that Dr. Habibollahi didn¡¯t give up,¡± adds David. ¡°He ran into a few snags during the procedure, but he kept trying, using an incredibly tiny tool set to do all this intravenously. The shunt is still there and working well. My blood counts are nearly normal.¡±?

Successful surgery means cancer treatment can continue?

Once it was clear the surgery had been successful, David was able to resume his cancer treatments. In all, he had 17 rounds of intravenous chemotherapy under gastrointestinal medical oncologist Shubham Pant, M.D., followed by three weeks of radiation therapy at the recommendation of radiation oncologist Eugene Koay, M.D.??

After his last radiation treatment in July 2021, David started taking an oral chemotherapy agent called capecitabine. He¡¯s been on that drug ever since for maintenance. He shows no evidence of disease.?

¡°Most people die within a year of my diagnosis,¡± says David. ¡°But scans show there¡¯s nothing but scar tissue left now where the tumor once was. That¡¯s why you can¡¯t just accept the first thing you¡¯re told. Dr. Habibollahi performed a surgery on me that¡¯s not done just anywhere. MD Anderson saved my life.¡±?

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