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Neuroendocrine Pancreatic Tumor Treatment Options duration 6 minutes 31 seconds Neuroendocrine Pancreatic Tumor Treatment Options Neuroendocrine Pancreatic Tumor Treatment Options	Neuroendocrine Pancreatic Tumor Treatment Options Neuroendocrine pancreatic tumors are dangerous because they might be potentially cancerous but can go relatively unnoticed for a long period of time. Dr. Tom Miller speaks with pancreatic transplant… u0035500 u0983801 pancreas transplant pancreatic cancer pancreas oncology From Interactive Marketing & Web 53 plays 0 Date Recorded February 23, 2016 Health Topics (The Scope Radio) Cancer Transcription Dr. Miller: Surgical treatments for uncommon pancreatic cancers. We're going to talk about that next on Scope Radio. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Dr. Miller: I'm here with Dr. Thomas Chaly. He's a pancreatic transplant surgeon, and we're going to talk about other kinds of pancreatic cancers. I think most people, Thomas, are used to knowing about the standard pancreatic cancer, but what we treat here at the University of Utah are more rare types of cancer called neuroendocrine tumors of the pancreas. Can you talk about that a little bit? Dr. Chaly: Pancreatic neuroendocrine tumors are a rare tumor, like you stated, representing approximately 5% of all tumors of the pancreas. Dr. Miller: Not common. Dr. Chaly: Not very common at all. They can be described as in two ways, nonfunctional versus functional, functional being quite more common than the other. The spectrum of these tumors range from insulinomas, glucagonomas, VIPomas. These may just sound like large terms, but basically my point to get across is these are hormone-producing tumors. Dr. Miller: So tell me what an insulinoma does. Dr. Chaly: An insulinoma is a tumor that's secreting insulin from the pancreas. Dr. Miller: That's where insulin is made anyway, right? Dr. Chaly: Correct. Dr. Miller: Okay. So if you have diabetes, your insulin-producing cells of the pancreas aren't producing enough, but in this case, too much. Dr. Chaly: Right. They're overproduced and then they're secreted based on the tumor so it's uncontrolled. It's an uncontrolled tumor secreting insulin in extreme amounts. Dr. Miller: And then there are other types of neuroendocrine tumors. Dr. Chaly: Correct. Like glucagonomas, which are increasing the amount of glucose you have in your body in extreme amounts. Dr. Miller: Almost the opposite of what the insulinoma does. Dr. Chaly: Exactly. In addition to that, there's also something that's more common on the spectrum, which would be a gastronoma. Dr. Miller: Would you think that these neuroendocrine tumors are as dangerous as pancreatic cancer as we commonly know it? Dr. Chaly: I would say they're dangerous in the fact that they act like ninja tumors, as I like to call them. Dr. Miller: That's interesting. What is a ninja tumor? Dr. Chaly: Well, tumors of the pancreas, I would say, can go relatively unnoticed for a longer period of time, kind of like a ninja. Now, maybe that's just kind of a term that's a little too broad, but I would say that these tumors are dangerous in that aspect, that they go unnoticed for long periods of time. Dr. Miller: So they're small. They may not produce much in the way of hormones. People don't notice them, and then later on as they get bigger and produce more hormones, all of a sudden they develop symptoms. Dr. Chaly: Right. And then at that point, that's when the diagnosis may in some cases be too late. But in other instances, this is just the tip of the iceberg of all their symptoms. Dr. Miller: One question I have is, are neuroendocrine tumors generally malignant in the sense that they can metastasize or not? Dr. Chaly: So that's an excellent question, and the answer is 50/50. Most are benign, but some are malignant and in some cases they can metastasize to the liver, which can be very scary to the patient themselves. Dr. Miller: So to point out to the audience, even though they're benign they still produce hormones like insulin or glucagon and that causes abnormal symptoms in the patient and then has to be treated. So generally, even though they're benign, if they're functional they are taken out or treated. Dr. Chaly: Right. So there are multiple treatment options, obviously surgical resection being one of the first and foremost. But in addition, there are other palliative measures as well that can temporize the hormone production of all of these tumors. Dr. Miller: Now, Dr. Chaly, when do you get involved? Are you getting involved when these are malignant and their metastatic? Dr. Chaly: Well, at this point our division gets involved when these lesions are metastatic to the liver. This indicates what we would call an expanded disease at this point, where they've gone beyond the lymph nodes and beyond the primary tumor sites, and have gone to areas in the liver where maybe not all practitioners are familiar with. Dr. Miller: Now, that's concerning because when we think about metastatic disease, we think about terminal disease. But you're also saying, maybe not. Maybe we have treatment for that. Dr. Chaly: Right. There are excellent results here at The U in regards to neuroendocrine tumor resection, in regards to debulking of these tumors, and it has been well-described that these tumors, if debulked and surgically managed, can be beneficial to the patient long-term. Dr. Miller: Debulking; could you describe that term for them? Dr. Chaly: It's basically an 80% reduction in the amount of tumor that's in the liver. If you're able to attain an 80% reduction in metastatic volume of the liver, essentially a metastasectomy of the liver, then you are doing a quite significant benefit to the patient's long-term survival. Dr. Miller: Now, if you leave some of that cancerous tissue in, do you have to go back in later and do another resection? Dr. Chaly: That's a possibility as well if it continues to grow. Another modality that can be used is interventional radiology and radio frequency ablation, essentially just burning the areas of the liver that would have remnant tumor in certain areas. Dr. Miller: Now, how do patients with these neuroendocrine tumors, especially ones that are metastatic to liver, find their way to your door? Dr. Chaly: Well, it's usually a situation where a patient had a primary tumor of the pancreas and it was found to be a neuroendocrine tumor. Then, they were later diagnosed, maybe a year or two later, sometimes less, where they had tumors now in the liver. The original physician maybe thought that a more experienced liver surgeon may have some other modalities that weren't available to him at his initial encounter. Dr. Miller: Now, I'm curious as to how many of these patients you see a year. Dr. Chaly: We see quite a number of patients a year. I would say we see close to 100 patients who need liver resections in some capacity. Maybe approximately 20% of those are pancreatic neuroendocrine tumors or neuroendocrine tumors that have metastasized to the liver. Dr. Miller: Now, I'm thinking that since these are pretty rare pancreatic tumors, patients are coming to see you from all over the place, probably from outside the state, elsewhere. Is that true? Dr. Chaly: Correct. We're getting patients from all over the surrounding states. They come concerned because of these liver metastases and what we're able to offer them. I would tell that it's not a death sentence by any means. Neuroendocrine tumors that have metastasized to the liver can be treated in a variety of ways. In addition to those that I've mentioned, surgical resection and burning them, liver transplantation is also an option in selective cases. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.
Whole Organ Transplant for Pancreatic Cancer… duration 3 minutes 23 seconds Whole Organ Transplant for Pancreatic Cancer… Whole Organ Transplant for Pancreatic Cancer Treatment	Whole Organ Transplant for Pancreatic Cancer Treatment There are many treatment options for pancreatic cancer—from resection to radiology to surgical de-bulking. But for some rare types of cancer, like neuroendocrine tumors of the pancreas, more… u0983801 u0035500 pancreatic cancer pancreas transplant pancreas oncology surgery From Interactive Marketing & Web 305 plays 0 Date Recorded February 23, 2016 Health Topics (The Scope Radio) Cancer Transcription Dr. Miller: Pancreatic neuroendocrine tumors and hepatic transplants. We're going to talk about that next on Scope Radio. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here for Scope Radio with Dr. Thomas Chaly from the Department of Surgery. Thomas is a transplant surgeon and he also specializes in metastatic neuroendocrine pancreatic cancers. These are rare cancers, Tom, as we've talked about in a previous session and my understanding is that in certain cases one might transplant the liver in order to cure a metastatic neuroendocrine tumor of the pancreas. Dr. Chaly: That's correct. So in instances where resection or interventional radiologic methods are not applicable to certain patients, University of Utah has shown excellent results in transplanting, in whole liver transplantation of these patients, and with a great long-term survival. Dr. Miller: Would you initially debulk the tumor in the liver, or would you decide to go straight to hepatic transplant? Dr. Chaly: That's an excellent question. Debulking is one of the primary modalities, and if we could debulk the tumor safely, leaving enough liver remnant, we would do that. But in instances where debulking wouldn't provide a benefit to the patient, transplantation is the next best option. Dr. Miller: Do you debulk first and then in some cases transplant later, or is that generally not done? Dr. Chaly: No, that is done. Debulking can offer a temporary solution of patient symptoms, and if this is not successful and there's a recurrence in the immediate post-operative period, approximately six months, we may consider transplantation at that point. Dr. Miller: Now perhaps for the audience we should distinguish this from regular or more common pancreatic cancer. You would not debulk or transplant a patient with what we know as common pancreatic cancer. Dr. Chaly: That is correct. Pancreatic cancer, or pancreatic adenocarcinoma, is extremely aggressive and debulking or transplantation, given the immunosuppression that the patient's on, would be of no benefit. Dr. Miller: So these neuroendocrine tumors, some are functional, that is, that they produce hormones and cause symptoms, and others are silent. I think you like to use the term ninja cancers. I think you might say that the ones that are less functional or not functional, that is, they don't produce hormones, are the ones that actually metastasize more frequently? Dr. Chaly: Well, that's correct that they metastasize a little more frequently, and that happens primarily because they're so silent and they're not producing hormones, so we're unaware of their activity. And so at this point, after the primary tumor has been controlled, a liver transplant is an option in some of these patients. Dr. Miller: What percent of patients with neuroendocrine disease in the liver, metastatic disease in the liver, would undergo a transplant versus the debulking that you talked about previously? Dr. Chaly: I would say the vast majority of patients would actually undergo a surgical debulking, and in select patients where debulking wasn't an option, maybe less than 10% transplantation would be available for them. Dr. Miller: But if that's the case, it sounds like the University of Utah would be a great place to have that treatment. Dr. Chaly: Absolutely. We've had an excellent experience in transplanting these patients and have had a great success rate, and these patients have done well over the long-term period. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.
Pancreas Transplant: An Alternative Treatment for… duration 6 minutes 43 seconds Pancreas Transplant: An Alternative Treatment for… Pancreas Transplant: An Alternative Treatment for Type 1 Diabetes	Pancreas Transplant: An Alternative Treatment for Type 1 Diabetes The University of Utah now performs pancreas transplants for qualified patients with type 1 diabetes. When other therapies have been exhausted, a pancreas transplant can eliminate the need for… u0817533 pancreas diabetes type 1 diabetes pancreas transplant From Interactive Marketing & Web 57 plays 0 Date Recorded September 10, 2014 Health Topics (The Scope Radio) Digestive Health Transcription Interviewer: Coming up next on The Scope, if you are a brittle diabetic, a possible treatment option. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: If you suffer from a kind of diabetes called brittle diabetes, you might want to consider a different type of treatment you might not have heard of before. We're with Dr. Jeffrey Campsen from the University of Utah Health Care. He's a transplant surgeon here. The process is called pancreas alone surgery. What exactly is that? Dr. Campsen: What we're talking about today are patients with type I diabetes that have very unstable diabetes, meaning they've tried their best to control it but they're still very brittle. What that means is they have swings in their sugar levels, their glucose levels, whether they go too high but more importantly they go too low. If you have too low sugars, it's known as hypoglycemia and that can be deadly. If you have the inability to control this with standard therapies, which is insulin and insulin pumps, one therapy we may offer you is a pancreas transplant. Interviewer: All right. So if some of these other things haven't been working for whatever reason, a pancreas transplant might be the key. How would somebody know if this is something that would be right for them? Dr. Campsen: Well I think first of all, there's two types of diabetes. There's type I diabetes, which means that your pancreas doesn't actually make the hormones that you need, insulin and glucagon and other things. Then there's type II diabetes, which means that you're resistant to the insulin. So a pancreas transplant doesn't work very well if I'm giving you a pancreas and you're already resistant to insulin, so we're just talking about the type I diabetics. Once you know that you're a type I diabetic, and most people do know that, it's are you able to comfortably treat this safely. Many people use insulin, they have insulin pumps and monitors, but the problem is not only do they not produce insulin, but they don't produce a hormone called glucagon, which then keeps them from going too low. If they continue to have these episodes where they get too low sugars, then it risks their life. So if this is happening they're referred to as a brittle diabetic. The final thing is that if they're brittle and the insulin levels are swinging back and forth and the glucose levels are swinging back and forth, they may have other complications. Whether or not they're going blind because of the diabetes, they have nerve damage, they have other issues, chronic infections. These may be reasons that we'll then offer you a pancreas transplant that you would then benefit from. Interviewer: The name pancreas alone sounds interesting to me. Why is it called that? Dr. Campsen: Historically the diabetes will attack the patient's kidneys over time. As their kidneys go into failure, we can give them a kidney transplant. But a kidney transplant in a type I diabetic doesn't work as long as it does in non-diabetics because the diabetes comes back and attacks the graft, the kidney transplant, and shortens the life of the kidney transplant. So historically we would give both a pancreas and a kidney to those patients that would need it to protect the kidney. The other school of thought is, why wait until your kidneys have already failed? Why not give you a transplant sooner, a pancreas transplant alone, that then protects your kidneys so you never need a kidney transplant? Interviewer: So kind of the old school way of thinking was, when it gets to the really dangerous situation, that's when you do the transplant. This is a little bit more proactive. Dr. Campsen: That's right. And you have to understand that there's a balance, because transplant surgery is a big deal. The surgery itself is a large vascular surgery, and on top of that you have to take immunosuppressive medications for the life of the transplant. So you're kind of trading diabetes for the disease of transplant. However the disease of transplant is much smaller and safer than this brittle diabetes that people talk about or kidney failure. Interviewer: So if catching the patient before things get terrible is the key, how soon could somebody get one of these transplants? Dr. Campsen: Many type I diabetics are diagnosed when they're children. That's probably too young because you have to have someone who's very responsible who can take care of the transplant. So we like to see the patients get at least towards their late teens if not into their 20s. They have to really show that they've really tried to manage their diabetes aggressively and very good compliance with their insulin and they've still failed. Interviewer: All right. What should a patient know at this point? This isn't something that necessarily a lot of physicians would refer. Dr. Campsen: Right. I think the interesting thing about type I diabetics is the only way that they survive is by really managing their disease. Obviously physicians, endocrinologists, medical doctors have to help them and support them to do this. But they're living every second of their day and their lives with this, and if they're able to control it, then they know a lot about diabetes. They know whether or not they're brittle. They know whether or not their other organs are starting to fail because of the diabetes. Then I think a patient who has this needs to realize that we now offer this as a therapy to help cure the diabetes. Interviewer: What would be your one takeaway for somebody listening to this? Dr. Campsen: I think if you're a brittle diabetic, and you know who you are, then pancreas transplant may be an option for you and you should come talk to us. You'll meet our transplant team, the professionals that manage different types of transplants at the University of Utah, and we'll sit down and see if you qualify for this and more importantly will you benefit from an organ transplant? Interviewer: What are some of the benefits of getting the transplant versus not? Dr. Campsen: Well I think that basically there's nothing better than a human organ. Everything that we do outside of transplant is approaching the quality that a human organ can give you, but there's nothing better than that. So if you're having trouble with your diabetes and you're noticing it's still damaging you, whether it's giving you heart disease, eye disease, nerve disease, all the kind of things that really happen because of type I diabetes, the fact that you're married to your insulin pump, then a pancreas transplant is an option that then will cure your diabetes. The moment that you have the transplant you're off insulin. Interviewer: It sounds like the sooner that you contact somebody and talk about this, the better because I would imagine there is a wait time for pancreas transplants. Dr. Campsen: There is a wait time. First of all you have to go through the workup, and then once you're listed the available organ has to be offered to you. It can be a year or two. Announcer: We're your daily does of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.
Should You Get a Pancreas Transplant for Type 1… duration 4 minutes 6 seconds Should You Get a Pancreas Transplant for Type 1… Should You Get a Pancreas Transplant for Type 1 Diabetes?	Should You Get a Pancreas Transplant for Type 1 Diabetes? You’re considering a pancreas transplant to cure your type 1 diabetes, but have questions – This episode of The Scope is for you. Dr. Jeffery Campsen, surgical director of transplants,… u0817533 pancreas pancreatic type 1 diabetes diabetes pancreas transplant transplant From Interactive Marketing & Web 1,542 plays 0 Date Recorded December 02, 2013 Health Topics (The Scope Radio) Family Health and Wellness Transcription Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio. Interviewer: A lot of people with Type 1 diabetes believe that the insulin shots and a pump is enough, but there might actually be a better option, a pancreas transplant. We're with Dr. Paul Campsen, Surgical Director of Pancreas Transplant Surgery with the University of Utah. That option is pancreatic surgery. Dr. Paul Campsen: That's correct. Right now we do pancreas transplants for Type 1 diabetics. Type 1 diabetics can't survive without insulin, so they give themselves shots and they can administer this sometimes through am insulin pump which is a very good way to keep them alive. The control that they get from that is not a replacement for the human organ, the pancreas. That's where the pancreas transplant comes into play in the sense that you can help yourself stay alive just like dialysis helps with kidney transplant, or with failure. A pancreas transplant gives you back the human organ that you actually need. Interviewer: Plus, also a better quality of life. Dr. Paul Campsen: A much better quality of life. Over the long term the pancreas transplant itself is completely correcting the diabetes, so any of the sequelae of diabetes, whether it be peripheral vascular disease, damage to your eyes, damage to your nerves, damage to your coronary arteries, all of that stuff is stopped with a pancreas transplant. Interviewer: Not with the insulin shots or the pump? Dr. Paul Campsen: No, I think that the insulin helps a lot. It slows down the damage. Obviously it literally saves their lives by giving them insulin, but it doesn't stop the diabetes because you're still a diabetic. The pancreas produces a variety of different enzymes and secretes many things that actually help the body including insulin, also glucagon, which keeps the sugars from going too low which can be life threatening, and any of the pancreatic enzymes that help with digestion. None of that' s given with the insulin pump. When you replace the pump with a human pancreas you get all of those benefits. Interviewer: It sounds like a great solution. Why aren't more people doing it? Is it a dangerous surgery or is it fairly safe? Dr. Paul Campsen: The diabetics who come to us hate their diabetes so much and they're so scared by it, and their so scared by brittleness of their, meaning they go too high with their sugar or too low, that they would do almost anything not to have to use insulin anymore, but they're scared because surgery is a big deal. The vast majority do very well with this surgery. It's very safe. They stay in the hospital for about a week afterwards, but the moment that they leave surgery they're not a diabetic anymore. Interviewer: That's pretty amazing, isn't it? Dr. Paul Campsen: It is pretty amazing. Many of the patients that come to us, their diabetes has also ruined their kidneys, so they're on dialysis at the same time. We'll do a simultaneous pancreas and kidney transplant. The moment that they leave the surgery the next morning they're cured of their diabetes and they're cured of the their renal failure and they're not on dialysis. The other thing that's very interesting in these patients is if you just give them a kidney transplant their Type 1 diabetes will still attack the kidney transplant. Interviewer: It just kills that organ. Dr. Paul Campsen: That's exactly right. The pancreas transplant added on top, because it cures the diabetes, actually protects the kidney transplant. Then both organs survive much longer. Interviewer: Who would be a good candidate for this type of surgery? Dr. Paul Campsen: I think anybody who has Type 1 diabetes. We're talking about unfortunate people who were diagnosed with diabetes probably before they were 20. We'd like to see these patients well before they get into their 30's. The earlier we see them the better. Interviewer: OK. What are your final thoughts for somebody that has Type 1 diabetes and is a little on the fence? Dr. Paul Campsen: I think basically this is a safe surgery. Coming and seeing us doesn't mean we're going to trap you and give you the surgery, but it's something where we can talk about it and see if this is the right surgery for you. If it is, we can cure your diabetes. If you have kidney problems we'll take care of those too. Announcer: We're your daily dose of science, conversation and medicine. This is The Scope University of Utah Health Sciences Radio.