Research or Regress
What if we could prevent pancreatic cancer?
A pancreatic cancer diagnosis is devastating. Penn State’s new procedure offers new hope for early detection and prevention.
When Lisa Timm went to the emergency room for chronic stomach pain, doctors ran tests, including a CT scan of her abdomen. While they couldn’t find an explanation for her discomfort, they did find a cyst on her pancreas. Most cysts are harmless, but the kind Timm had was more likely to turn into pancreatic cancer. Unfortunately, a follow-up scan showed that it was growing.
“I knew that the survival rate for pancreatic cancer is very low, even if you’re young and healthy. I absolutely did not want cancer,” Timm said.
Timm was worried and scared, especially when she learned that treatment options for precancerous pancreatic cysts were so limited. So, she started researching clinical trials, looking for better options.
She discovered a clinical trial led by Matthew Moyer, professor at Penn State College of Medicine and physician at Penn State Health, and applied to join the study. The quick, minimally invasive procedure was the glimmer of hope Timm was looking for.
I was so hopeful. If this works, I don’t have to have surgery and continue to worry about possibly getting cancer."
Lisa Timm
The Challenge: Detecting Pancreatic Cancer Early
Pancreatic cancer is the third leading cause of cancer-related death in the United States, and it’s expected to become the second deadliest by 2030, surpassing colon cancer. One reason for this is that it’s hard to find early. The pancreas is deep in the body, and early-stage tumors often don’t cause symptoms, which means they're usually not detected until they’ve reached an advanced stage.
While the exact answer to what causes pancreatic cancer is often unknown, a specific type of cyst can be an early warning sign. Approximately 15% to 20% of pancreatic cancers are caused by these cysts, and doctors can identify the high-risk cysts that may be precancerous.
Currently, there are only two options for treating a high-risk cyst:
Continued monitoring, which comes with the anxiety of waiting to see if the cyst will begin to show signs of cancer, or
Major abdominal surgery that is expensive and risks serious complications.
Timm was discouraged when she heard these options. Continued monitoring didn’t seem like the best choice because her cyst had already grown. With surgery, doctors would have to remove most of her pancreas, some lymph nodes, and her spleen, too.
“I left the meeting frustrated and scared,” she said. “There had to be a way.”
MRI images taken before and after Timm's procedure. Days after the procedure, her cyst had shrunk in half and was completely gone after one year.
A Better, Minimally Invasive Procedure
Fifteen years ago, Dr. Moyer began work to improve a third option. He modified an existing procedure—a minimally invasive approach where doctors use a tube with a camera to target and destroy a precancerous cyst. This is like a colonoscopy, where doctors remove precancerous polyps before they can become cancerous.
Typically, the procedure uses alcohol, which can damage the pancreas and cause complications. After testing, Moyer swapped the alcohol for saline. He also drained the cyst and replaced the fluid with chemotherapy medication.
"This targeted method allows the chemotherapy to seep into every nook and cranny of the cyst and kill it in a slow and controlled way,” Moyer said.
Just as colonoscopies have led to a new standard in the prevention and early detection of colon cancer, this procedure opens the door to possibly changing the trajectory for pancreatic cancer.
“When I was accepted into Dr. Moyer’s study, I was so hopeful. If this works, I don’t have to have surgery and continue to worry about possibly getting cancer,” Timm said.
Promising Prevention Results
Moyer and his colleagues tested the improved procedure in two randomized clinical trials. The results are exciting. In two-thirds of patients who had the procedure, the cysts were gone within a year; 87% remained cyst-free four years later and did not develop cancer. Additionally, the 20-minute procedure also had no harmful side effects, unlike the traditional method.
“Dr. Moyer’s idea to remove alcohol from the procedure changed everything. It’s now a safe, effective, and minimally invasive procedure that we can confidently offer patients,” said Nazia Hasan, Director of Pancreaticobiliary Endoscopy at California Pacific Medical Center and Associate Professor at UCSF.
To help increase adoption, Moyer and his team developed a comprehensive training program and are now championing this new protocol to other medical centers across the country. To date, he has trained fifteen medical centers, including California Pacific Medical Center in San Francisco.
“It's unprecedented. More doctors need to hear about this so more patients can access it,” Dr. Hasan said.
Lisa Timm working in her home office in Washington state.
Hopeful for the future, Lisa and her father shortly before their cross-country journey from Washington to Pennsylvania for her procedure.
Days after the procedure, Lisa is all smiles after her father cheers her up with a Penn State jacket and cozy pajamas.
Grateful for her positive outcome, Lisa and her fiancé, Jeff, look forward to a long, healthy, and happy life together.
Research Gives a Second Chance
In March 2022, Timm traveled to Hershey, Pennsylvania, to be treated by Dr. Moyer. She avoided major abdominal surgery and no longer needs to worry that her cyst would become cancerous.
A few days after the procedure, her cyst had shrunk by half. A year later, it was completely gone.
“I can go back to living my life,” Timm said. “I’m so thankful to Dr. Moyer. My health outcomes would have been so much worse without his work.
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