Cancer In The Lymph Nodes

>> announcer: "second opinion" is broughtto you by bluecross blueshield. accepted in all 50 states. bluecross blueshield. live fearless. >> announcer: "second opinion" is producedin conjunction with u.r. medicine, part of university of rochestermedical center, rochester, new york. >> dr. peter salgo: this is "second opinion," andi'm your host, dr. peter salgo.

this week, myth or medicine? david linehan: pancreas cancer is the fourthmost common cause of cancer death in the united states, and in the next 10 years, it's predictedthat it will become the second most common cause. peter salgo: and special guest peter suess. some unusual symptoms turned in to a diagnosisthat turned his world upside down. >> peter suess: it about -- it about did mein. peter salgo: yeah. >> peter suess: it was an extremely toxicchemotherapy.

i lost 40 pounds in those 6 months. peter salgo: he's here for a second opinion. peter salgo: thanks so much for being here,peter. i know you've got a lot to share with us,so we're gonna get right to work. what i'd like to do first is introduce youto your "second opinion" doctors. they're gonna be hearing your story for thefirst time. they are dr. a. james moser, from beth israel deaconessmedical center and harvard medical school, and dr.

lou papa, our "second opinion" primary carephysician, from the university of rochester medical center. gentlemen, thank you so much for joining usagain. peter, why don't you start telling us yourstory? this all began while you were on vacation,right? >> peter suess: vacation, yes. peter salgo: there you were, minding yourown business. >> peter suess: minding my own -- mindingmy own business. peter salgo: what year is this?

>> peter suess: july of '09. peter salgo: okay. >> peter suess: in retrospect, i felt somesymptoms coming on probably in june. i was tired, lethargic. it was a very hot summer in san antonio. i attributed it to the weather. but i didn't get any better. our vacation was, each year, down in galveston. we rented a house.

my wife and i would typically take long walksup and down the beach. it was very, very, very, very difficult. peter salgo: why? >> peter suess: i really felt like layingin bed, sitting up in the air-conditioned house, rather than going out into the heat. finally, i got through that week, and, finally,we got back to san antonio, and my urine changed color, and "something's wrong." peter salgo: did you have any other symptomsat that time? >> peter suess: i had a lot of itching.

>> peter suess: i felt just -- just terrible-- just terrible. and i had a little bit of weight loss. you know, i didn't put it all together. so, we got a changing color of the urine. we got itching, fatigue, what the doctor mightcall -- what? -- general malaise. you weren't feeling right. lou papa: well, i'm concerned because he hasthis general malaise, which is not very specific, but the thing that really kind of is the handlefor me is the change in his urine color, which

could be a number of things. it could be blood. it could be bilirubin, which comes from yourliver. i'm concerned about it being related to bilirubin'cause he has this itching, and sometimes you'll see that when the bilirubin level shootsup. did anybody say at that time that your eyeslooked a different color, your skin looked a different color? >> peter suess: that was my next -- that wasmy next statement. peter salgo: tell me about that.

>> peter suess: well, when my urine changedcolor, i got scared, and i go, "oh, my gosh. you know, something's going on here." went right to my family doctor, said thisvery same thing to him, and he said, "stand up." so i stood up. he says, "look at me in the eyes. now roll your eyes back." and when i rolled my eyes back, the whitesof the bottom of my eyes were turning jaundiced. and he goes, "we better get you to a sonogram."

peter salgo: what's he looking for, lou? lou papa: so, there's a couple of differentthings. i mean, the big question is is there somethinggoing on in the hepatobiliary system? peter salgo: that's where the bile leavesthe liver and heads to the gut. lou papa: so, this could be hepatitis. this could be a problem with a blockage causingthe bile to back up. there's a number of different things thatcan cause that. so, looking at the ultrasound, especiallysince it's kind of painless jaundice, is gonna be helpful to see if the liver's inflamedor if there's any other tumors that are causing

blockages. so, tumor. that's the first time we've heard this term"tumor." lou papa: or stones. peter salgo: or stones. >> peter suess: i went to the ultrasound,and they found a spot or they saw a spot and said, "you should go have a ct scan." and the ct scan confirmed it. i had a meeting with the doctor the next monday,and there was the report -- possible pancreatic

cancer. and then what did they do? >> peter suess: because i was jaundiced, hefelt i needed to go to a g.i. doctor and open up my bile duct, so they immediatelyput me to sleep and went down my throat and put a stent in my bile duct. peter salgo: to end the blockage? >> peter suess: the symptoms virtually disappearedin like four days. by that weekend, i was -- i was almost symptom-free. lou papa: did they see anything else in thescan other than the mass?

was there any other tumors anywhere else -- inthe liver, in the lymph nodes around that dimension? >> peter suess: well, uh, my liver showedsome abscesses, and that -- and that scared me. after they did the stent in the bile duct,then i had a small needle biopsy, and when i woke up from that, they had already lookedat the tissue, and the doctor looked at me and said, "you have pancreatic cancer." peter salgo: and at that instant, tell mewhat you thought. >> peter suess: well, i was feeling prettydazed from the anesthesia, but...

frankly, i was more crushed at the radiologist'sreport in the doctor's office the monday before than i was after the biopsy. so, now, james -- jim -- you've seen thisa lot now. what is so bad or what do they think is sobad about pancreatic cancer? a. james moser: well, the problem with pancreaticcancer is it's oftentimes called the silent killer, and the reason being that people havethe tumor for a lot longer than they actually recognize any symptoms related to it. peter salgo: okay, but it's silent, it's growing,it's doing bad things, and there's no way to know.

a. james moser: there's no way to know, exactly,and people tend to attribute their other very vague symptoms -- the fatigue, malaise, maybemild weight loss -- many people are already trying to lose weight, and so they just thinkthat, "well, this is something mild," and they don't really pay any attention. peter salgo: and nothing could be furtherfrom the case. now... >> peter suess: absolutely. i felt it was the heat of the summer. that's right.

peter salgo: did they say, "let's go and operate"? what did they say? >> peter suess: okay. the, uh, gastroenterologist sent me to a surgicaloncologist, who sat us down... so, we're gonna have a diagram of the pancreas. >> peter suess: ...and walked us through justwhat jim has -- what jim has said here right now. peter salgo: jim, tell us about the pancreas. where is it?

what is it? what does it do? can you live without it? a. james moser: well, the pancreas is herein the upper abdomen, just beneath your rib cage. most people, when they start to have symptoms,may have a very mild ache in the middle of their bellies. peter salgo: it's the yellow stuff on thatpicture right there -- is the pancreas. a. james moser: and the pancreas is responsiblefor two really important functions.

first, it makes insulin to control your bloodsugar, and the second thing it does is make enzymes to digest your food. and the bile duct passes through it on itsway into the intestine, and so when there's a tumor there, it blocks the duct, and that'swhat causes the jaundice. peter salgo: so, why didn't they just takeyou to the operating room and whip that pancreas out? >> peter suess: my doctor told me that only15% of the patients qualify for the whipple. peter salgo: the name of the procedure isthe whipple procedure. >> peter suess: the procedure to take outthe pancreas.

and in order for me to get to the whipple,i had to do this, this, and this. peter salgo: that was what? >> peter suess: it was three weeks of gemzar. peter salgo: that's chemotherapy. >> peter suess: chemotherapy -- three weeksof chemotherapy. then there was about a two-week break there,and then i went to a radiologist who mapped out my interior, and then i had 28 radiationtreatments. and the purpose behind the radiation treatmentswas to shrink the tumor, to get it away from the veins, to get it away from the bile duct-- you know, stuff like that.

peter salgo: so the surgeon could have a reasonableshot... >> peter suess: perfect. peter salgo: ...at peeling the stuff off. >> peter suess: that's exactly correct. peter salgo: and did that treatment work foryou? >> peter suess: it -- it did. peter salgo: but now comes the part whereyou've got to -- you've got to do the operation. >> peter suess: now we've got to do the operation. peter salgo: and throughout my medical career,one of the most fearsome words i've ever heard

is "we're going in to do a whipple." what makes that operation so difficult anddangerous? a. james moser: well, the challenging partof the operation when you remove the pancreas is you're removing, really, the epicenterof the digestive tract. you're taking away the outlet of the stomach,where the bile duct ends, and where the pancreas secretes enzymes, and then you have to reconstructall of that. this has come a long way. you know, we do a high percentage of thosecases minimally invasive, but it's important, as peter said at the beginning, really, theepicenter of this operation is really about

making sure that somebody's cancer-free, andthat operation is just part of chemotherapy and radiation to make sure that tumor is notleft behind. peter salgo: so, you got the whipple? >> peter suess: i did. peter salgo: you had the old-fashioned whippleback then. >> peter suess: well, i was just thinkingalso, "boy, i wish i could have had the whipple with six simple incisions," but i was openedup and taken apart and reconstructed and put back together. peter salgo: i want to quickly review what'shappened since, because you had the chemotherapy,

the radiotherapy, the whipple operation, andyour hope was, "this is it." >> peter suess: "this is it." peter salgo: "i'm done." and? >> peter suess: 18 months later, it came back. peter salgo: common? a. james moser: unfortunately, this is theproblem, is that pancreatic cancer -- our current radiology tests just don't see singlecells, and the tumors have spread by the time they're diagnosed, and although the operationis successful, the patient's cancers come

back elsewhere. peter salgo: it came back where -- in thetail of your pancreas? >> peter suess: it came back in the tail ofmy pancreas. it was biopsied, and the suggested methodwas operating again to remove the rest of the pancreas, or another large portion ofit, and my spleen. peter salgo: and the spleen. >> peter suess: right. peter salgo: and then you had a period whereyou thought, "okay, things are okay." >> peter suess: then we thought things wereokay, 'cause both times i was cancer-free

coming out of surgery. peter salgo: and it then appeared again? >> peter suess: it appeared on my liver. it came back on -- it came back with a couplespots on my liver. peter salgo: and they treated that? >> peter suess: i was put on a chemo calledfolfirinox. and i was on that from april to october of2012. and it about -- it about did me in. >> announcer: "second opinion" is broughtto you by bluecross blueshield. accepted in

all 50 states. bluecross blueshield. livefearless. >> announcer: "second opinion" is producedin conjunction with u.r. medicine, part of university of rochester medical center, rochester,new york. >> dr. peter salgo: this is "second opinion,"and i'm your host, dr. peter salgo. this week, myth or medicine? >> dr. david linehan: pancreas cancer is thefourth most common cause of cancer death in the united states, and in the next 10 years,it's predicted that it will become the second most common cause. >> dr. peter salgo: and special guest petersuess. some unusual symptoms turned in to

a diagnosis that turned his world upside down. >> dr. peter salgo: yeah. >> peter suess: it was an extremely toxicchemotherapy. i lost 40 pounds in those 6 months. >> dr. peter salgo: he's here for a secondopinion. >> dr. peter salgo: thanks so much for beinghere, peter. i know you've got a lot to share with us, so we're gonna get right to work.what i'd like to do first is introduce you to your "second opinion" doctors. they'regonna be hearing your story for the first time. they are dr. a. james moser, from bethisrael deaconess medical center and harvard

medical school, and dr. lou papa, our "secondopinion" primary care physician, from the university of rochester medical center. gentlemen,thank you so much for joining us again. peter, why don't you start telling us your story?this all began while you were on vacation, right? >> dr. peter salgo: there you were, mindingyour own business. >> dr. peter salgo: what year is this? >> dr. peter salgo: okay. >> peter suess: in retrospect, i felt somesymptoms coming on probably in june. i was tired, lethargic. it was a very hot summerin san antonio. i attributed it to the weather.

but i didn't get any better. our vacationwas, each year, down in galveston. we rented a house. my wife and i would typically takelong walks up and down the beach. it was very, very, very, very difficult. >> dr. peter salgo: why? house, rather than going out into the heat.finally, i got through that week, and, finally, we got back to san antonio, and my urine changedcolor, and "something's wrong." >> dr. peter salgo: did you have any othersymptoms at that time? >> peter suess: i felt just -- just terrible-- just terrible. and i had a little bit of weight loss. you know, i didn't put it alltogether.

>> dr. peter salgo: okay. so, we got a changingcolor of the urine. we got itching, fatigue, what the doctor might call -- what? -- generalmalaise. you weren't feeling right. >> dr. lou papa: well, i'm concerned becausehe has this general malaise, which is not very specific, but the thing that really kindof is the handle for me is the change in his urine color, which could be a number of things.it could be blood. it could be bilirubin, which comes from your liver. i'm concernedabout it being related to bilirubin 'cause he has this itching, and sometimes you'llsee that when the bilirubin level shoots up. >> dr. peter salgo: tell me about that. you know, something's going on here." wentright to my family doctor, said this very

same thing to him, and he said, "stand up."so i stood up. he says, "look at me in the eyes. now roll your eyes back." and when irolled my eyes back, the whites of the bottom of my eyes were turning jaundiced. and hegoes, "we better get you to a sonogram." >> dr. peter salgo: what's he looking for,lou? >> dr. lou papa: so, there's a couple of differentthings. i mean, the big question is is there something going on in the hepatobiliary system? >> dr. peter salgo: that's where the bileleaves the liver and heads to the gut. >> dr. lou papa: so, this could be hepatitis.this could be a problem with a blockage causing the bile to back up. there's a number of differentthings that can cause that. so, looking at

the ultrasound, especially since it's kindof painless jaundice, is gonna be helpful to see if the liver's inflamed or if there'sany other tumors that are causing blockages. >> dr. peter salgo: okay. so, tumor. that'sthe first time we've heard this term "tumor." >> dr. lou papa: or stones. >> dr. peter salgo: or stones. said, "you should go have a ct scan." andthe ct scan confirmed it. i had a meeting with the doctor the next monday, and therewas the report -- possible pancreatic cancer. >> dr. peter salgo: okay. and then what didthey do? >> peter suess: because i was jaundiced, hefelt i needed to go to a g.i. doctor and open

up my bile duct, so they immediately put meto sleep and went down my throat and put a stent in my bile duct. >> dr. peter salgo: to end the blockage? >> peter suess: the symptoms virtually disappearedin like four days. by that weekend, i was -- i was almost symptom-free. >> dr. lou papa: did they see anything elsein the scan other than the mass? was there any other tumors anywhere else -- in the liver,in the lymph nodes around that dimension? me. after they did the stent in the bile duct,then i had a small needle biopsy, and when >> dr. peter salgo: and at that instant, tellme what you thought.

>> peter suess: well, i was feeling prettydazed from the anesthesia, but... cancer. >> dr. peter salgo: okay. so, now, james -- jim-- you've seen this a lot now. what is so bad or what do they think is so bad aboutpancreatic cancer? >> dr. a. james moser: well, the problem withpancreatic cancer is it's oftentimes called the silent killer, and the reason being thatpeople have the tumor for a lot longer than they actually recognize any symptoms relatedto it. >> dr. peter salgo: okay, but it's silent,it's growing, it's doing bad things, and there's no way to know. >> dr. a. james moser: there's no way to know,exactly, and people tend to attribute their

other very vague symptoms -- the fatigue,malaise, maybe mild weight loss -- many people are already trying to lose weight, and sothey just think that, "well, this is something mild," and they don't really pay any attention. >> dr. peter salgo: and nothing could be furtherfrom the case. now... >> peter suess: absolutely. i felt it wasthe heat of the summer. that's right. >> dr. peter salgo: did they say, "let's goand operate"? what did they say? >> peter suess: okay. the, uh, gastroenterologistsent me to a surgical oncologist, who sat us down... >> dr. peter salgo: okay. so, we're gonnahave a diagram of the pancreas.

>> dr. peter salgo: jim, tell us about thepancreas. where is it? what is it? what does it do? can you live without it? >> dr. a. james moser: well, the pancreasis here in the upper abdomen, just beneath your rib cage. most people, when they startto have symptoms, may have a very mild ache in the middle of their bellies. >> dr. peter salgo: it's the yellow stuffon that picture right there -- is the pancreas. >> dr. a. james moser: and the pancreas isresponsible for two really important functions. enzymes to digest your food. and the bileduct passes through it on its way into the intestine, and so when there's a tumor there,it blocks the duct, and that's what causes

the jaundice. >> dr. peter salgo: so, why didn't they justtake you to the operating room and whip that pancreas out? >> dr. peter salgo: the name of the procedureis the whipple procedure. >> peter suess: the procedure to take outthe pancreas. and in order for me to get to the whipple, i had to do this, this, and this. >> dr. peter salgo: that was what? >> dr. peter salgo: that's chemotherapy. >> peter suess: chemotherapy -- three weeksof chemotherapy. then there was about a two-week

break there, and then i went to a radiologistwho mapped out my interior, and then i had 28 radiation treatments. and the purpose behindthe radiation treatments was to shrink the tumor, to get it away from the veins, to getit away from the bile duct -- you know, stuff like that. >> dr. peter salgo: so the surgeon could havea reasonable shot... >> dr. peter salgo: ...at peeling the stuffoff. >> dr. peter salgo: and did that treatmentwork for you? >> dr. peter salgo: but now comes the partwhere you've got to -- you've got to do the operation.

>> dr. peter salgo: and throughout my medicalcareer, one of the most fearsome words i've ever heard is "we're going in to do a whipple."what makes that operation so difficult and dangerous? >> dr. a. james moser: well, the challengingpart of the operation when you remove the pancreas is you're removing, really, the epicenterof the digestive tract. you're taking away the outlet of the stomach, where the bileduct ends, and where the pancreas secretes enzymes, and then you have to reconstructall of that. this has come a long way. you know, we do a high percentage of those casesminimally invasive, but it's important, as peter said at the beginning, really, the epicenterof this operation is really about making sure

that somebody's cancer-free, and that operationis just part of chemotherapy and radiation to make sure that tumor is not left behind. >> dr. peter salgo: so, you got the whipple? >> dr. peter salgo: you had the old-fashionedwhipple back then. >> dr. peter salgo: i want to quickly reviewwhat's happened since, because you had the chemotherapy, the radiotherapy, the whippleoperation, and your hope was, "this is it." >> dr. peter salgo: "i'm done." and? >> dr. peter salgo: common? >> dr. a. james moser: unfortunately, thisis the problem, is that pancreatic cancer

-- our current radiology tests just don'tsee single cells, and the tumors have spread by the time they're diagnosed, and althoughthe operation is successful, the patient's cancers come back elsewhere. >> dr. peter salgo: it came back where -- inthe tail of your pancreas? >> peter suess: it came back in the tail ofmy pancreas. it was biopsied, and the suggested method was operating again to remove the restof the pancreas, or another large portion of it, and my spleen. >> dr. peter salgo: and the spleen. >> dr. peter salgo: and then you had a periodwhere you thought, "okay, things are okay."

>> dr. peter salgo: and it then appeared again? >> peter suess: it appeared on my liver. itcame back on -- it came back with a couple spots on my liver. >> dr. peter salgo: and they treated that? >> peter suess: i was put on a chemo calledfolfirinox. and i was on that from april to october of 2012. and it about -- it aboutdid me in. months. my doctor wanted me to do 12 of thetreatments, and i -- i didn't know how i was gonna do it. i wanted to stop at 10, and wehad a family meeting, and my kids looked at me, and they said, "dad, you've done 10. whatthe heck is 2 more?" well, we did 2 more.

i did the 2 more. and i got through thoselast 2 because it's my understanding you can lower the toxicity of the chemo, so insteadof getting like an 85% chemo, i got like a 60% chemo. >> peter suess: and because i was having goodresults with the tumor shrinking and my cancer marker coming down, the doctor felt that icould go to a little bit reduced toxicity of chemo and still get the results. so i wentthrough those two, had a scan, and the spots were virtually gone. >> dr. peter salgo: then you had a periodof a pretty calm time. >> peter suess: a year.

>> dr. peter salgo: a year? >> dr. peter salgo: and then... >> peter suess: and then it came back in mylung. >> peter suess: and it was biopsied and shownto be cancer, and my surgeon suggested that we try a thing called the radial frequencyablation. >> peter suess: so they put me to sleep, andan interventional radiologist went into my lung, zapped it, took it out. my lung collapsed.i spent a night in the hospital. they inflated -- it reinflated. i went home the next day.i was back in the gym in a week. >> dr. peter salgo: holy moly. i mean, youmake it sound -- i know you said it was terrible,

and as you zip through all of this, it's awalk in the park. this had to be awful, for you and your family. >> peter suess: well, you know, your familyis in this journey with you also, okay? and my kids are terribly -- motivators, as ismy wife, and so i've always considered myself lucky in that the cancers that i've had havebeen specific or localized. i didn't get pancreatic cancer with the head and the tail and a lung.i didn't get pancreatic cancer in my liver. so, we took care of the pancreas, we tookcare of the lung -- we took care of the liver, we took care of the lung, so we're doing itone step at a time. >> dr. peter salgo: i want to observe twothings. you've got a stricken look on your

face about this poor man's course. how commonis this? >> dr. a. james moser: well, you know, firstly,let me say that peter's having a strong family is a very important support mechanism, andthe second thing is that he's really witnessed what's tremendous improvement in the treatmentfor pancreatic cancer. he got what we call "multimodality therapy," which is absolutelythe 21st-century model of chemotherapy, radiation, and surgery at the beginning. and then inthe course of his illness, folfirinox came along. it was published in 2010, and he wasa beneficiary of that. so, what peter shows is the fact there can be hope for people withpancreatic cancer to have something less than an immediately lethal disease and that thelonger that somebody can be kept healthy,

more treatment becomes available. >> dr. peter salgo: we're at five years, andwe've got -- i want everybody to sit right here, because we're gonna be right back tohear your second opinion, peter, but first, i want to go to this week's "myth or medicine." >> narrator: of all the major cancers, pancreaticcancer is largely considered to be incurable, and although the survival rates have beenimproving, the prognosis can seem grim. does this mean that pancreatic cancer is a deathsentence? is this myth or medicine? >> dr. david linehan: pancreas cancer is adeath sentence. this is a myth, and i'm going to tell you why. my name is david linehan.i'm the seymour schwartz professor and chairman

of the department of surgery at the universityof rochester medical center and the co-director of clinical services at the wilmot cancerinstitute. there is a lot of research that's going on right now on pancreas cancer, andthere is some reason for hope and optimism. recently, there was a paper published thatshowed a biomarker, a test that showed promise for early detection, something that's reallyneeded in this disease. there have been recent studies showing that you can use the immunesystem to help fight the cancer in combination with chemotherapy by trying to reverse immunesuppression or by trying to activate the immune system to recognize the cancer and attackit. and the important message to patients with this disease is participation in clinicaltrials, testing novel therapies, is very important

for us to make progress so that we can changethis disease from what many people perceive as a death sentence to a treatable diseasewith better outcomes and more survivors. and that's medicine. >> narrator: not sure if it's myth or medicine?connect with us online. we'll get to work and get you a second opinion. >> dr. peter salgo: and we're back with petersuess, 69 years old, battling, for the past 5 years, pancreatic cancer. lovely wife, martha,whom i've met. >> peter suess: thank you. >> dr. peter salgo: three grown children,grandchildren.

>> peter suess: seven grandchildren. >> dr. peter salgo: and here you are, movingalong day by day, facing each of these challenges, and somewhere along the way, another devastatingproblem crops up. what happened? >> peter suess: my brother-in-law was diagnosedwith pancreatic cancer 15 months after i was diagnosed. >> peter suess: and he went through the sameprotocol with it, with the gemzar, the chemo, the radiation, to get to the whipple. thewhipple was performed on him, and what took me 10 days to recover from... it took himsix weeks. we spent a lot of time with him the last six, eight months of his life, buthe just continued -- he never -- he never

-- he never got over that -- that hump likei got over it, where, eventually, you feel pretty darn good. >> dr. peter salgo: okay. same disease, sametherapy, same operation -- tremendously different outcome. how do you explain that? >> dr. a. james moser: well, i've seen thesame. i took care of two sisters with the same exact -- same exact outcome, and therewas obviously a lot of genetic variability between the tumors. there's what are called"chemosensitivity factors" that affect how tumor cells in this case would metabolize,gemcitabine, which is the chemotherapy that they both received, and, obviously, peter'sbrother-in-law wasn't so fortunate to have

a tumor that grew and was sensitive to chemotherapylike peter's was. >> dr. peter salgo: why isn't there a screeningtest to find this horrible tumor earlier? >> dr. a. james moser: well, that's a goodquestion. there are some recent reports suggesting some family traits that might lead somebodyto have genetic testing, but, still, even in the 21st century, only about 10% of peoplehave an identifiable cause of pancreatic cancer, and that's even despite the fact that, by2020 in the united states, pancreatic cancer is forecast to surpass both colon and rectalcancer, as well as breast cancer as causes of cancer deaths. so, we are all desperatelyhoping that a marker could be identified. >> dr. peter salgo: is that because the rateof pancreatic cancer is going up or the rate

of everything else is going down? >> dr. a. james moser: well, it's probablyboth at the same time. treatment for colorectal cancer and breast cancer has led to improvedsurvival, and pancreatic cancer is becoming more frequent in an aging population. >> dr. lou papa: and that's an aging populationthat smoked more and it's also a population where we see obesity going up, and those arerisk factors. >> dr. peter salgo: okay. now, you're doinggroundbreaking research in biomarkers. what are biomarkers? what does this mean for peoplewho might get pancreatic cancer or who have pancreatic cancer?

>> dr. a. james moser: well, our project'scalled project survival. it's an international collaboration with a group called the pancreaticcancer research team and a very innovative pharmaceutical company, and what we're doingis sequencing the entire genome, which is all the dna in a tumor, all the proteins ina tumor, the lipids, which are the fatty acids that make up the cell membranes, and thenwe're looking at these metabolic factors to understand what makes pancreatic cancer tick,and then, using that information, through artificial intelligence, to drill down onthe factors that might both predispose to pancreatic cancer and then, also, to allowearly diagnosis, with the hope being that if we identify a good marker, something calleda biomarker, we'll actually be able to select

which chemotherapy agents. and that's beenan example that's worked very effectively for breast cancer, for example. now womenthat have node-negative breast cancer can have a 21st-century test that tells them whetheror not they should get chemotherapy. >> dr. peter salgo: now, peter, how are youdoing right now? where are you in this journey? >> peter suess: right now in this journey,we have been -- we have been watching -- we have been watching a spot on my liver anda spot on my lung where the thing was burned out in march of '14. and in the last couplemonths, as they have done labs on them, my cancer marker has gone up, so we've done apet scan, and the pet scan has come back lit up in these two -- in these two areas. okay.it's been suggested to me that i have two

more ablations, and next week i will be goingin to the hospital for an ablation on my liver and a reablation on my lung. >> dr. peter salgo: okay. i want to give youa little time to talk to these great guys, ask them any questions you've got about yourproblems, and the floor is yours. >> peter suess: i want somebody to come upwith an early, quick marker. i had a physical every year with my doctor, with my p.s.a.everything in the world is being determined by the blood that's taken out of my arm oncea month, okay? is there coming a blood test for pancreatic cancer that doesn't cost anarm and a leg? >> dr. lou papa: well, i'll tell you, fromthe primary-care point of view, the blood

markers have been kind of a bust for mostthings. there's been blood markers for colon cancer, blood markers for even p.s.a.s beingquestioned, so, from the primary-care point of view, it's in the testing phase. it's stillin kind of the lab. how it performs in the real world, on real roads, in real life -- that'sprobably down the road. hopefully, that'll be there. >> dr. peter salgo: jim? >> dr. a. james moser: well, that's somethingcalled "biomarker discovery," and, as lou was saying, you know, there are certain thingson the horizon. there are some new detectors which even allow -- you know, cost 6 cents.i mean, the person that won the intel prize

for this was working on a new detector. somethingthat we're working on which i think is gonna be very effective in the near future is gonnabe something called the pdx mouse, and that's personalized medicine -- what's called "precisionmedicine" -- and growing somebody's tumor in a mouse. that can be done now on a muchmore frequent basis with a rapid turnaround, where the chemotherapy agents are being testedin the mouse models of a specific person's >> peter suess: wow. >> dr. peter salgo: so, there's somethingpotentially coming, but don't hold your breath in the next 10 days. now, you've gotten 5years. you haven't been disease-free 5 years, but 5 years. what has that 5 years boughtyou?

>> peter suess: a multitude of memories. rightafter -- right after the whipple, my daughter got married, so i was able to walk my daughterdown the aisle cancer-free at her wedding. we've had two grandkids born in these fiveyears. my wife and i are very much involved in the american cancer society, also. andamerican cancer society is the creator of birthdays, okay? that's one of their mottos.and i've had the pleasure of five birthdays with my family and grandkids, plus all thebirthdays of the family, eating ice cream and cake, the christmases, the anniversaries,okay? martha and i have been married 46 years, so it's been -- it's all been good. it's okay.i'm a big, strong guy. i don't want to get any sicker than i've been, but i'm a big,strong guy, and i can handle this. i've handled

it. >> dr. peter salgo: you're from texas. >> peter suess: i'm from texas. everythingis bigger in texas. >> dr. peter salgo: if you have one messageto leave with our viewers, other than "move to texas," what would that message be? >> peter suess: um... well, pancreatic canceris not a death sentence, but you have to know the symptoms. again, the itching, the turningof jaundice, the feeling bad, the weight loss -- those are all things that might be partof the pancreatic-cancer thing. so, do not be afraid of your doctors. do not be afraidof the diagnosis. uh... watch your body, look

at the symptoms, and then move aggressively. >> dr. peter salgo: great words, peter. thankyou so much. >> peter seuss: you're welcome. >> dr. peter salgo: panel, great panel. thankyou so much for joining us today. i'd like to know what you think about today's discussionof peter's second opinion by tweeting us or by commenting on our facebook page. and nowhere's this week's "second opinion 5." >> alicia coffin: hello. i am alicia coffin,oncology nurse and survivorship specialist, and i am here to tell you about five waysyou can support someone with cancer. one of the most important things to do is listen.allow the person to talk about their cancer,

their diagnosis, and treatment. it's okayto ask them how they're feeling and how things are going. it can be hard to know what tosay when someone is facing cancer, but it's important to let them know how much you care.listening when they want to talk about their cancer is one of the best ways you can dothat. second, respect their treatment decisions. listen without judgment and be supportivewhen they choose to participate in a clinical trial, for example, and avoid sharing others'experiences undergoing treatment without being asked. third, know that it's okay to talkabout things other than cancer. although treatment is a big part of their lives, it's not theonly thing. family activities, favorite tv shows, and whatever else you normally talkabout are perfectly fine to share with each

other. another way you can support a familymember or friend with cancer is to offer to help with specific tasks or chores. insteadof saying, "let me know how i can help," ask what night you can make dinner for the family,what day you can mow the lawn, or which appointments you can drive them to. finally, continue toinclude them in your activities. it's natural to worry that someone undergoing cancer treatmentwon't feel well enough or won't want to join for a night at the movies, book club, or alunch date, but allow them to decide what is too much. continue to invite them for outingsand activities as you always have. and that's your "second opinion 5." >> dr. peter salgo: thank you so much forwatching, and remember, you can get more second

opinions and patient stories at our websiteat secondoinion-tv.org. you can also send us your show ideas, share your own healthstory. maybe we'll invite you to be on the show with us. you never can tell. you cancontinue the conversation on facebook and twitter, where we are live every day withbreaking health news. i'm dr. peter salgo, and i'll see you next time for another "secondopinion."