The AHN Cancer Institute is leading the way in pancreatic cancer care, offering an early intervention clinic, clinical trials, and comprehensive support.

Dulabh Monga, MD

The fight against pancreatic cancer is a complex one, marked by challenging outcomes and a constant search for effective treatments. But at the Allegheny Health Network (AHN) Cancer Institute, a team of specialists are turning the tide on the disease through early intervention, collaboration, and research.

The undeniable importance of early detection initiated AHN’s development of a High-Risk Pancreatic Cancer Clinic. The monthly clinic performs regular screenings of patients who are at high risk for developing the disease over the course of their lifetime. The clinic categorizes patients as high-risk if they have a family history of pancreatic cancer, known genetic mutations, or underlying medical conditions, such as hereditary pancreatitis or sudden-onset diabetes.

Dulabh Monga, MD, a leading pancreatic cancer specialist at AHN, has committed a significant amount of her career to improving and extending the lives of patients with this challenging cancer. It claims almost 50,000 American lives a year, but Dr. Monga explained that oncology experts are making incremental improvements through such initiatives as the clinic. She said it’s urgent for these patients to receive comprehensive germline and somatic testing, and their at-risk family members are also considered for testing.

“This type of tailored surveillance plan allows us to identify pancreatic changes early and closely monitor patients with an elevated risk,” Dr. Monga said. “Integral to this approach is us working closely with our physician colleagues in the communities to identify these patients as early as possible and let them know of clinical trials that may be suitable for their patients.”

Positive physician partnerships

In one visit, patients receive a multidisciplinary assessment by a surgical oncologist, gastroenterologist, and a genetic counselor. After the risk assessment is complete, the patient undergoes a screening, which includes imaging studies and/or endoscopic studies for early detection of pancreatic changes that may be cancerous or precancerous. Specialists also conduct genetic testing, followed by counseling and a custom surveillance plan developed for ongoing patient monitoring.

Candidates for the clinic include those with a first-degree relative diagnosed with pancreatic cancer at or before age 45, two or more first-degree relatives diagnosed at any age, or those with one first-degree relative and two second-degree relatives with malignancies. Patients with inherited genetic syndromes and gene alterations would also be at risk. Patients can be screened for other associated diseases like breast, prostate, and ovarian cancer.

“Lifelong surveillance is recommended for patients at elevated risk of developing pancreatic cancer to improve survival,” Dr. Monga explained. “The goal of pancreatic surveillance is to reduce mortality through early detection by allowing for identification of cancer at earlier stages or identification of high-grade dysplasia.”

Center of Excellence Designation

The National Pancreas Foundation (NPF) designated AHN’s Pancreas Cancer Program a Center of Excellence. This designation is given to premier health care facilities that focus on the multidisciplinary treatment of pancreas disease, treating the whole patient with a focus on the best possible outcomes and improved quality of life. Centers such as the one at AHN help patients with pain management, nutrition information, surgery, and psychosocial support.

To receive this designation, AHN had to undergo an extensive auditing process and meet the criteria developed by a task force composed of pancreas disease clinicians and patient advocates. The criteria include required expert physician specialties, such as gastroenterologists, pancreas surgeons, and interventional radiologists, along with more patient-focused programs.

Dr. Monga said multidisciplinary care is nothing new in medicine, but the AHN Cancer Institute truly takes it to a level of daily collaboration. She explained that specialists from surgical oncology, medical oncology, radiation oncology, and pathology, to name a few, meet weekly to discuss patient cases. During these tumor board meetings, physicians discuss the most appropriate path forward for patients.

“These in-depth discussions lead to better outcomes for our patients,” Dr. Monga said. “And outside of those meetings, we connect with each other continually to follow up on patients and keep their care cohesive.”

Treatments for pancreatic cancer continue to evolve. Patients with operable tumors often benefit from neoadjuvant chemotherapy followed by surgery and adjuvant therapy to manage micrometastatic disease.

Other therapies are incredibly personalized, Dr. Monga said. Next-generation sequencing is essential for all patients, particularly those with advanced disease, to identify potential targets for targeted therapies. AHN also has clinical trials that are investigating immunotherapy and vaccines.

Beyond the medicine

Early referral to palliative care can improve quality of life and life expectancy for patients with advanced disease. At the AHN Cancer Institute, every patient is offered a personal navigation team to help with coordinating their care. These navigators give guidance, emotional support, and financial counseling, so patients can focus on healing.

Navigators connect with their patients at diagnosis and follow them to survival or end of life. They also provide referrals to additional support services, such as pain management, nutrition, and behavioral health. The navigation teams include nurses and supportive care professionals who can help with the details of appointments, records, and test results. This helps to streamline care and simplify the process for patients.

“This care addresses the emotional and physical challenges patients face,” Dr. Monga said. “It’s not just for end-of-life care. It’s to keep these patients living in the most positive and healthy way possible.”

The Cancer Institute has also launched a dedicated oncology rehabilitation and exercise program, recognizing the importance of physical activity in managing chemotherapy side effects and improving overall health.

“Like any medical condition, patients can become sedentary and lose interest in getting up and moving,” Dr. Monga said. “We've seen firsthand how even basic exercise can help patients with pancreatic cancer cope with neuropathy and other challenges.”

AHN’s multidisciplinary team is available to consult with community oncologists and other physicians, offering guidance on treatment decisions, surgical referrals, and treatment modifications.

The High-Risk Pancreatic Cancer Clinic is held monthly at AHN Allegheny General Hospital and AHN Wexford Hospital for prescheduled appointments. If you’re interested in referring your patients, call 412-359-3115.