In October 2016, Bill Donarski, of Green Bay, attended his nephew’s wedding. He and his wife enjoyed a full day of family and friends, but afterward Bill began to feel itchy.
“It was weird because there was nothing I could point to as the cause,” said Bill, 55, a criminal defense attorney. “I had finished a difficult jury trial two days earlier, so I just chalked it up to stress.”
But over the next week, his itching went from bad to worse. He also began experiencing diarrhea and other odd symptoms. Suspecting a blocked bile duct, his family physician sent him for imaging. Two days later, CT scans confirmed a biliary obstruction.
Later that week, specialists in Green Bay used an endoscope to examine Bill’s bile duct and look for a possible tumor. They placed a stent to hold the duct open and also took biopsy samples. To Bill’s relief, the samples showed no signs of cancer.
Bill felt better for a few days, but then the itching came back stronger than ever. He developed jaundice, and a bout of sepsis landed him in the hospital during Thanksgiving week. Doctors placed a larger stent, but it did not provide lasting relief. He had a battery of tests, including another biopsy. Still, his physicians found no malignancies.
“At this point, my specialist in Green Bay said he had never seen anything like this,” Bill said. “He told me he needed to refer me to a hospital where they see cases like mine all the time.”
Bill and his wife were soon driving to Froedtert & the Medical College of Wisconsin Froedtert Hospital. There, gastroenterologists used endoscopic ultrasound and discovered a tiny lesion in the ampulla of Vater, the opening where digestive enzymes flow into the small intestines.
“It ended up being cancer, and they found it on the first try,” Bill said.
Unique approach to care
“One of the challenges with pancreatic cancer is that it can be difficult to diagnose if it is not causing any symptoms,” said Beth Erickson, MD, radiation oncologist and MCW faculty. “In Bill’s case, he had a bile duct obstruction, which led to a relatively early diagnosis.”
The next step was to decide on a care plan. Cancer experts within the Froedtert & MCW Cancer Network craft personalized care plans during weekly tumor board meetings.
“In this day and age, the tumor board is absolutely instrumental in cancer care,” said Kathleen Christians, MD, surgical oncologist and MCW faculty. “It brings together all the different specialists involved in treating these cancers and lets us have an in-person discussion about each patient’s care.”
Specialists at the pancreatic tumor board discussed Bill’s case extensively. The group ultimately decided on an advanced approach, giving Bill a combination of radiation therapy and chemotherapy before he had surgery.
“In many other hospitals, a patient like Bill would likely have surgery first,” Dr. Erickson said. “But we have found patient outcomes are better when surgery is almost last in the sequence.”
Bill received radiation therapy at Froedtert Hospital every weekday for more than a month. Weekly chemotherapy infusions were supervised by Paul Ritch, MD, hematologist/ oncologist and MCW faculty. This approach appeared to work well. After the chemoradiation was complete, follow-up imaging detected no spread of cancer cells, and blood tests showed a drop in markers for malignant disease.
In April 2017, a team led by Dr. Christians performed an extensive surgery called the Whipple procedure. It involves removing parts of the pancreas, stomach, bile duct, adjacent lymph nodes and gallbladder. After the complex surgery, Bill received good news: Tissues that had surrounded the tumor and all 27 lymph nodes tested negative for cancer.
Because the surgery proceeded without complication, Bill had a relatively short hospital stay and was able to complete chemotherapy through his local oncologist. The combination of chemotherapy, radiation therapy and surgery provided him with the best chance for a good cancer outcome.
Expertise made the difference
More than a year after his surgery, Bill remains cancer-free and feels great. He said the choice to seek treatment from the Cancer Network was the best decision he ever made.
“I would absolutely recommend Froedtert Hospital to others, especially for something very complicated like the Whipple,” he said. “Hospitals in my area do this surgery but maybe only a few per year. At Froedtert Hospital, they may do multiple Whipples each week.”
Dr. Erickson believes Bill’s choice to work with an academic medicine team was critical. “Bill had a very difficult diagnostic dilemma, and he was willing to take the extra step and be referred to us,” she said. “Some people aren’t willing to leave their city, but in many cases it can be lifesaving.”
Bill has nothing but respect for the specialist at home who knew when to refer him for a higher level of care.
“If you have a problem your physicians have not seen, then you need to go to the experts,” he said. “That’s when going to an academic medical center like Froedtert Hospital makes a big difference — because that’s where the experts are.”
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I have been told that there is a cyst in the headod my pancreas. My Dr keeps asking if I want surgery or we can just monitor it. It's slow growing but the kind that can turn to cancer. I do not know what to do. I am a fairly healthy 71yearold and have a family history of pancreatic cancer.