Surgical options to remove cysts in the pancreas have greatly improved in past decade

Surprise discovery of precancerous cysts in his pancreas threatened Jim Page’s life, but surgical care from a dedicated UCHealth team saved it.
May 7, 2020
Jim Page and wife Ginny stand on a glacier in New Zealand just months after surgery at UCHealth removed a cyst in the pancreas.
Jim Page and his wife, Ginny, ski a glacier in New Zealand just months after surgery at UCHealth removed cysts in his pancreas. Photo courtesy of Jim Page.

Jim Page has had a 70-year love affair with skiing. If the oft-quoted observation that geography is destiny is true, he grew up in the right place to meet the object of his affection.

That would be Lake Placid, New York, which averages 102 inches of snowfall a year. A guy could spend months shoveling the white stuff and waiting for the spring thaw.  Page had other ideas.

“You had to do something in Lake Placid in the winter,” Page said. “I chose skiing.”

For Page, now 78, hitting the slopes became far more than a diversion. He began skiing competitively in high school and went on to compete at Ivy League Dartmouth College in New Hampshire. Page won three individual NCAA championships, including one for cross country in 1962 and consecutive titles in 1962 and 1963 for skimeister (awarded for the best all-around performance in downhill, slalom, cross-country and ski jumping).

In 1964, Page qualified for the Winter Olympics in Innsbruck, Austria, and competed in ski jumping. A bronchial infection he couldn’t shake hurt his performance. He finished 28th, putting an end to his competitive skiing career, but not to his connection to the sport. He went on to return to Dartmouth to coach for six years, a stint that included an NCAA championship in 1976. He also coached with the U.S. Olympic Ski Team for nine years before moving on to a long stint with the United States Olympic Committee (USOC).

Sticking to the slopes

Page retired from the USOC in 2005, but not from the slopes. He still skis recreationally, traveling to Colorado resorts like Vail and Copper Mountain a couple of times a week from his home in Manitou Springs.

“I have been fortunate to have skiing in my life,” Page said. “I’ve been able to spend time with athletes and travel extensively and ski in some of the greatest environments around the globe. I need to get in as many days as I can because I love doing and it and because it’s just part of my soul.”

The brush with ill health that cost him at Innsbruck sharpened Page’s focus as he built his career. He devoted much of his years after setting aside competitive skiing to finding ways to use science and medicine to help train athletes to reach their peak performance.

Last year, however, he needed help from science and medicine himself. Page faced an opponent that threatened not only his ability to ski but also his life. He’s back to making turns in fresh powder, thanks to care he received from the UCHealth Pancreas and Biliary Multidisciplinary Clinic and to insights he gained from the sport he loves. His uplifting story also carries a cautionary message.

Surprise discovery: possible cysts in the pancreas

Early in 2019, Page had an MRI with a Colorado Springs provider to check out a suspicious lesion on his liver. That didn’t turn out to be a problem, but the test also showed a possible cyst in the pancreas, an organ that regulates digestion and blood sugar levels in the body. An MRI three years before had also revealed a spot, but Page wasn’t told to follow up. Now, however, the suspect area seemed to have grown. Page’s gastroenterologist advised him to get it looked at by a specialist.

Dr. Marco Del Chiaro helps remove cysts in the pancreas.
Dr. Marco Del Chiaro

On his own, Page located Dr. Marco Del Chiaro, chief of Surgical Oncology and director of the Hepatopancreatobiliary Program at the University of Colorado School of Medicine. In July 2019, Page traveled from his home to Aurora for two endoscopic ultrasound probes of the pancreas at UCHealth University of Colorado Hospital on the Anschutz Medical Campus. The tests showed that he had precancerous cysts dilating the main duct of his pancreas, a condition called intraductal papillary mucinous neoplasm (IPMN).

Options to remove cysts in pancreas

Without treatment, the cysts in his pancreas would almost certainly have progressed to pancreatic cancer, Del Chiaro said. Prevention and early detection are important for all cancers, but especially so for pancreatic cancer, which had an improving but still low five-year survival rate of just 9.3 percent for the period 2009-2015, according to the National Cancer Institute. By comparison, the five-year survival rate for lung cancer, the number-one cancer killer, was 19.4 percent for the same period.

Had Page not gotten the MRI for the liver lesion, it’s unlikely he would have discovered the IPMN, as he experienced no symptoms. The element of luck involved is all too common, said Del Chiaro, who noted he has recently operated on several patients who tell a story similar to Page’s. It’s why it is important that providers tell patients of any unusual finding on an image of the pancreas. Patients who receive the news should visit a medical center that is dedicated to treating pancreatic disease and can recognize the often subtle signs of it, he added.

“Recognizing a lesion is part of prevention of pancreatic disease,” Del Chiaro said. “But you cannot identify it if you cannot recognize it.”

Commitment to excellence in pancreas health care arena

The expertise that benefited Jim Page has not gone unnoticed on the national stage. University of Colorado Cancer Center was recently named a Center of Excellence by the National Pancreas Foundation. The designation reflects the Cancer Center’s broad range of medical, educational and social services as well as its commitment to research. The backbone of the program is multidisciplinary care that includes specialists in surgery, medical and radiation oncology, diagnostic and interventional radiology, pathology, gastroenterology, genetics, pain, and endocrinology.

Dr. Richard Schulick helps remove cysts in the pancreas.
Dr. Richard Schulick

The multidisciplinary team holds weekly pancreas-specific  meetings to discuss all cases and arrive at a mutually agreed-upon treatment plan tailored to each patient’s needs. “Each team member has a role to play in taking care of the patient,” said Dr. Richard Schulick, chairman of CU’s Department of Surgery and director of the Cancer Center.

The team’s recommendation for Page was surgery, which Del Chiaro performed in early August 2019. In a Whipple Procedure, Del Chiaro removed half of Page’s pancreas; the distal bile duct, which runs through the pancreas into the small intestine; the gallbladder; and the first part of the small intestine. He then reconnected the remaining pancreas to Page’s digestive organs.

The Whipple Procedure is most often performed on patients with pancreatic cancer, Del Chiaro said. “What’s exceptional [in Page’s case] is that we caught the lesion, and that saved his life. Now he has a normal life. The lesion is cured.”

Taking on tough cases of pancreatic cancer

Pancreatic cancer is a stubborn opponent. It’s situated deep in the body and is therefore difficult to reach. As yet there is no reliable test for it. But experience helps to level the playing field, Del Chiaro said, noting the Cancer Center performed some 200 procedures for pancreatic disease last year. That, along with early diagnosis and improved radiation and chemotherapy treatment, can boost patient outcomes.

“Centralization of pancreatic surgery is the key to improved results,” Del Chiaro said. “The volume of a center’s patients makes a difference.”

man on skis after cysts in the pancreas removed.
Page was back to making regular ski trips to Vail after the removal of cysts in his pancreas. Photo courtesy of Jim Page.

One such difference is the willingness of the Cancer Center to more often consider surgery for patients with pancreatic cancer, Schulick said. He noted, for example, that many surgical oncologists will not operate on pancreas cancer that has invaded the main arteries and vein that feed the organ.

“Few people will take that on, but we will,” said Schulick, explaining that the center’s surgical team has expertise dealing with both the cancer and the blood vessels involved. The cancer must not have metastasized (spread outside the pancreas), he stressed. Other factors, including a favorable response to chemotherapy and time for observation, go into the decision.

Del Chiaro added that cancer that does not metastasize is a sign of hope, even if it seems that a patient’s treatment hasn’t progressed. For example, if chemotherapy doesn’t shrink a tumor, it’s not necessarily a sign of failure. If the cancer has not spread, surgery could still be an option. Patients in that situation could consider seeking a second opinion, he maintained.

“If you can control the disease, you can be more aggressive in removing the source of the cancer cells, which is the primary tumor,” Del Chiaro said.

“We’re doing operations today that we would not have done 10 years ago,” Schulick said. “If we put these patients through [our] multidisciplinary process, and they have gone through all the appropriate steps, we are very confident taking patients to the OR for resection and that we will get good results.”

Aggressive surgery is not the choice for every patient, he cautioned. “As important as selecting the right patient, is not doing very aggressive surgery on the wrong patient,” Schulick said. “If you do, you’re going to get bad results.”

Back to the slopes after cysts in the pancreas were removed

Jim Page is grateful that the help he got from Del Chiaro and the team has for now headed off even more difficult decisions. He spent 10 days at UCH following the Whipple surgery and is back to skiing in the winter, golfing and hiking with renewed vigor and no limitations. The incomparable vistas of the Garden of the Gods that lie just outside his door provide an added spur.

He credits Del Chiaro and the expertise of the entire multidisciplinary team for helping him to make an informed decision about his surgery.

“The entire staff was fabulous,” Page said. “I went into the surgery with a high level of confidence in part because of the successful surgeries the physicians had done, but also in part because I trusted that the people at the center would make me better. I think the confidence that I had that I could recover completely was a big driver in getting me going afterwards,” Page said.

family lined up in meadow in the mountains on a sunny day.
Page (far right) hiking last fall in Telluride with (left to right) friend Ian Hiebert, granddaughter Page McCargo, daughter Jenny Page, granddaughter Sydney Martin, and wife Ginny. Photo courtesy of Jim Page.

That point demonstrates that with any procedure, a patient committed to recovery makes even the most highly skilled medical team better. Page’s disappointing experience at the Olympics more than half a century ago taught him an important lesson that he used as he prepared for his pancreatic battle.

“I learned that if you are not in good shape, you can’t perform at a high level,” he said.

Page carried that insight forward in his career as a coach and USOC committee member, establishing volunteer physician and trainer programs to support athletes and prepare them to reach their maximum competitive potential. The effort paid off most notably at the 2002 Winter Olympics in Salt Lake City, where the United States team won 34 medals, nearly triple its best previous effort.

Nearly 20 years later, Page committed to preparing for surgery and recovering from it with the same sense of purpose.

“I knew going into surgery that you have to be in the best shape you can be,” he said. “I intensified my walking, hiking and time in the gym. Dr. Del Chiaro is a great surgeon, but he says surgery is all about how a patient recovers. That’s up to me.”

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.