Northwestern Medicine team correctly diagnoses man with rare pancreatic cancer, offering surgical cure

Alex Timchak portrait

OAK BROOK, ILLINOIS – Over the Fourth of July holiday weekend, Alex Timchak, 47, had a deep cough. Days later, the cough went away, but pain in his left side did not.

“That was new. I never had that before and after about a week, I decided I needed to reach out to my primary care doctor,” said Timchak, a psychiatrist who lives in River Forest, Illinois.   

Timchak says his primary care doctor told him imaging showed his pancreas was inflamed and the pancreatic duct was enlarged. He referred Timchak to a gastroenterologist at another health system. During an endoscopy, no mass was detected, but a biopsy was obtained near the area where the pancreatic duct looked abnormal. The biopsy results came back normal, and the gastroenterologist recommended follow-up imaging in a month.

“That didn't seem to make the most sense to me, so I made an appointment at Northwestern Medicine for a second opinion,” Timchak said. 

Getting a second opinion

Timchak went to see interventional gastroenterologist Sri Komanduri, MD, at the Northwestern Medicine Oak Brook Outpatient Center and underwent another biopsy.

While waiting for the results, Timchak and his wife visited their son, who attends college at the University of Alabama. They had just sat in the stadium for their first Alabama football game, when Dr. Komanduri called with the results.

“Fortunately for Alex, we did repeat that endoscopic ultrasound and what we saw was a small growth in the pancreas. However, when we took the biopsy of this lesion, this came back as what is called a neuroendocrine tumor, which is very different than a typical cancer of the pancreas or what we call adenocarcinoma,” Dr. Komanduri said. “The reason this is so different is it has a much slower growth rate and doesn't spread to adjacent organs anywhere nearly as quickly as the standard cancer of the pancreas.”

“I am not going to lie, I jumped up and pumped my fist and screamed loudly, ‘Yes’, because I knew that this was a completely different picture than what I was most fearing,” Timchak said.

At Alabama football game

Fearing the worst

Timchak had been worried he would suffer the same fate as his father, who died of pancreatic ductal adenocarcinoma at age 70. 

“I've got four amazing kids, a beautiful wife and a job that I love, and the thought of having to fight a really aggressive cancer that has a very low, five-year survival rate that was a lot to have to think about and work through,” said Timchak.

Learning he had a different form of cancer that was highly treatable was a gamechanger. 

Dr. Komanduri recommended a referral for consideration of surgery to remove the cancerous lesion. 

Alex with his kids at NMH

Moving forward, cancer-free

Surgical oncologist David Bentrem, MD, with the Robert H. Lurie Comprehensive Cancer Center at Northwestern Memorial Hospital, discussed surgical options with Timchak. They determined a Whipple procedure, which involves removing the head of the pancreas, the first part of the small intestine and the gall bladder and a portion of the bile duct, was the best course of action.

“By removing the lesion completely, we are eliminating the need for any further treatment. Alex will need monitoring and surveillance, but there’s no need for chemotherapy or radiation. The cure rate is over 90%,” Dr. Bentrem said. 

Two weeks before Thanksgiving, on November 14, the procedure was performed at Northwestern Memorial, successfully removing the cancerous tumor.

The tumor had clear margins and 24 lymph nodes were negative for cancer. Timchak said the operation and recovery all went as planned.

“To be able to get back to a point where I am almost back to my pre-surgical level of functioning is just such a blessing and a gift and it's because I have a supportive family and supportive colleagues, but also an amazing medical team here at Northwestern Medicine,” Timchak said.

Scan of Alex's tumor

Understanding pancreatic neuroendocrine tumors

Pancreatic neuroendocrine tumors (NETs) are less common than other types of pancreatic cancer and often misdiagnosed, which can delay diagnosis and treatment. 

Northwestern Medicine offers a multidisciplinary team of experts who specialize in NETs with care available at locations across Chicagoland, including pathologists with experise in identifying and diagnosing these rare tumors.

“Neuroendocrine tumors are rare in general,” said Dr. Komanduri. “With that said, when we're talking about all the growths that we see in the pancreas, even amongst that, the vast majority are adenocarcinoma, or cancers of the pancreas. However, a small percentage of them can be these neuroendocrine tumors which make the proper testing and diagnosis very critical, in terms of which direction you take the patient moving forward,” Dr. Komanduri said.

For more information about NETs and treatment options for pancreatic cancer, visit nm.org.