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How Can Loss Of Appetite Due To Pancreatic Cancer Be Treated?

Posted on Wed, 9 Aug 2017

Question: I have been on this site for several years and my worse fear came to pass. Since May of this year I was diagnosed with locally advanced pancreatic cancer. I have been devastated.My GI doctors have been following my IPMN lesions since 2014. How could this happen? I have had 2 PET scans, 3CT's, several MRI's and EUS. In everyone of these scans no primary tumor is found. The Lesions are always stable and show no change. The cytology shows the cancer originating in the Pancreas, but no tumor. My Ca antigen 19-9 is only 18. My cancer encases the celiax and SMA and at this time is not resectable. But I did meet with a specialized surgeon at the Mayo clinic who can do surgery on locally advanced adencarcinoma. I started Chemo with Folfirinox. I have no appetite and continue to lose weight. I have lost 15 pounds since February and need to stop this trend. Please comment on my cancer that shows no primary tumor and how can that be possible? Also I am desperate to find a way to start eating. This has caused much torment and I believe it should have never got to this point because of the supervision that took place. Also, what is new or another type of treatment in the event the chemo doesn't work? Finally is a feeding tube a possibility if my no appetite continues?

Answered by Dr. Deepak Sundriyal (36 minutes later)

Brief Answer:
Hello. Sometimes primary may not be there

Detailed Answer:
Hello dear. I have gone through the details.

So it is sometimes possible that the primary gets autolysed and hence not visualised but the immunohistochemistry marker of the tumor suggest a pancreatic origin.

Since you have a locally advanced tumor, Folfirinox in the beginning follwed by surgery at the time of tumor shrinkage is the right approach.

If somehow that doesn't work, chemoradiation will be the next strategy.

For your feeding, I will advise a feeding tube straightforward. You should not wait for the appetite to be normal.

Thanks and regards
Feel free to ask further

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Deepak Sundriyal (18 minutes later)

If the primary tumor gets autolysed how can the existing cancer spread? Is it a good thing or a bad thing to have no primary tumor?

Answered by Dr. Deepak Sundriyal (2 minutes later)

Brief Answer:
Hello. It doesnot make good or bad

Detailed Answer:
Hello dear. Existing cancer has its own blood supply. The prognosis doesnot depend on the presence of primary tumor. If it is respectable, it has to be taken out. You are getting the right treatment.
Thanks and regards

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Deepak Sundriyal (35 hours later)

I had a chest Xray and chest CT Scan yesterday. My Xray show a new 1.5mg nodular density in left lower lung zone. The CT does not mention this nodular. What could this nodular represent?

Answered by Dr. Deepak Sundriyal (5 hours later)

Brief Answer:
Hello. That can be anything

Detailed Answer:
Hello dear. Difficult to say but that can be anything frin a calcified lesion, infected lesion or a fibrotic lesion.
Thanks and regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Deepak Sundriyal (1 hour later)

Dr XXXXXXX is it possible that the new nodular found By Xray in the lower left lung region could be spread from my pancreas cancer? The Ct scan report does not mention this nodular.

Answered by Dr. Deepak Sundriyal (5 hours later)

Brief Answer:
Hello. It may be possible

Detailed Answer:
Hello. Ideally speaking, the sensitivity of ct to pick smaller lesions is greater than that of xray. So i dismiss the xray lesion as nonsignificant if it is not there on ct. Still one cant be 100 percent sure and only an fnac or biopsy can tell with surity.
You need not to worry.
Thanks and regards

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Deepak Sundriyal (3 days later)

Dr XXXXXXX my ca antigen 19-9 went from16 to 35 in two months. What does this mean? I started my chemo the day it was at 35.

Answered by Dr. Deepak Sundriyal (12 minutes later)

Brief Answer:
Hello. It. Means disease is progressing

Detailed Answer:
Hello dear. Although still in the range, rising ca 19.9 crudely suggest that the disease is slowly progressing.
Thanks and regards

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Deepak Sundriyal (31 minutes later)

More to worry about. What does in range mean? And does slowly progression have any benefit?

Answered by Dr. Deepak Sundriyal (2 minutes later)

Brief Answer:
Hello. Nothing to worry

Detailed Answer:
Hello again. Nothing to worry as you are on treatment. Moreover, its a crude marker and not a guaranteed one. Lastly, we take upper limit of range as 37.
Thanks and regards

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Above answer was peer-reviewed by : Dr. Remy Koshy