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Suggest treatment for Pancreatic Cancer

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Posted on Mon, 14 Apr 2014
Question: Hi one of my friend is suffering from Pancreatic Cancer from last 9 months,he has been given chemo therapies and all CT Scan & CA19-9 test are done wen reqd. After the first scan after chemo the size of the tumor got reduced and CA19-9 reports were also in favor.The same treatment continued for say 6-7 months and in scans it was found that the size of the tumor was same as in previous scan and CA19-9 report was also in favour not much deviations were there & it did not spreaded in the body.In last 1.5 months the line of treatment was changed more strong chemo was given with the hope that size will get reduced and can be in a stage where it can be removed from the body but in the recent scan it was again found that tumor was in same size & it did not spreaded by god's grace but CA19-9 report was not in favour counts were very increased there was lot of deviation.My friend again went for his second biopsy in which it was concluded that tumor is cancerous.The situation is that inspite of strong chemo the size and condition of tumor is same but CA19-9 has increased,what should be concluded what should be line of treatment Can you please advice any Pancreatic Cancer Specialist of India,Asia or Globe who can probably help out with the case or do you suggest that the treatment should be taken out of India,as because as per articles if CA19-9 increase the tumor should also increase but here tumor is same from last 6-7 months only the deviations can be seen in CA19-9 ....the cancer has also not spreaded which is a good thing in itself.the situation has became very dicy... what is to be done or do you suggest any other Big scan which can probably give most accurate results...I want that this query should be answered by any Oncolgist Specialist or to the related field
doctor
Answered by Dr. Krishna Kiran Kannepalli (1 hour later)
Brief Answer: Need more tests. Detailed Answer: Hi. Thanks for the query. It is a difficult situation for friends and family and I know what you are going through. Regarding your query, I have read it in detail. The fact that your friend is being treated with chemotherapy first means that it is an advanced stage. According to the details provided by you, it is probably a locally advanced pancreatic cancer. Size is not the only criterion for response assessment. First there will be some variation in size when measured by two different radiologists and this is known as inter observer variability and it can't be totally eliminated. Secondly, the fact that CA 19-9 is rising suggests that the tumor is progressing. CTscanalone is not enough in this situation. We need more tests. One of them is a whole body PET-CT. It is a good test in detecting distant metastasis especially in the liver. The second test which is superior to CT scan in determining local extent, especially vessel involvement and nodal status is EUS(endoscopic ultrasound). Based on these tests we can come to a conclusion whether it is worth operating or not. In case the tumor is not operable, local radiation can be given if it had not spread elsewhere and that will provide some relief.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Krishna Kiran Kannepalli (20 minutes later)
Thank you for your response can u please guide with name of a specialist in india or out of india....please advice do this treatment shld b taken out of india plz advice the name of doctor country hospital nd if in india doctor name and all...bt yes one thing i wld like to tell if we tlk abt the physical appearence of my friend he doesnt seem to be a patient....as per your reply does it seem to be a critical issue...as i mentioned the size is nt increased in ct scan it has shown it has not spreaded...bt as per your guidance a pet scan is reqd to check....plz advice abt a specialist in india or out of india
doctor
Answered by Dr. Krishna Kiran Kannepalli (36 minutes later)
Brief Answer: Tata Memorial, Mumbai or AIIMS, New Delhi. Detailed Answer: Thanks for the query. TATA MEMORIAL HOSPITAL Mumbai is one of the premier hospitals in India and Dr. XXXXXXX Shrikhande who is the HOD of GI oncology has good experience. If you are in North India, you can consult with Dr. Durgatosh Pandey at IRCH, AIIMS.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Krishna Kiran Kannepalli (20 hours later)
Hi,thank you for your reply....it has been detected that it is adenocarcinoma pancreatic cancer....only the good part is that it has not spreaded as per ct scan but then there is no treatment until the size is not reduced, even the radiation cannot be given as the tumor is surrounded by sensitive organs...as per doctors...do u still suggest to go in for a pet scan or any other test....please advice the specialist who can realy guide us wat best can be done specialist from india or from out of india as major good research centres r outside india plz share the details...also throw light if it spreads in other parts wat can be the symtoms...
doctor
Answered by Dr. Krishna Kiran Kannepalli (8 minutes later)
Brief Answer: PET-CT and EUS ate useful. Detailed Answer: Hi. Thanks for the query. As I have already mentioned in the previous reply, PET-CT and EUS are required in this case. At EUS, fiducials(radio-opaque markers ) are placed at the tumor site which can help in targeted radiation without damaging the other organs. That best center in the world is Memorial XXXXXXX Kettering Cancer center in New York. You can take him there.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Krishna Kiran Kannepalli (1 hour later)
Hi thankyou for your reply i have been trying to search about dr.durgatosh pandey on google regd his contact details on how to go in for appointment but unfortunately no such detail is available on google...plz guide from where the appointment can be taken as no contact detail is there on net only the profile as he is a faculti in aiims nd other institutes... please guide from where i can get the contact dtails from where the appointment cn b taken...if dr.pandey is in mumbai my friend is there he can probably try nd meet him nd consult him
doctor
Answered by Dr. Krishna Kiran Kannepalli (15 hours later)
Brief Answer: AIIMS, New Delhi Detailed Answer: Hi. Thanks for the query. I only know that Dr.Pandey works at AIIMS, New Delhi. I am sorry I don't have his contact details.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Krishna Kiran Kannepalli

Oncologist, Surgical

Practicing since :2004

Answered : 59 Questions

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Suggest treatment for Pancreatic Cancer

Brief Answer: Need more tests. Detailed Answer: Hi. Thanks for the query. It is a difficult situation for friends and family and I know what you are going through. Regarding your query, I have read it in detail. The fact that your friend is being treated with chemotherapy first means that it is an advanced stage. According to the details provided by you, it is probably a locally advanced pancreatic cancer. Size is not the only criterion for response assessment. First there will be some variation in size when measured by two different radiologists and this is known as inter observer variability and it can't be totally eliminated. Secondly, the fact that CA 19-9 is rising suggests that the tumor is progressing. CTscanalone is not enough in this situation. We need more tests. One of them is a whole body PET-CT. It is a good test in detecting distant metastasis especially in the liver. The second test which is superior to CT scan in determining local extent, especially vessel involvement and nodal status is EUS(endoscopic ultrasound). Based on these tests we can come to a conclusion whether it is worth operating or not. In case the tumor is not operable, local radiation can be given if it had not spread elsewhere and that will provide some relief.