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    Suggest ways to manage pancreas cancer

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Posted on Mon, 12 Jan 2015 in General Health
Question: Hi, I was pleased with your last answere.
I would like to make a summary of my wifes treatment.
February 2014 she was operated for cancer at the "head" of the pancreas.
She received chemotherapy till september.
No treatment till december, when she got the same symptoms. (yellow skin).
They then made a bypass to the Whipple by-pass, and more chemo therapy till september when it stopped. 10.th of december this year she became very sick. Vomitting all she ate. While she had the chemo therapy treatment, she had CAT Scan of the tumor.
Thorough testing has revealed that the tumor has closed the small intestins and she will have a external bag for the feces. They say that it will be dry as the liquid is going to the kidneys.
I have three questions:
1. Is it usual to completely stop the CAT Scan and the chemotherapy for three months like they did? The tumor grew like wild fire in both periods? (September to December, 2013 and 2014)
2. They tell me that the tumor closed the small intestins far down, so the bottle on the stomack will have mainly solids. How is that possible as the small intestins start at the stomack and meanders vertically downwards?
3. They do not want to put a tube in the intestins as they say that was usual a few years age, but many bad results have stopped the procedure. I do not think she has long to live, but I think that would improve her quality of life. What do you think?
I may have to pay thre times for three answeres, but so be it.

doctor
Answered by Dr. Grzegorz Stanko 31 minutes later
Brief Answer:
Pancreatic Cancer information and Management...

Detailed Answer:
Hello!

Thank you for the query.

First of all some explanation. I am really sorry for your wife and for you being in such hard situation. I see you do know that not much life has left for her. This is actually sad but true. Pancreas cancer is the worst cancer from all possible cancers. For now we do not know how to treat it. It does not respond to any chemotherapy. Not at all. Even if the tumor can be removed, the chances for being cured is less than 10% (mostly 0%).
If its about chemotherapy, please note that this is a toxic treatment. It destroys bone narrow, liver, kidneys and heart. The complete dosage of chemotherapy can not be higher than the toxicity level. In simple words every person can take some dosage if it and no more.
Moreover, during the chemotherapy the response for it is checked. If there is no response after lets say 2-3 cycles, there is a need to consider chemotherapy termination. The same situation is with CAT scans. Continuing both chemo and scans can give more harm to the body without any benefits.

So answering your questions:
1. Yes, it is usual to terminate chemotherapy and CAT scans if there is no response for it. Most likely with or without chemo the tumor grows in the same way. CAT is a test which should be done for some reason. Just knowing how the tumor grows and not being able to do anything with makes this test pointless.
2. After the Whipple surgery, small intestine is not located as it has been before. When we finish the surgery, we put back small intestine in rather random location. The point is to do not make it twisted, rest is less important. Moreover, Whipple surgery makes a part of small intestine attached to the pancreas and bile ducts. So now you can not be sure how the intestine is located and which part of it is being obstructed. If its about the liquidity of the stool, even at the end of small intestine, it still contains lots of water. Its because water is absorbed on the large intestine, not small. So her stool will be watery for sure.
3. Jejunostomy (small intestine tube to give liquids) want change anything. It can give her more suffering as the surgery is necessary to put it. And it is possible that they wont be able to find the place to put this tube. So I do not think its a good idea. What can give her more comfort is parenteral nutrition (food give to the veins).

I wish I could give you some hope or support. But trying to be hones with you, I had to write whole true.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5768 Questions

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