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Slow-Growing, Malignant, Pancreatic Tumor?

Pancreatic Cancer Discussions

Slow-Growing, Malignant, Pancreatic Tumor?

Postby okes » Sat Jul 14, 2012 6:16 am

My elderly friend was complaining of nausea, vomitting, with considerable weight loss. In Early 2011, a 2.5cm tumor was found at the head of the pancreas. Sent to another city.

Two biopsies were performed, both came back as negative for cancer. Twice they placed stents to keep the biliary duct open, but had to go back both times to remove the stents ... initially saying they would come out on their own, but since they didn't they went back to retrieve them. One doctor wanted to operate to resect the tumor, but my friends cardiologist would not agree to take them off of their medications so that an operation could be performed. So, they sent my friend back home with instructions to continue watching the tumor.

Some months later, with no alleviation in pain, his GI doctor gave my friend an injection via endoscopy near the tumor to control pain. This worked to control the pain and my friend regained their weight.

Of course, the pain returned and my friend started losing weight again; so recently, another imaging study was done. The tumor had grown in size from last year. The GI doctor referred my friend to another doctor.

When my friend arrived at new doctor, they were surprised to find that their GI doctor had referred them to a surgeon at a cancer center, who tells them, "there is no way this cannot be cancer ... you are not a candidate for surgery ... I have not lost a patient on the table yet and am not about to start". Sent back to his GI doctor with instructions to keep getting endoscopic pain injections.

Of course, I am hours away and hear all of this second hand, and was told that chemo/rad was in the future for a 'walnut-sized tumor'.

A call was arranged for me to speak with surgical oncologist. In the mean time, I talk to physicist friend and find out this is what he does - in cases of inoperable cancer, uses a 'cyberknife' in 'radiosurgery' procedure at direction of MD - extending life to an average of 22 months. Great, I think.

So, on to call with surgeon.

When I ask about:

Malignancy - Cannot say with 100% assurance it is malignant, but 95% sure it is based on symptoms

Tumor size - Doesn't know, doesn't have file right now and can't remember

Metastasis - It has not metastasized

Biposies - Notorious for not finding cancer. Can only prove it is cancer, cannot prove it is not cancer

Radio Therapy - Not a candidate for surgery, chemotherapy, radiation therapy, or radio-surgery due to cardio-pulmonary problems

Ongoing symptoms for 1.5 years - Maybe a slow growing tumor, could live with it for years

What to do next - No longer his doctor, sent back to GI doctor. Can only treat symptoms

First thing, all of this is very condensed. Some information is second hand. Not complaining about doctors, procedures, prognosis, etc. Just trying to understand what is happening and what to expect.

All my knowledge says - Pancreatic cancer is incurable. Once diagnosed prognosis not good. Less than 20% survive past the first year, less than 5% survive past 5 years - and this is with treatment. Death process is very painful.

If any doctor, nurse, or other medical professional is out there reading this that has a good understanding of pancreatic cancer, what can you tell me?

Is there some type of diagnostic procedure that can determine with 100% accuracy if tumor is malignant? How can surgeon know it has not metastasized?
I can understand conventional surgery not being an option due to cardio-pulmonary, but what about Radio surgery? I thought it was much more precise and way less damaging. Or chemo? I know it is basically poison for the entire body, but is this actually unavailable as well due to cardio-pulmonary condition?

I can find no literature related to 'slow-growing, malignant, pancreatic tumors'. What gives? If they do exist, could a person actually live for years with one?

On one hand I think, come to major metropolitan area, get more diagnostic work up and second opinion.

On the other hand, I do not believe this person would survive thoracic surgery, and more than one doctor has said this - related to cardio/pulmonary. If there is actually no therapy available for my friend, why pursue this any further. Just try and make their remaining time as easy as possible.

But is there actually no treatment for them? And how long do they really have?

Any information based on real science or real knowledge would be appreciated.
okes
 
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Joined: Thu Mar 31, 2011 5:00 pm

Slow-Growing, Malignant, Pancreatic Tumor?

Postby yeung » Sat Jul 14, 2012 6:21 am

I think your friend has received good advice.

This is cancer based on imaging and based on imaging there are no mets. People are not surgical candidates if there is. The problem with cancers of the pancreas is the anatomy of the pancreas itself, as it is connected to various organs and shares blood supply with the duodenum and this allows cancer cells to travel easily. When a doctor says there are no mets they mean there are none that can be found with our current technology.

This is a major surgery with a fairly high mortality rate and takes awhile to recover from and is out of the question for someone with a cardio problem.

Without histology there is no way for an oncologist to know how to treat this and I can’t imagine anyone treating this blindly that would not be in the best interest of the patient. I would hope they would have done a CA 19-9 to maybe help narrow it down a bit.

It is really hard for me to tell you much without the chart. Slow growing tumors of the pancreas are rare. Maybe a colloid tumor? It could be a sarcoma for all we know, as I said without histology it is really impossible to answer you. The best way to biopsy these cancers is ERCP, sometimes FNAs are used.

Spreedog is the oncologist in this forum and JLI is a pathologist they both are far more knowledgeable than I am. Hopefully one of them will see this question and give an opinion. I will star it so people will pay more attention to it.

It sounds like this person lives in a small town and may benefit from another opinion from the closest teaching hospital. Sometimes it is better to treat the symptoms and manage the pain to allow the patient to live the best life possible for however long they have. Of course this is always the patient’s decision as it should be. Best wishes.
yeung
 
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Joined: Thu Mar 31, 2011 12:43 pm


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