Jerry's Updates

Jerry's Updates

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Dave here again with an update and the next bit of information. Sorry this is long but I divided it into topical chunks to make it easier

Dads' current situation

We are still waiting the formal biopsy results but the three doctors (four if you include me) dad saw today agree with 99% certainty that dad unfortunately has pancreatic cancer which is stage IV (four). There is a 1% chance this is lymphoma. The only treatment is palliation which means to control his symptoms of discomfort, fatigue, etc. He has already had one form of palliation successfully performed with the placement of the stent. That has helped markedly and improved his appetite, energy and decreased the jaundice.

The blood clot will require long term treatment with an injectable for of heparin and then pills.

The palliative chemo that dad is considering only gives a 15% response but is not real toxic. Investigational trials might be an option but increase the toxicity of treatment without a reasonable likelihood of increasing longevity.

Fortunately dad is not in pain and he might be able to go home this weekend. Mom is stressed but is holding up reasonably well. She has focused all her energy and time toward helping dad. They both need all of the prayers you can spare. Dad also enjoys having people come to visit or sending e-mail or a card.

General Information about pancreatic cancer from the National Cancer Institute
Cancer of the pancreas has markedly increased in incidence over the past several decades, and ranks as the fifth leading cause of cancer death in the United States. Despite the high mortality rate associated with pancreatic cancer, its cause is poorly understood. Cancer of the pancreas is rarely curable. The highest cure rate occurs if the tumor is truly localized to the pancreas. Unfortunately, this stage of disease accounts for fewer than 20% of cases and results in approximately a 20% 5-year survival rate in patients with completely resected tumors, but only a 4% 5-year survival rate for all patients with pancreatic cancer. For patients with small cancers (< 2 centimeters) with no lymph node metastases and no extension beyond the "capsule" of the pancreas, the survival rate following resection of the head of the pancreas approaches 20%. Improvements in imaging technology, including spiral computed tomographic scans, magnetic resonance imaging scans, positron emission tomographic scans, endoscopic ultrasound examination, and laparoscopic staging can aid in the diagnosis and the identification of patients with disease that is not amenable to resection. In a case series of 228 patients, positive peritoneal cytology had a positive predictive value of 94%, specificity of 98%, and sensitivity of 25% for determining unresectability. For patients with advanced cancers, the overall survival rate of all stages is less than 1% at 5 years with most patients dying within 1 year. Patients with any stage of pancreatic cancer can appropriately be considered candidates for clinical trials because of the poor response to chemotherapy, radiation therapy, and surgery as conventionally used. However, palliation of symptoms may be achieved with conventional treatment. Symptoms due to pancreatic cancer may depend on the site of the tumor within the pancreas and the degree of involvement. Palliative surgical or radiologic biliary decompression, relief of gastric outlet obstruction, and pain control may improve the quality of survival while not affecting overall survival. Palliative efforts may also be directed to the potentially disabling psychological events associated with the diagnosis and treatment of pancreatic cancer.

Stage IVB Pancreatic Cancer is dad's stage, unfortunately this is the worst stage
The low objective response rate and lack of survival benefit with current chemotherapy indicates clinical trials as appropriate treatment of all newly diagnosed patients. Occasional patients have palliation of symptoms when treated by chemotherapy with well-tested older drugs. A randomized, placebo- controlled trial demonstrated that chemical splanchnicectomy (nerve killing) with 50% alcohol at the time of surgical exploration significantly reduces pain, particularly in those patients with preoperative pain. Gemcitabine has demonstrated activity in pancreatic cancer and is a useful palliative agent..

Treatment options:

Standard:

1. Chemotherapy with gemcitabine or fluorouracil.

2. Pain relieving procedures (e.g., celiac or intrapleural block) and supportive care.

3. Palliative surgical biliary bypass, percutaneous radiologic biliary stent placement, or endoscopically placed biliary stents.

Under clinical evaluation:

Clinical trials evaluating modulated fluorouracil, new anticancer agents, or biologicals (phase I and II).

If people want to determine their risk of cancer (this stuff is scary) go to

http://www.yourcancerrisk.harvard.edu/ and answer the questions in regard to the type of cancer you want to check. Risk of pancreatic cancer is increased with diabetes, smoking, history of chronic pancreatitis, family history of sister, brother, or parent with pancreatic cancer. Unfortunately, pancreatic cancer has few controllable risk factors. Some things you can do are eating 5 or more servings of fruits and vegetables per day and taking a multiple vitamin daily. Screening for pancreatic cancer hasn't been effective.

I hope this stuff has been helpful.

Dave Augustine

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