News  |  Journals  |  Conferences  |  Blogs  |  Articles  |  Forums  |  Twitter   
 

 Headlines:

 
 

Doctors Lounge - Oncology Answers

"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."

Back to Oncology Answers List

Forum Name: Pancreatic Cancer

Question: Recent questionable pancreatic cancer?


 uniname - Thu Jun 03, 2004 2:23 am

I would enormously appreciate some information and direction. My dad is an 84 year old white male who has been pointing to his abdominal area to complain of nausea, discomfort, gripping sensation, and on/off pain since about December of the year 2003. He was treated with Prevacid and Nexium, but with no noted improvement to his condition.

On May 13 & 25 of the year 2004, he presented for one CT scan each. No lab work or other testing was ever ordered. The CT reports are listed verbatim here below. My dad's physician now believes that the 2 CT reports reflect the presence of cancer in the tail of the pancreas and in the liver and spleen as well. He says that my dad is terminally ill, and estimates him to live "months" more. The physician advised against aggressive treatment/intervention suggesting that such measures, under similar circumstances, have proven to be futile in the past due to the widely known irreversible status of tumors located in the pancreatic tail. The physician explains that the natural location of the pancreas in itself is of such great difficulty to reach for any possible treatment considerations. He advised against informing my dad of the serious findings. He suggested that I do not subject dad to the rigors of medical management for his knowledge that dad will not tolerate pertinent treatments. The physician directed that I merely provide dad with comfort and support. I am currently in a state of shock with denial, but eager for information and help.

If at all possible, I would be profoundly grateful helping me:
A) To learn if the 2 CT reports, listed below, show enough information for a physician to
determine the finding of cancer without the need for other medical work-ups.
B) To learn the meaning of the word "primary" as in "primary pancreatic neoplasm"
C) To learn if the word "metastasis" always implies the presence of cancer.
D) To learn if there are such conditions as metastatic tumors that are classified as benign.
E) To learn if pancreatic tail cancers are reputed to be fast-growing; fast-spreading, and do
ultimately cause definite death with or without medical intervention.
F) To learn, in general, if cancers of the spleen and liver have been clinically defeated by
history, and if humans can survive without a spleen and/or liver.
G) To learn if any studies show hereditary connection or other causes associated with
cancers of the pancreas, spleen, liver.
H) To learn of available medical options for treating my dad's condition.
I) To learn if my dad stands to benefit/recover from any available course of treatment based
on the findings of the 2 CT reports.
J) To learn if the 2 CT reports, listed below, carry enough information for a physician to
establish a prognosis -- predicting death.
K) To learn if dad's symptoms are merely normal manifestations of old age.
L) learn of your impression, opinion, prognosis and suggestions please.
##################

CT REPORT (1)
"Exam date: May 13/2004
Proc: R-CT abdomen w/100 ml. cont

INDICATION: abdominal distention & abdominal bloating/change in bowel habits/right
lower quadrant. Pain today.

FULL RESULT: Contrast-enhanced images were obtained following 100 cc of optiray 320
contrast from the level of the diaphragms through the level of the kidneys. Visualized lung bases demonstrate bilateral pleural effusions, worse on the right than on the left. Associated basilar density is identified. There is ascites. There are multiple punctate masses within the liver & spleen consistent with metastatic disease. There is right porta hepatis mass. It is irregular in appearance with mixed contrast enhancement. It measures approximately 4 x 3 cm. This is consistent with metastatic lymphadenopathy to this region. The pancreas is abnormal. There is a hypodense mass in the tail of the pancreas measuring up to 4.8 x 3.6 cm consistent with primary pancreatic neoplasm. There is minimal pancreatic ductal dilatation on this examination. There is no intrahepatic ductal dilatation. There is no pancreatic head mass. There is thickening of the stomach wall. This may represent contracted stomach. The adrenal glands are unremarkable bilaterally. A right superior pole renal cyst is noted measuring 3.3 x 2.6 cm. No other right kidney abnormality is identified. The left kidney is unremarkable. There is no hydronephrosis or nephrolithiasis. There is no retroperitoneal adenopathy. There is no bowel obstruction. Gallbladder is contracted. There are no gallstones or significant fluid collection.

CONCLUSION:
1. Bilateral pleural effusions, worse on the right than on the left with associated basilar
consolidator.
2. Multiple variably sized liver masses consistent with metastatic disease.
3. Pancreatic tail mass consistent with a pancreatic neoplasm. Follow-up CT-guided
pancreas biopsy would be helpful to identify the histology make up of this mass.
4. Ascites.
5. Right renal cyst.
6. No bowel obstruction."
~~~~~~~~~~~~~~~~~~~

CT REPORT (2)
"Exam date: May 25/2004
Proc: R-CT abdomen

INDICATION: Abdominal pain.
COMPARISON: May 13/2004
FULL RESULT: Axial sections were obtained from lung bases to iliac crest after oral
contrast administration. No intravenous contrast administered which limits the evaluation. There are bilateral pleural effusions. There is evidence of ascites which has increased in comparison with the prior study. There are metastatic lesions of both liver and spleen, more conspicuous on the contrast-enhanced examination. There is a large mass in the region of the porta hepatis. Additional mass identified in the region of the tail of the pancreas. There are vascular calcifications. There is no evidence of hydronephrosis. There is atelectasis at lung bases. Cyst within the superior pole of the right kidney.

IMPRESSION:
1. Limited evaluation due to lack of intravenous contrast.
2. Hepatic & splenic metastasis.
3. Mass in region of the porta hepatis.
4. Mass within the pancreatic tail.
5. Interval increase in ascites in comparison with the May 13/2004 study.
6. Bibasal effusions, right greater than left, as well as atelectasis at lung bases."
~~~~~~~~~~~~~~~~~~~

Thank you beyond limits for any applicable information you do contribute to enable me to cope and form educated decisions in my difficult time.
 Dr. Brim M. - Thu Dec 23, 2004 4:11 am

Hi there. I noticed that your post is from several months ago, and I'm not sure if you have had your questions answered already somewhere else, but I thought I'd reply anyway since it may be of use to you or somebody else. You asked a lot of really good (and really tricky) questions.

A) To learn if the 2 CT reports, listed below, show enough information for a physician to
determine the finding of cancer without the need for other medical work-ups.

Cancer can only be diagnosed by a biopsy. There are a lot of tumors that look and smell like cancer but turn out to be something benign. Similarly, there are a number of cancers diagnosed that were originally felt to be benign. The only way to know for sure is to get a biopsy. Most good cancer doctors will not offer treatment unless there is absolute proof that it's truly a cancer. There are a few exceptions for a few types of cancer where a biopsy is not performed because either it's too dangerous to biopsy (such as in the brainstem) or because the look on CT scan is so diagnostic that it is highly unlikely to be anything else. But the general rule is that a CT scan cannot diagnose cancer; only a biopsy can. With that being said, however, there are some appearances on CT scan, particularly when there are metastases all over, that there can't really be any other diagnosis other than cancer. In your dad's case, I feel that is so. With the caveat that you can't be absolutely sure, you can be "almost" absolutely sure that it's cancer. The CT scan can't tell you what type of cancer, however. There's a possibility that it's not pancreatic cancer, but it could be another type of cancer that spread to the pancreas and beyond. The highest likelihood is for pancreatic cancer, but this should be biopsied to be sure.

B) To learn the meaning of the word "primary" as in "primary pancreatic neoplasm"

Primary means that it started out there. A primary pancreatic neoplasm is a cancer that started out in the pancreas, as opposed to a cancer that started in the colon and then spread to the pancreas.

C) To learn if the word "metastasis" always implies the presence of cancer.

Yes.

D) To learn if there are such conditions as metastatic tumors that are classified as benign.

No.

E) To learn if pancreatic tail cancers are reputed to be fast-growing; fast-spreading, and do
ultimately cause definite death with or without medical intervention.

Cancers can be of different grades -- low grade, intermediate grade, and high grade -- with the grade meaning how different from normal cells the cancer looks under the microscope, and with the implication that high grade cancers are faster growing and more aggressive. Pancreatic cancers, in general, behave very aggressively. Pancreatic cancer is the cancer that unfortunately has the lowest survival rate of any cancer. Without treatment, it usually causes death within 3-4 months.

F) To learn, in general, if cancers of the spleen and liver have been clinically defeated by history, and if humans can survive without a spleen and/or liver.

The spleen is not a vital organ. Many people who suffer trauma to the abdomen (like in a car accident) have to have their spleens removed, and they can live without a spleen. You cannot live without a liver though.

G) To learn if any studies show hereditary connection or other causes associated with
cancers of the pancreas, spleen, liver.

A few (about 5%) of pancreas cancers are hereditary. Most are sporadic, and we don't know what causes them, but they're more common in the elderly (very rare before age 40), more common in men than women, and more common in blacks than whites. They seem to be associated with the American diet -- associated with obesity and eating high fat foods and animal meats. There is some association with smoking.

H) To learn of available medical options for treating my dad's condition.

For widespread metastatic disease, the main treatment option is palliative chemotherapy. If he has intractible pain, radiotherapy may give him some relief. If he develops jaundice or has an obstruction in his gut, he can have biliary bypass or gastric bypass surgery.

I) To learn if my dad stands to benefit/recover from any available course of treatment based on the findings of the 2 CT reports.

The prognosis of metastatic pancreatic cancer is very poor, and it sounds like your dad has extensive disease. Chemotherapy is an option, but the benefit is very modest. Chemotherapy won't be curative in Stage IV disease.

J) To learn if the 2 CT reports, listed below, carry enough information for a physician to
establish a prognosis -- predicting death.

Yes, the CT scans are enough to give a very poor prognosis.

K) To learn if dad's symptoms are merely normal manifestations of old age.

His symptoms are non-specific and could be caused by anything. However, the CT scans paint the picture of a metastatic cancer. Those CT scans aren't just showing old age.

L) learn of your impression, opinion, prognosis and suggestions please.

If he's not gravely ill, I would recommend that he see an oncologist for a trial of chemotherapy. If he's very very ill, then I think comfort care (hospice) would be the best thing for him. The doctor would need to have a very frank discussion with your dad about how extensive his disease is, and that the outcome doesn't look good. And then they need to decide together how aggressive they want to be. He can be one of the lucky ones who lives longer than expected, so if he wants to be aggressive, then it's worth a shot. At the same time, he shouldn't be given a false sense of hope. A realistic picture should be painted. It's a very personal decision to decide to go ahead with cancer treatment or to undergo the dying process with dignity.

I wish the best for you and your dad.

|

Check a doctor's response to similar questions

 

advertisement.gif (61x7 -- 0 bytes)
 

Are you a Doctor, Pharmacist, PA or a Nurse?

Join the Doctors Lounge online medical community

  • Editorial activities: Publish, peer review, edit online articles.

  • Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.

Doctors Lounge Membership Application

 
     

 advertisement.gif (61x7 -- 0 bytes)

 

 

Tools & Services: Follow DoctorsLounge on Twitter Follow us on Twitter | RSS News | Newsletter | Contact us

 
Copyright © 2001-2010
Doctors Lounge.
All rights reserved.

Medical Reference:
Diseases | Symptoms
Drugs | Labs | Procedures
Software | Tutorials

Advertising
Links | Humor
Forum Archive
CME Articles

Privacy Statement
Terms & Conditions
Editorial Board
About us | Email

We subscribe to the HONcode principles of the HON Foundation. Click to verify.We subscribe to the HONcode principles.
Verify here