Pancreatic Cancer, the Silent Disease on MedicineNet.com

A MedicineNet doctor-editor’s perspective on his own struggle with pancreatic
cancer

Medical Author: Dennis Lee, MD

Medical Editor: Melissa Conrad Stöppler, MD

The diagnosis

I was diagnosed with pancreatic cancer on May 25 of this year. On a routine
yearly blood test, I was found to have slightly elevated blood levels of liver
enzymes (my alkaline phosphatase, ALT, and AST were mildly elevated). Since I
had no symptoms of abdominal pain or weight loss, both my doctor and I felt
quite confident that these liver abnormalities were merely due to the statin
that I was taking to lower cholesterol. For the sake of completeness, my doctor
ordered a liver ultrasound, which showed multiple liver tumors. A subsequent CAT
scan of the abdomen done that same afternoon showed an orange-sized mass in the
tail of my pancreas with multiple metastases (spread of tumor) in the liver. A
liver biopsy confirmed that it was pancreatic cancer.

It was a shock

At the time of my diagnosis, I was a healthy, reasonably fit 57-year-old newlywed working as a
gastroenterologist in a thriving medical practice in South Orange County. My
wife and I just bought a new home and were in the process of decorating it and
putting in the landscaping.

I have no risk factors for developing pancreatic cancer. I do not drink
alcohol and do not smoke (smoking cigarettes is a risk factor for pancreatic
cancer). None of my parents and relatives had pancreatic cancer. I never had
diabetes mellitus (diabetes mellitus is another known risk factor). I exercise
vigorously almost daily (four days per week of tennis, and one to two days of strength
training). I maintained a healthy weight (obesity is also a risk factor for
pancreatic cancer).

Ironically, since the spring of this year, I have been researching the topic
of pancreatic cancer prevention. I have attended several lectures given by
experts who postulated that pancreatic cancers arise from certain cysts and
small lesions along the pancreatic duct, and early detection and removal of
these lesions and cysts can prevent pancreas cancer. I was in the middle of
gathering information in this area so that I could write an article for
MedicineNet viewers and my colleagues when this bad news hit.

More bad news

One week before my cancer diagnosis, I had noticed some
shortness of breath when I played singles tennis. Since I had a busy on-call
night that week and a busy week at the office, I attributed these mild symptoms
to work fatigue. However, two days after the CAT scan, I noticed shortness of
breath when climbing stairs. My radiologist re-read my CAT scan and noticed
blood clots in my pulmonary arteries (arteries in my lung). A blood clot in the
lung (a condition called pulmonary embolism) is a dangerous but common
complication of pancreatic cancer. I was immediately hospitalized to receive
anticoagulants to dissolve these clots and to prevent new ones. In the
hospital, I was found for the first time in my life to have developed diabetes
mellitus. Pulmonary embolism and diabetes mellitus are both diseases caused by
certain substances produced by the pancreatic cancer.

In one week, I went from a
healthy, active doctor to a disabled patient with advanced pancreatic cancer
complicated by diabetes and pulmonary embolism-it wasn’t fun.

What is the treatment?

Since most pancreatic cancers are discovered late (the cancer has
usually spread to other organs at the time of diagnosis), only a handful of
lucky ones ever get cured by surgical resections. Therefore, the prognoses for
pancreatic cancer patients were mostly poor, and treatments had generally been
ineffective. Survival of these patients was measured in months, not years.

Based on my CAT scan findings of liver metastasis, I know I am not a surgical
candidate. Therefore I was not surprised when my oncologist at USC Norris Cancer
Center offered me chemotherapy. My oncologist, Dr. Lenz, is in
active practice and conducts clinical trials on gastrointestinal cancer
treatments at USC.

I was started on a combination of gemcitabine (Gemzar) infusions every
Monday for two weeks, with one week off, along with daily oral erlotinib (Tarceva) and
capecitabine (Xeloda). Gemzar infusion leaves me with several days of fatigue, nausea, and low-grade fever.
The soles of my feet became dry, cracked from Tarceva, and I also developed constant and painful
mouth sores from Xeloda. Otherwise, I feel well enough to play
tennis on weekends and weekdays during the off-week.

How is my cancer responding to treatment?

My cancer is responding quite well to chemotherapy. I have had three CAT
scans in the past five months to monitor treatments. All three CAT scans showed
progressive shrinkage of the liver metastases. My blood liver enzymes levels
have also completely normalized, coinciding with shrinkage of the liver
metastases. Another way to monitor treatment response is by measuring tumor
marker (tumor markers such as CA19-9 are substances usually produced by the
cancer in large quantities) levels in the blood. A progressive decline in CA19-9
blood levels signals tumor shrinkage. Since my CA19-9 levels were normal
initially even before chemotherapy, my doctor cannot use CA 19-9 to monitor my
progress.

My oncologist is quite pleased with my progress. Shrinkage of pancreatic
cancers with chemotherapy can occur but is not common. In his words, not many
metastatic pancreatic cancer patients are playing tennis either. But he cautions
that only time will tell whether my responses to chemotherapy are sustainable.
Many patients who initially respond develop resistance to the drugs, and their
cancers recur.

There is hope

My wife and I attended a symposium on pancreatic cancer put on by Pancan last weekend. Pancan is a volunteer
organization that provides education and support to pancreatic cancer patients
and their caregivers, funds scientific research, and galvanizes the government to
fund research.

At that meeting, I was astonished by the number of attendees who are
multiyear pancreatic cancer survivors. I was also impressed by the energy and
enthusiasm of the Pancan volunteers.

Many bright young scientists are working on treatment and prevention. Many
new anticancer drugs are under development. There are also new ways of
delivering existing drugs to make them less toxic and much more effective. Some
gastroenterologists are doing research on using EUS (endoscopic ultrasound, a
procedure that combines the techniques of endoscopy and ultrasound) to inject
antitumor substances directly into the pancreatic cancer. Some radiologists are
doing research on using computer-directed radiation and heat devices to destroy
tumors without damaging surrounding tissues. Treatments of all types of cancers
are improving.

How am I really feeling?

The outpourings of support from my family, friends, colleagues, nurses, and
many of my patients have been phenomenal. Many are praying for me on a regular
basis. Thanks to my wife, my family, and friends, never once have I felt alone,
isolated, or sad. I am living every day to the fullest.

Yes, all my journal readings and past experiences as a doctor tell me that my
prognosis is poor. But let me share with you a small secret: In tennis terms, I
believe the match is going to be decided by a long tiebreaker in the fifth set,
and I am afraid I will win this one.

There are just too many things I want to do in my backyard with my family and
Fabio. Fabio is our new white 55-pound standard poodle puppy and the joy of
my life.