Pancreatic cancer- please share

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February 11, 2018 at 1:42 pm  #1293958    

chris123

Mom is 80. Diagnosis with PC feb 28 2017.  Wipple was performed.  The tumor spread to the main  arterie and 4 out of the 22 lymph nodes had the csncer.  Surgery was consider successful however cancer had spread.  We had various visits to ER after that until Jun 2017.  Then a good 6 months.  End of Dec 2017 back in ER with sepsis, was clear with drain and antibiotic and then urine infection – mid Jan had so much pain, was lathargic   very low energy, and had collapaed in my hands… decided to admit into palitative care.  She has stabilized now and is walking with walker….eating….  

This is all very confusing for us.  We are enjoying to good days however I’d like to understand if anyone else has experienced such bad days thinking it was the end and being told this may be the time… to being stabilize enough to eat, drink, walk?

Please share….

Reply

February 11, 2018 at 5:07 pm  #1293960    
JimC Forum Moderator
JimC Forum Moderator

Hi Chris,

Welcome to GRACE. I’m sorry to hear of your Mom’s diagnosis and the difficulties she has faced. Although not the norm, it’s not uncommon for a patient’s overall health to improve after starting palliative care. There is even a study that showed an improvement in survival when palliative care is started early, which Dr. West wrote about here. (As Dr. West describes, the article by Dr. Gawande linked in his post is a very thought-provoking but difficult read for those who have a loved one with cancer). We have had several patients here on GRACE who have seen such improvement.

I hope you and your family can enjoy many of these good days with your Mom.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

February 11, 2018 at 5:15 pm  #1293961    

chris123

This was her last c.t scan before she got the drain inserted.

Any insight you can provide?

Radiology

Image Available
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CT ABDOMEN AND PELVIS

TECHNIQUE: Routine abdomen and pelvis protocol following administration of IV contrast and portal venous phase. Coronal and sagittal reformats obtained.

HISTORY: 80-year-old female status post Whipple March 2017. Presents with sepsis. Rule out intra-abdominal source.

COMPARISON: Multiple priors including most recent CT abdomen and pelvis November 17, 2017

FINDINGS:

Status post Whipple. Intact anastomoses. Soft tissue fullness at the surgical bed is not progressed. Atrophic pancreatic tail with cystic changes, unchanged.

Slight interval increase in moderate intrahepatic bile duct dilatation most prominent in the left lobe of the liver now measuring up to 5 mm previously 3 mm (image 46). No definite peribiliary enhancement. No pneumobilia suggesting patency of the
anastomosis.

New 4 mm vague subcapsular hypodense focus in segment 8, indeterminant (image 38). Interval stability of 1.5 cm segment 4 hypodense lesion previously described as a collapsing cyst (image 48). Patent portal veins.

Moderate left hydronephrosis and hydroureter with delayed/decreased left renal function, similar to previous. Mild interval atrophy of the left kidney. 1.1 cm obstructing metastatic nodule at the level of the left mid ureter is stable (image 113).

Small volume ascites, progressed from previous, now perisplenic and tracking along the left paracolic gutter.

Omental nodularity and mesenteric stranding in keeping with peritoneal carcinomatosis, progressed. Marker node in the left upper quadrant now measures 2.4 cm previously 1.1 cm (image 74). New 1.3 cm left subphrenic deposit (image 35).

1.1 cm (previously 0.6 cm) subcutaneous deposit (likely metastatic) in the left anterior abdominal wall (image 81). Ventral periumbilical hernia containing fluid increased compared to prior.

February 12, 2018 at 6:01 am  #1293962    
JimC Forum Moderator
JimC Forum Moderator

Hi Chris,

Analysis of scan reports is beyond the scope of what we can do here, both for legal and practical reasons. Although the scan does seem to indicate progression of the cancer, your Mom’s local medical team, with access to all of her previous scans and medical information, would be able to provide the best analysis.

I wouldn’t expect that there is anything in the scan results that would explain her recent improvement in mobility and appetite.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

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