Looking for Suggestions on Pancreatic and Lung Cancer - 1248837

Mon, 10/08/2012 - 20:23

My mother was diagnosed with Stage 4 Lung Cancer in March of this year. A non smoker and healthy person. She has BAC with a KRAS mutation. The cancer was found in her upper right and lower left lobes. Her right upper lobe was removed at time of diagnosis due to it being collapsed.

Additionally during the summer she was diagnosed with a separate primary cancer in her pancreas. She had the Whipple Procedure about 2.5 months ago. The cancer was resectable and her margins were clear.

1. She has severe constant cramping in her upper stomach since the surgery. Her stomach is often distended and hard. She has seen her iconologist, surgeon and gastroenterologist and none of them have been able to provide her relief or suggestions as to what me be causing it. She has tried enzymes and antispasmodic medication and nothing has helped. These cramps are usually a couple a days and then leave her stomach very sore. Does anyone have any suggestions on what the issue could be and what other things we might asks the doctors to look into?

2. Since she has recovered from the whipple she is now back on chemotherapy. The doctors advised that she have chemotherapy for her pancreas even thought her margins are clear. Is it necessary for her to have chemo for the pancreas? She is having a rough time now with the chemo. Her schedule is once a week, so she has no time between rounds to recover. I am questioning her quality of life. Recently she has felt miserable and complained of anxiety and depression. Can we just treat the lungs? What is the likelyhood of reoccurence if she does not have chemo on the oancreas?

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Dr West

I'm sorry to say that I don't have a good idea of what could be happening in terms of the pain. There are many possibilities, and there isn't anything much more complex than the reconstruction after a Whipple procedure.

Dr. Katz from MD Anderson has written a helpful piece about the potential role, which is individualized, for post-operative chemotherapy after a resection for pancreatic cancer:

http://cancergrace.org/pancreatic-cancer/2012/07/16/adjuvant-folfirinox…

I hope that's helpful.

-Dr. West

Dr. Javle

Dear Adria,

In response to your question # 2, is it required to treat the pancreatic cancer after surgery..it really depends upon the nature of the lung cancer and its prognosis. However, several drugs used for lung cancer also have some effect on pancreatic cancer, for instance gemcitabine. So between operated pancreatic cancer and stage 4 lung cancer, I think the latter is more aggressive and needs MORE immediate attention.

I am more worried about your question # 1, post operative pain and bloating. I am going to request a surgical colleague to address that.

All the best,

M Javle MD

catdander

This is an email comment from Dr. Katz, a pancreatic surgeon at MD Anderson

"Adria:

I am very sorry to hear about your mother, it sounds as though she is really having a rough go of it.

First let me address the cramping following surgery. This symptom is not terribly uncommon following surgery, and its possible causes are multiple. The first problems that would be important to exclude (and presumably have been) are those that are fixable but critical… things like leaking from any of the three connections that are formed, an abscess in the abdomen, or even problems in the chest such as a blood clot in the lungs. Since none of these are terribly likely if she is doing otherwise well 2.5 months out from surgery, I will assume they have been excluded radiographically or clinically. Other causes include exocrine insufficiency (creon is almost always under-dosed; what is she taking?) and gastric emptying problems. I would discuss with her physician croeon dosing and dietary changes."

Continued on next post...

catdander

Dr. Katz' comment continued,

"With regard to the treatment sequencing: a realistic discussion about treatment planning ideally should have taken place prior to the operation, not following it. Unfortunately, recurrence following surgery alone for pancreas cancer is essentially a certainty, and survival rates with surgery alone are typically on the order of 12-18 months. "Cure" from pancreas cancer in the absence of postoperative chemotherapy is uncommon. However, in the context of the treatment's adverse effects on your mother's quality of life, it is also important that you both recognize that recurrence following pancreatic surgery is unfortunately common even with postoperative chemotherapy. It is also important to also consider the prognosis associated with the lung cancer. I would have a conversation with your oncologist -- a conversation that will almost certainly be long, and may well be difficult-- to sort out a therapeutic plan that will maximize not only the quantity but (perhaps more importantly) the quality of your mother's life."

I hope this is helpful,
Janine