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Gastroenterology (Expert Forum)
Required recommendation for treatment of pancreas cancer
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Required recommendation for treatment of pancreas cancer
by Moshe Stravinski, Sep 21, 2005 12:00AM
A Pancreatic cancer has been detected in my brother (48) body in June 2003. The diagnosis was of 'MAL NEO PANCREAS BODY – ADENOCARCINOMA'.
In July 2003 My brother had gone surgery of the following type: 'SPLENECTOMY TOTAL / PANCREATECTOMY DISTAL / WEDGE RESECTON OF STOMACH' and the tumor has been removed completely. During the surgery an involvement of 4 lymph nodes has been detected.
From September 2003 to January 2004 my brother has received chemotherapy treatment combined with radiation therapy with 13 courses of GEMZAR and 28 rounds of radiation treatments.
In September 2004 a rise in CA-19 marker was diagnosed. There were no findings in CT scan of stomach and chest test.
In October 2004 after additional rise in CA-19 marker to 320 had been diagnosed. A PET-FDG test has been conducted. The results has indicated a focal pathologic uptake in the anterior and right lateral abdominal wall, centered at the anterior aspect of the EXTERNAL ABDOMINAL OBLIQUE muscle. There were no other indications of uptakes in the pancreas or in the rest of the body.
In November 2004 my brother has gone biopsy procedure. It was biopsy of soft tissue-FNA/FNB from RT abdominal wall lesion.
The result of the biopsy: In the excised specimen a malignant section has been found, that is compatible to a pancreas tumor spread.
In December 2004 second surgery has been performed. The surgery type was 'EXC LESION OF ABDOMINAL WALL ADENO. CA.' In the surgery a local resection of lump in the incision scar has been performed. The removed lump was stiff, unfixed and partially attached to the internal obliques. It did not penetrate the peritoneum but attached to it. In light of the pertinent findings it was decided to remove section of the fascia and the close peritoneum tissue.
Pathology results:
The lump is ADENOCARCINOMA with secretion of moist that matches pancreas tumor. The tumor has penetrated the skeleton muscle and in one place it has arrive up to 0.1 CM from the peritoneum surface and.0.4 cm from the outer surface (against the peritoneum).
In January 2005 5 weeks after the surgery the CA19 in 2 consecutive tests has not shown the expected drop – 260 and 310 (small rise in the second reading). The CEA marker has shown 1.1.
In February 2005 in PET-FDG has shown 6 pathological uptakes in various places in the body. Soon after the following chemical therapy has been initiated:
- 600mg (FLUOROURACIL) 5FU
- 40 mg Cisplatin
- 40 mg Leucovorin
The first two courses has shown no response and the CA19-9 marker has increased to 932 value. The 5 additional consecutive courses has shown monotonic drop down to value of 36.
In September 2005 another PET-FDG has been conducted. This test has not shown any pathological uptake (the previous uptakes have not visualized). Concurrently with the PEG-FDG test a CA 19-9 marker test has been conducted and the marker has increased to 94. In addition there are minor pain in the right waist.
I will appreciate your answering me the question:
What is the recommended treatment in your opinion? Do you recommend to continue with the existing treatment to replace it or to make a pause in the any treatment ?
In July 2003 My brother had gone surgery of the following type: 'SPLENECTOMY TOTAL / PANCREATECTOMY DISTAL / WEDGE RESECTON OF STOMACH' and the tumor has been removed completely. During the surgery an involvement of 4 lymph nodes has been detected.
From September 2003 to January 2004 my brother has received chemotherapy treatment combined with radiation therapy with 13 courses of GEMZAR and 28 rounds of radiation treatments.
In September 2004 a rise in CA-19 marker was diagnosed. There were no findings in CT scan of stomach and chest test.
In October 2004 after additional rise in CA-19 marker to 320 had been diagnosed. A PET-FDG test has been conducted. The results has indicated a focal pathologic uptake in the anterior and right lateral abdominal wall, centered at the anterior aspect of the EXTERNAL ABDOMINAL OBLIQUE muscle. There were no other indications of uptakes in the pancreas or in the rest of the body.
In November 2004 my brother has gone biopsy procedure. It was biopsy of soft tissue-FNA/FNB from RT abdominal wall lesion.
The result of the biopsy: In the excised specimen a malignant section has been found, that is compatible to a pancreas tumor spread.
In December 2004 second surgery has been performed. The surgery type was 'EXC LESION OF ABDOMINAL WALL ADENO. CA.' In the surgery a local resection of lump in the incision scar has been performed. The removed lump was stiff, unfixed and partially attached to the internal obliques. It did not penetrate the peritoneum but attached to it. In light of the pertinent findings it was decided to remove section of the fascia and the close peritoneum tissue.
Pathology results:
The lump is ADENOCARCINOMA with secretion of moist that matches pancreas tumor. The tumor has penetrated the skeleton muscle and in one place it has arrive up to 0.1 CM from the peritoneum surface and.0.4 cm from the outer surface (against the peritoneum).
In January 2005 5 weeks after the surgery the CA19 in 2 consecutive tests has not shown the expected drop – 260 and 310 (small rise in the second reading). The CEA marker has shown 1.1.
In February 2005 in PET-FDG has shown 6 pathological uptakes in various places in the body. Soon after the following chemical therapy has been initiated:
- 600mg (FLUOROURACIL) 5FU
- 40 mg Cisplatin
- 40 mg Leucovorin
The first two courses has shown no response and the CA19-9 marker has increased to 932 value. The 5 additional consecutive courses has shown monotonic drop down to value of 36.
In September 2005 another PET-FDG has been conducted. This test has not shown any pathological uptake (the previous uptakes have not visualized). Concurrently with the PEG-FDG test a CA 19-9 marker test has been conducted and the marker has increased to 94. In addition there are minor pain in the right waist.
I will appreciate your answering me the question:
What is the recommended treatment in your opinion? Do you recommend to continue with the existing treatment to replace it or to make a pause in the any treatment ?
Doctor's Answer
by Kevin Pho, MD, Sep 22, 2005 12:00AM
, Sep 22, 2005 12:00AM
It is difficult to give concrete recommendations without personally reviewing the chart.
That being said, there are differences in the approach to resected pancreatic cancer. Depending on where you are in the world (Europe vs the US), various approaches via chemo-radiotherapy can be used.
The 5-FU regimen with cisplatin is a very reasonable course of treatment. This can be continued after discussion with your oncologist.
The addition of radiation therapy can be considered. Studies have shown it does reduce local recurrance rates, but has no difference in survival.
Further questions can be discussed with your oncologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
That being said, there are differences in the approach to resected pancreatic cancer. Depending on where you are in the world (Europe vs the US), various approaches via chemo-radiotherapy can be used.
The 5-FU regimen with cisplatin is a very reasonable course of treatment. This can be continued after discussion with your oncologist.
The addition of radiation therapy can be considered. Studies have shown it does reduce local recurrance rates, but has no difference in survival.
Further questions can be discussed with your oncologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
Should be800mg (FLUOROURACIL) 5FU (instead of 600mg.
Moshe Stravinsky