Mass found in the head of my fathers pancreas

[db113067]

About 2 months ago my father was told he had a large mass at the head of his pancreas.  Numerous films were taken Cat scan, MRI, endoscopic ultrasound done and unable to get a biopsy due to to many blood vessels.  Three doctors said it was inoperable and sent him on his way.  We found one doctor that felt he could do a whipple and decided to move ahead and try even though we were told more than likely it was cancer and would not be able to be removed.  He went in for surgery and the doctor was not able to remove it due to vessel involvement.  He went ahead and took out his gall bladder that had sludge in it and noticed there was not any metastis. And cut 2 of the nerves to help with pain management. We were told that he would probably live only 6 to 9 months and the course of treatment would depend on the results of the 3 deep tissue biopsies and the other two taken from other places other than the pancreas. Five days later the doctor informed us there were no cancer cells found in the biopsies and that it was acute pancreatitis. Totally relieved he was released from the hospital and has not got any better and its been over three weeks. He is getting worse. When this all started he was at 210 pounds and now down to 175. He saw another doctor that said this was chronic pancreatitis and gave him some enzymes and told him to change his diet and they would repeat some of the scans and blood tests.  The cancer marker they did on him 2 months ago was at 34. He is now in an alternative treatment program by IV therapy, loading him with vitamins and nutrients.  They do not believe the mass will shrink and the main vessel is blocked which they said other blood vessels would help compensate for the blockage. I just wanted your thoughts on the possiblity this could still be cancer and what you would suggest from this point. What kinds of tests what we should ask the doctor. The doctor who the the endoscopic ultrasound stated he saw a complex cystic mass and even then felt it was an adenocarcinoma. He is a 64 yr old man who has taken good care of himself, but about 10 years ago started getting ill being very tired all the time, bowel problems, digestive issues he turned vegetarian, cut out sugar and most dairy because it made him ill.  He has had 2 episodes that could have been a pancreatic attack and this last one he came back septic and no known cause, they said. We just need some guidance as to what we should do or any thoughts would help. Over the years one doctor told him he had fibro myalgia, another chronic fatigue and in 2001 Mayo did a complete and total work up on him and really did not find anything significance to his illness. Any doctor suggestions in Arizona for something like this would be helpful.  He is just going down hill and we do not feel like we are getting anywhere with all of the doctors we have seen, even outside of Arizona.

[Kevin Pho, MD]

I'm sorry to hear about your father's situation.  I don't have any specific recommendations without reviewing the case.  Other tests that can further evaluate the pancreatic mass would be either an ERCP or MRCP - which can sometimes give characteristics of the mass that were previously unable to be seen.  

Ultrasound biopsies of the pancreatic mass can be considered as well which can help determine if the mass is cancerous.  You have mentioned serum tumor markers (like CA 19-9 in the case of pancreatic cancer).  Using a cutoff of above 37 U/mL can suggest pancreatic cancer with a 77 perecent sensitivity.  You note the level to be 34 - which is at the borderline.

Given that the mass seems inoperable, the fine needle aspiration (FNA) or endoscopically-obtained biopsies would be a reasonble option to give a more definitive diagnosis.

These options can be discussed with your personal physician.

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.
Medical Weblog:
kevinmd_b

[GallbladderBaby]

Dear dB,
Sorry that you, your Dad, and family find yourselves in the middle of this ordeal.  Did the doctor do an ERCP?  Those are pretty effective in diagnosing pancreatic cancer.  Also, the CA-19 blood test is a good indicator, but not full proof.  Also, there are different types of pancreatic cancer like islet cell that may not make CA-19 ris like adenocarcinoma can.  I would get a second opinion because they weight loss is not good for your Dad and obviously he is not getting enough nutrition.  Something is "funky" in his pancreas.  He probably should have the mass removed because it could develop into something worse.  Go to a major research center that deals with pancreatic cancer to be sure.  Another awesome resource is the Johns Hopkins Patient Information Board.  The board is "chock-full" of patients and caregivers who give pretty good advice and provide support when you really need it.  I highly recommend it.  Good luck and may God bless!
Gallbladder Baby
P.S. Take one day at a time.  Take care of yourself so you can be the best help to your Dad...