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Gastroenterology (Expert Forum)
Treatment of pancreas cancer post surgery of recurent local tumor appearance
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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.
Treatment of pancreas cancer post surgery of recurent local tumor appearance
by baruch_cyzs, Jan 13, 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).
2 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.
The oncologist of my brother from Rambam hospital recommended not to perform any additional treatment after the surgery and to continue with monitoring the markers.
Question : What do you think can be done after the surgery for my brother.
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).
2 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.
The oncologist of my brother from Rambam hospital recommended not to perform any additional treatment after the surgery and to continue with monitoring the markers.
Question : What do you think can be done after the surgery for my brother.
Doctor's Answer
by Kevin Pho, MD, Jan 17, 2005 12:00AM
, Jan 17, 2005 12:00AM
This is certainly a difficult case where the pancreatic cancer is present despite treatment with surgery, radiation and chemotherapy.
In advanced cases, there is some preliminary data that combination chemotherapy (i.e. Gemzar plus either cisplatin, oxaliplatin or gemcitabine) may increase response rates. However, there is no good data that survival is improved with additional chemotherapy.
If there continues to be a rise in the CA 19-9, this may be suggestive of unrectable cancer. This is especially true, if the cancer keeps recurring despite surgery.
Continuing the monitor the markers is a reasonable course of action. You may want to inquire about combination chemotherapy.
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
In advanced cases, there is some preliminary data that combination chemotherapy (i.e. Gemzar plus either cisplatin, oxaliplatin or gemcitabine) may increase response rates. However, there is no good data that survival is improved with additional chemotherapy.
If there continues to be a rise in the CA 19-9, this may be suggestive of unrectable cancer. This is especially true, if the cancer keeps recurring despite surgery.
Continuing the monitor the markers is a reasonable course of action. You may want to inquire about combination chemotherapy.
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
