chronic pancreatitis and tumor tail of panreas

[carrot]

What a great web site, I hope you can help. My mother is 66 years of age, recently discharged from hospital, present weight is 62 lbs, diagnosis of chronic pancreatitis, pseudocyst and  tumor tail of the pancreas detected by C.T scan, my mother is booked forERCP,I'm very worried as she is very frail, is there any risk in doing this test with someone so malnurished.Internist says she is not srong enough for a biopsy,therfore we don't know if the tumor is malignant, is there any other way of finding out,?ultrasound. also I'm concerned about her overall health as a result of such dramatic weight loss, her symptoms include profound backpain, fatty stools,nausea, vomitting, presently these symptoms are being managed with codeine contin 100mg b.i.d. and digestive enzymes. At present my mother's follow-up includes occassional follow-up by dietician, should she have bloodwork done also her blood sugars have been elevated however no followup in regards to this. My mother has been a heavy consumer of alchol for at least 40 years as well as a heavy smoker, I'm very concerned about her present state, I must say I was surprise T.P.N. was not an option to help build her up, any suggestions as a concerned family what we may suggest for follow-up, desperately seeking advice, Thank-you,Carrot. Hope to hear back soon as I'm concerned that her present state of health may require more aggressive treatment and if not done soon she could decompensate furthur.Thanks again!!!!

[carrot]

sorry i forgot to add that my mother also has diarrhea which she takes alot of Immodium for, also
she experiences intense itchiness all over her body with sores on her legs,thanks Carrot

[carrot]

thank-you for responding, I hope you go back in dates as it has been a while. My mother's pain is subsiding and she no longer is getting sick, the digestive enzymes have helped alot, however she still is very weak, intense itching continues and although her skin is not yellow she looks tanned. My mother spends her days in bed, in her pyjamas 24/7, since we don't know if it is cancer of the pancreas I'm afraid to push her to be more active. She has gained weight and now has an appetite, so I'm hoping these are good signs. My mother has had a few falls when up, although she has a walker. I think she is also afraid.At present my mother is 73 pounds, do you think a biopsy would be an option at this point. I realize from what you and the Drs. have said, that likely if cancer there wouldn't be much that could be done, however I think knowing what we are dealing with would help. Everytime I think she should be getting better quicker and be up by now I feel quilty in the event that maybe we have unrealistic expectations and shouldn't push her, thank-you again, not only for answering my questions, but everyone else that is searching for help. Carrot

[surgeon]

with a tumor in the tail of the pancreas, it's not too likely that ERCP will get a definite answer. The only way to be absolutely certain is with some sort of tissue analysis, and ERCP likely wouldn't be able to get it from the tail. A CT-guided needle aspiration is probably the most common way to get tissue; it's not very risky, and is typically a minor procedure. However, your mother's condition is such that one would need to ask in what way the information would be used, if gotten. In other words, an operation for cancer would be virtually impossible in someone so frail; so the question is whether, if one knew it was cancer, one would procede with TPN and the other modalities necessary to get her to the point where she might tolerate surgery. And one would need to keep in mind that cancer in the tail of the pancreas is almost never curable, because by the time it becomes evident, it has moved beyond the surgical field.

[Kevin Pho, MD]

In addition to the ERCP, there are a variety of modalities that can be used to elucidate pancreatic cancer.  This can include endoscopy ultrasound, CT scans and MRIs.  Small studies suggest that the accuracy of an MRI compares to that of an ERCP, and is less invasive.  

With your mother being only 62 lbs., this suggests that she is markedly underweight.  Tests looking for albumin or pre-albumin can be considered to further evaluate malnutrition.  

The decision as to how aggressive one should be depends on the stage of cancer present.  There comes a point where aggressive measures may not be in your mother's best interest.  This decision needs to be discussed with your personal physician as well as an 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.

Thanks,
Kevin, M.D.