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Cancer of the PancreasDr Kingsley’s comments Cancer of the pancreas accounts for approximately 20% of all cancers of the gastrointestinal tract, and it seems to be becoming more common. There is an association with smoking. What is unfortunate is that, by the time it is diagnosed, about 85% of cases are already in an advanced state, and in half of them it has already spread.Signs and Symptoms. As I have already said, pancreatic cancers are often in an advanced state before there are any significant symptoms. One patient I saw was diagnosed with cancer of his pancreas when he went into hospital for a simple hernia operation. The surgeon found something obstructing the area, which, when he took a biopsy, turned out to be a secondary tumour from his pancreas. So far as he was aware, he had not had any symptoms that could remotely have suggested the diagnosis, even though he had been under a lot of stress before it was discovered. So any signs or symptoms tend to be not very specific, but they include back pain, tummy pains of various types, loss of appetite and weight loss, the last becoming very obvious quite rapidly. Sometimes there is a fever, which is unusual in cancers. Jaundice may be the first sign if the cancer obstructs the flow of bile anywhere from the liver to the intestines, or has already spread to the liver. In advanced cases, fluid collects in the tummy area, so the first indication may be apparent increase in abdominal girth. However, by the time this occurs, it is most likely that other features will also have occurred. Investigations. Ultrasound and CT scanning are likely to clarify the diagnosis, but sometimes dyes are put into the area to help with the diagnosis. There is a tumour marker called CA19.9, which, if over 2000, is suggestive of cancer of the pancreas. When looked at under a microscope, various names are given according to what the doctor can see. This is called the histological type. While some types are described as lymphoma, cystadenocarcinoma, neuroendocrine small-cell and undifferentiated, the great majority are called ductal adenocarcinomas. However, these names are merely used for clinical precision, but don’t alter the treatment or outcome, which, at the best of times is rather poor. Overall, only between 3 and 5% of people diagnosed with pancreatic cancer survive for three years. If cases are selected very carefully, and are operated on in specialist units, the five year survival rate can go up to 25%.Conventional Conventional Treatment. While chemotherapy and radiotherapy are sometimes used, there is not much evidence that they make much difference in the long run. The mainstay for the surgeon is an extremely complicated operation called Whipple’s procedure or pancreaticoduodenectomy, which, as its name suggests, means the removal of the pancreas and the duodenum. It is a risky procedure, 10% of patients dying during the actual operation or shortly after it. Various other operations are sometimes needed, basically to bypass a blockage caused by the spread of the cancer, but these are merely palliative to relieve one form of suffering or another. I cannot leave this section without mentioning the nutritional work of Dr. Nicholas Gonzales in New York. His approach is currently being compared, in a study carefully watched by the Food and Drug Administration, with the standard methods that I have basically described above. As I understand it, he is achieving excellent results. His website is (I have written to him to ask his permission to mention his name) An Explanation by Dr Kingsley Before Your Consultation about your Pancreatic Cancer “Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having pancreatic cancer. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your pancreatic cancer, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer. |
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