Pancreatic Cancer, the Silent Disease
A MedicineNet doctor-editor's perspective on his own struggle with pancreatic cancer
I was diagnosed with pancreatic cancer on May 25 of this year. On a routine yearly blood test, I was found to have slightly elevated blood levels of liver enzymes (my alkaline phosphatase, ALT, and AST were mildly elevated). Since I had no symptoms of abdominal pain or weight loss, both my doctor and I felt quite confident that these liver abnormalities were merely due to the statin that I was taking to lower cholesterol. For the sake of completeness, my doctor ordered a liver ultrasound, which showed multiple liver tumors. A subsequent CAT scan of the abdomen done that same afternoon showed an orange-sized mass in the tail of my pancreas with multiple metastases (spread of tumor) in the liver. A liver biopsy confirmed that it was pancreatic cancer.
It was a shock
At the time of my diagnosis, I was a healthy, reasonably fit 57-year-old newlywed working as a gastroenterologist in a thriving medical practice in South Orange County. My wife and I just bought a new home and were in the process of decorating it and putting in the landscaping.
I have no risk factors for developing pancreatic cancer. I do not drink alcohol and do not smoke (smoking cigarettes is a risk factor for pancreatic cancer). None of my parents and relatives had pancreatic cancer. I never had diabetes mellitus (diabetes mellitus is another known risk factor). I exercise vigorously almost daily (four days per week of tennis, and one to two days of strength training). I maintained a healthy weight (obesity is also a risk factor for pancreatic cancer).
Ironically, since the spring of this year, I have been researching the topic of pancreatic cancer prevention. I have attended several lectures given by experts who postulated that pancreatic cancers arise from certain cysts and small lesions along the pancreatic duct, and early detection and removal of these lesions and cysts can prevent pancreas cancer. I was in the middle of gathering information in this area so that I could write an article for MedicineNet viewers and my colleagues when this bad news hit.
More bad news
One week before my cancer diagnosis, I had noticed some shortness of breath when I played singles tennis. Since I had a busy on-call night that week and a busy week at the office, I attributed these mild symptoms to work fatigue. However, two days after the CAT scan, I noticed shortness of breath when climbing stairs. My radiologist re-read my CAT scan and noticed blood clots in my pulmonary arteries (arteries in my lung). A blood clot in the lung (a condition called pulmonary embolism) is a dangerous but common complication of pancreatic cancer. I was immediately hospitalized to receive anticoagulants to dissolve these clots and to prevent new ones. In the hospital, I was found for the first time in my life to have developed diabetes mellitus. Pulmonary embolism and diabetes mellitus are both diseases caused by certain substances produced by the pancreatic cancer.
In one week, I went from a healthy, active doctor to a disabled patient with advanced pancreatic cancer complicated by diabetes and pulmonary embolism-it wasn't fun.
What is the treatment?
Since most pancreatic cancers are discovered late (the cancer has usually spread to other organs at the time of diagnosis), only a handful of lucky ones ever get cured by surgical resections. Therefore, the prognoses for pancreatic cancer patients were mostly poor, and treatments had generally been ineffective. Survival of these patients was measured in months, not years.