Pancreatic Cancer, the Silent Disease (cont.)
Based on my CAT scan findings of liver metastasis, I know I am not a surgical candidate. Therefore I was not surprised when my oncologist at USC Norris Cancer Center offered me chemotherapy. My oncologist, Dr. Lenz, is in active practice and conducts clinical trials on gastrointestinal cancer treatments at USC.
I was started on a combination of gemcitabine (Gemzar) infusions every Monday for two weeks, with one week off, along with daily oral erlotinib (Tarceva) and capecitabine (Xeloda). Gemzar infusion leaves me with several days of fatigue, nausea, and low-grade fever. The soles of my feet became dry, cracked from Tarceva, and I also developed constant and painful mouth sores from Xeloda. Otherwise, I feel well enough to play tennis on weekends and weekdays during the off-week.
How is my cancer responding to treatment?
My cancer is responding quite well to chemotherapy. I have had three CAT scans in the past five months to monitor treatments. All three CAT scans showed progressive shrinkage of the liver metastases. My blood liver enzymes levels have also completely normalized, coinciding with shrinkage of the liver metastases. Another way to monitor treatment response is by measuring tumor marker (tumor markers such as CA19-9 are substances usually produced by the cancer in large quantities) levels in the blood. A progressive decline in CA19-9 blood levels signals tumor shrinkage. Since my CA19-9 levels were normal initially even before chemotherapy, my doctor cannot use CA 19-9 to monitor my progress.
My oncologist is quite pleased with my progress. Shrinkage of pancreatic cancers with chemotherapy can occur but is not common. In his words, not many metastatic pancreatic cancer patients are playing tennis either. But he cautions that only time will tell whether my responses to chemotherapy are sustainable. Many patients who initially respond develop resistance to the drugs, and their cancers recur.
There is hope
My wife and I attended a symposium on pancreatic cancer put on by Pancan last weekend. Pancan is a volunteer organization that provides education and support to pancreatic cancer patients and their caregivers, funds scientific research, and galvanizes the government to fund research.
At that meeting, I was astonished by the number of attendees who are multiyear pancreatic cancer survivors. I was also impressed by the energy and enthusiasm of the Pancan volunteers.
Many bright young scientists are working on treatment and prevention. Many new anticancer drugs are under development. There are also new ways of delivering existing drugs to make them less toxic and much more effective. Some gastroenterologists are doing research on using EUS (endoscopic ultrasound, a procedure that combines the techniques of endoscopy and ultrasound) to inject antitumor substances directly into the pancreatic cancer. Some radiologists are doing research on using computer-directed radiation and heat devices to destroy tumors without damaging surrounding tissues. Treatments of all types of cancers are improving.
How am I really feeling?
The outpourings of support from my family, friends, colleagues, nurses, and many of my patients have been phenomenal. Many are praying for me on a regular basis. Thanks to my wife, my family, and friends, never once have I felt alone, isolated, or sad. I am living every day to the fullest.
Yes, all my journal readings and past experiences as a doctor tell me that my prognosis is poor. But let me share with you a small secret: In tennis terms, I believe the match is going to be decided by a long tiebreaker in the fifth set, and I am afraid I will win this one.
There are just too many things I want to do in my backyard with my family and Fabio. Fabio is our new white 55-pound standard poodle puppy and the joy of my life.
Last Editorial Review: 4/14/2008