Pancreatic cancer is a serious disease that affects about 43,000 patients in the United States annually, making it the fourth leading cause of cancer death among men and women. The most common risk factors are cigarette smoking, obesity, and hereditary factors. The only potentially curative treatment for pancreatic cancer is surgery, either with via pancreaticoduodenectomy (the whipple procedure) or distal pancreatectoy and splenectomy. However, only 15-20% of patients have limited disease at the time of diagnosis and are candidates for surgical resection. Even with surgery, 25-30% of patient with disease that has not spread to the lymph nodes will survive 5 years, and with patients with disease in the lymph nodes at the time of surgery 10% will survive 5 years. For patients with unresectable cancer at the time of diagnosis, patients with locally advanced disease have a median survival of 8 to 12 months, whereas people with widely metastatic disease have a median survival of 3 to 6 months. This does not mean nothing can be done.
There are several palliative (designed to improve quality of life rather than cure disease) options that can be done. One option is surgery. Because many pancreatic cancers obstruct the GI tract causing inability to eat without vomiting and obstruct the biliary tract causing jaundice, often patients with unresectable cancer are candidates for another type of surgical procedure to bypass the cancer and reconnect the GI tract and Bile ducts in such a way as to allow patient to be able to eat and be jaundice free for as long as possible. Other measures are focused on treatment of pain and depression that can sometimes accompany advanced cancers. Sometimes patients with pancreatic cancer do not absorb nutrients well and sometimes things as simple as nutritional supplements and vitamins may improve the quality of life for patients with advanced disease. No single doctor will be likely to be able to fully assess all of these options for your mother. A good place to start is always with a primary care physician
, who can assess the situation and refer you to the appropriate specialists. A general surgeon
, hepatobiliary surgeon, or surgical oncologist
will be the best specialist to discuss the surgical options for treatment of pancreatic cancer.
An oncologist would be the best specialist to discuss issues like chemotherapy, radiation, or prognosis of your mother's cancer. A palliative medicine specialist is an expert in making people, such as those with advanced cancer, as comfortable as possible and improving their quality of life while not necessarily working toward curing their disease. I suggest you seek consultation in person with all of these specialists to fully understand the options for treating your mother's cancer and improving her quality of life while fighting this serious disease.