Fruit of the Womb
Fruit of the Womb

Grand Rounds 4.30 at Women's Health News - Thanks Rachel!

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Sincere thanks to Rachel at Women's Health News for including a link to my recent post "Pancreatic Cancer Takes Another Young Life" in this week's Grand Rounds 4.30. The post was written in memory of my brother-in-law, John Darrek Offutt, who succumbed this past week after a two year battle against pancreatic cancer.

Like ovarian cancer, pancreatic cancer is insidious in onset and is usually not recognized early in its course. More than 32,000 individuals die annually with this condition in the U.S. and most will do so within one year of the initial diagnosis. Indeed, the time from diagnosis to death is perhaps the worst of all common cancers. Median survival of untreated disease is less than 4 months and even with state-of-the-art therapy only about 6 months. Mortality at 2 years, despite advances in therapy, is greater than 95%. Currently, pancreatic cancer is the 9th or 10th most common cause of cancer in the U.S., but the 4th leading cause of cancer-related deaths in both men and women. The National Cancer Institute estimates that more than $1.5 billion is spent each year on the treatment of pancreatic cancer.

Although pancreatic cancer is most common in the ages of 60-80, my personal experience with this disease has been in men and women between the ages of 30 and 50. Symptoms leading to the diagnosis of pancreatic cancer are often subtle, nonspecific, and may precede the actual diagnosis for months before the disease is recognized. Common symptoms include vague abdominal discomfort, nausea, loss of appetite, weakness, and weight loss. In many instances, the diagnosis is not suspected until the individual actually presents with jaundice, and perhaps, itching secondary to biliary obstruction.

At the time of diagnosis, no more than 15-20% of patients have disease that is limited enough to be considered for surgical removal. The procedure most commonly performed to manage pancreatic cancer is the Whipple procedure. This is a complicated operation that has significant associated morbidity and mortality ranging between 1-3%. Even with a 'successful' operation, median survival in experienced centers is still only about 15 months and five-year survival only 20%.

As is the case in most instances of pancreatic cancer, my brother-in-law was only a candidate for chemotherapy and radiation therapy when his disease was diagnosed. After Darrek searched the internet, he was quite aware of his poor prognosis and like so many of these patients was willing to try anything that might improve his prospects for survival. He was enrolled in a clinical trial here in Greenville, South Carolina at our Cancer Treatment Center that involved direct injection of his pancreas with viral vectors carrying, I believe, tumor necrosis factor-alpha (TNF-alpha). He lived with us during the better part of 8 months while he underwent the experimental treatment and follow-up and was later begun on 'conventional' therapy.

The treatment arrested the growth of his tumor and his condition remained quite stable for almost a year. When the cancer started to regroup, he was subject to its relentless course despite the best efforts of conventional therapy to control the disease. At the time of his death, he had been on dialysis for almost nine months, had not eaten anything by mouth in two months, developed the persistent pain that accompanies this disease and is poorly responsive to narcotics, and finally a high fever that signalled deliverance from his ordeal. At his funeral, it was commented upon by his father that he never once complained or failed to say "please" when he needed help. He remained quite lucid until right before his death - fully aware of his family who watched over him and cared for him until the end.
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About the Author

Dr. Trofatter is an expert on maternal-fetal medicine.

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