Pancreatic Cancer: The Silent Disease

A doctor-editor’s perspective on his struggle with pancreatic cancer Medical Author: Dennis Lee, MD
Medical Editor: Melissa Conrad Stöppler, MD

The diagnosis I was diagnosed with pancreatic cancer on May 25 of this year. A routine yearly blood test revealed slightly elevated levels of liver enzymes (alkaline phosphatase, ALT, and AST). Since I had no abdominal pain or weight loss symptoms, my doctor and I believed these abnormalities were due to the statin I was taking to lower cholesterol. To ensure completeness, my doctor ordered a liver ultrasound, which revealed multiple liver tumors. A subsequent CAT scan of the abdomen confirmed an orange-sized mass in the tail of my pancreas with metastases in the liver. A liver biopsy confirmed it was pancreatic cancer.

It was a shock At the time of diagnosis, I was a healthy 57-year-old gastroenterologist living in South Orange County. I had no known risk factors for developing pancreatic cancer, such as alcohol consumption, smoking, or a family history of the disease. I exercise regularly, maintain a healthy weight, and do not have diabetes mellitus. Ironically, I had been researching pancreatic cancer prevention prior to my diagnosis. I was in the process of gathering information to write an article when I received this bad news.

More bad news A week before my diagnosis, I experienced shortness of breath while playing tennis. Initially, I attributed it to work fatigue. However, after the CAT scan, blood clots were discovered in my pulmonary arteries, a dangerous complication of pancreatic cancer. I was hospitalized to receive anticoagulants to dissolve the clots. During my hospital stay, I was also diagnosed with diabetes mellitus, another condition caused by substances produced by pancreatic cancer. In just one week, I went from being a healthy doctor to a disabled patient with advanced pancreatic cancer complicated by diabetes and pulmonary embolism.

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Treatment

Since most pancreatic cancers are discovered late, surgical resection is not usually an option. Therefore, chemotherapy is the recommended treatment. I was placed on a combination of gemcitabine infusions, erlotinib, and capecitabine. While the side effects are unpleasant, I still have the ability to play tennis during my treatment breaks.

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Treatment response

My cancer has responded well to chemotherapy. Three CAT scans have shown progressive shrinkage of the liver metastases, and my liver enzyme levels have normalized. Although I cannot use tumor markers to monitor progress, my oncologist is pleased with my response. However, only time will tell if the response is sustainable, as some patients develop drug resistance and experience disease recurrence.

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There is hope

At a pancreatic cancer symposium held by Pancan, I was amazed by the number of attendees who were long-term cancer survivors. The energy and enthusiasm of Pancan volunteers were also inspiring. Bright young scientists are working on new treatments and prevention methods, and there are promising developments in drug delivery and radiation techniques. The future of cancer treatment is improving.

My current state

The outpouring of support from my family, friends, colleagues, nurses, and patients has been phenomenal. Thanks to them, I never feel alone or sad. I am living each day to the fullest. Despite the poor prognosis, I am optimistic and believe I will win this battle, just like a long tiebreaker in tennis. There are so many things I want to do in my backyard with my family and Fabio. Fabio, our new standard poodle puppy, brings immense joy to my life.