Question Title: Need second opinion and guidance

We have a loving family member who has just been diagnosed with pancreatic and liver cancer, after two catscan biopsies, an endoscopy, and an upper GI. He is emitting a green colored fluid and has not been able to retain anything--including water--on his stomach for three (3) weeks. He is being intravenously fed a high calorie (3,000/day) diet. Originally they had placed a tube through the nose into the stomach to suction out the fluid but have since removed it because they feel there is no blockage in the intestines (small or large). However, the doctors speculate that the pancreatic tumor is pressing against the intestines and this may be the reason he is not able to retain anything.

The physicians (GI Specialist/Surgeon/Primary Medical) want to do a bypass this Monday, 6/1/98. Please explain to us what exactly this bypass entails and/or accomplishes. Also, how does this affect his stomach and bowels? Will these organs continue to function properly or will he be required to use the colostomy bag? We are uncertain because they have not made it clear to us (the family) if this is the cause and/or whether the prognosis will be positive in terms of his retaining food. If they are just now doing this procedure, at what stage do you consider the disease to be since it has metastasised to the liver? What would be his life expectancy? Is this a routine procedure or are there alternatives to be considered? What exactly would you recommend?

If you are able to shed some light on the above and some guidance in the types of questions we should ask the physicians we will be eternally grateful.

Thank you.

Respectfully,

Connie & Jacquetta
____

---

Dear Connie,
Pancreatic cancer can grow and block the bile duct (causing jaundice) as well as the duodenum ( causing an inability to eat and vomiting). The tumor can also grow into the liver. I believe that your family member has metastatic pancreatic cancer rather than 2 different cancers.

The inability to eat, necessitating the use of intravenous nutrition, suggests that there may be a bowel obstruction. Often the obstruction is due to the growth of the pancreatic tumor into the bowel in the region of the duodenum. Evidence of obstruction can be easily demonstrated with a barium study.

Patients with pancreatic cancer can be managed in two different ways. It is possible to place a tube into the bile duct by either the endoscope or via placement through the skin. The purpose of these tubes is to drain the bile duct and relieve any symptoms of itch. Alternatively, the bile duct can be bypassed surgically, although this approach does not offer any survival or quality of life benefits over the nonsurgical approaches.

A second bypass, and possibly the one for your family member, is a bypass of the bowel obstruction so that the patient will be able to take nutrition by mouhn and not be dependent on intravenous therapy. It is necessary, however, to know the location of the obstruction prior to the surgery. Bypassing the obstruction should substantially improve quality of life although again survival will not be prolonged.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
HFHSM.D.-rf
*keywords: pancreatic cancer
0.4

---