I am a 48- year- old man and my doctor recently told me that I have pancreatic cancer. To be honest, I didn’t even know what a pancreas was until my diagnosis and now I am not sure how to proceed with my treatment. Three weeks ago, I went for a check-up after my eyes became yellow. I thought maybe I had hepatitis or some other liver infection, but my doctor didn’t think so and decided to do tests. He was concerned because I had also lost a lot of weight in the past six months despite no change in diet. Blood tests and a scan of my belly showed that I have pancreatic cancer. I am not convinced of my diagnosis since I do not have any abdominal pain (surely how can an organ have cancer yet not give you pain?). In addition, isn’t jaundice a sign of liver disease? How does pancreatic cancer give jaundice yet the pancreas and the liver are two separate organs? Finally, my doctor says I might need radical surgery which even involves cutting out part of my intestines— isn’t this too extreme? Why can’t they just remove the affected part of the pancreas or just give me medication/chemotherapy?
Cancer is a very difficult diagnosis to come to terms with so one can understand your dilemma. Let me try and break down pancreatic cancer for you.
What exactly is a pancreas?
The pancreas is an organ found inside your abdomen. It is located behind the stomach. Its function is to produce digestive juices to break down food once it gets into the intestines. It also produces hormones (chemicals) such as insulin and glucagon to regulate blood sugar levels. Diabetics usually have problems with either insulin production or response.
What is pancreatic cancer?
Pancreatic cancer occurs when a group of cells inside the pancreas begin to grow out of control. If left untreated, these cells grow into areas outside the pancreas (this is known as spreading of the cancer). It can spread to organs around the pancreas or to distant organs such as the liver, lungs and even brain.
Is pancreatic cancer painful?
It is important for you to understand that the initial stages of pancreatic cancer are painless (the same applies to all cancers). Pain in pancreatic cancer occurs in the more advanced stages. Pancreatic cancer is often only discovered in the later stages because most people only go to hospital when they develop pain.
Is jaundice only found in liver problems?
No. Although jaundice is common in liver disease, it can occur in other conditions. (It can even occur in blood disorders and infections such as malaria). In pancreatic cancer, it often occurs as a result of blockage of the tubes connecting the liver to the intestines (these tubes are known as bile ducts and they can be compressed by the tumour in the pancreas). Jaundice can also occur due to spread of the pancreatic cancer to the liver.
Is the surgical option suggested too extreme?
Cancer surgery is always radical. You must remove the part of the organ with the cancer and some surrounding healthy tissue with it. This is to try and ensure that you have rid the body of any cancer cells. In pancreatic cancer, the choice of surgery depends on the location of the tumour. In some cases, only part of the pancreas is taken out but sometimes, you need to take out part of the intestines (even part of the stomach). In some instances, you can even remove parts of the liver or lung to which the cancer has spread. Each cancer patient is evaluated on an individual basis.
How about medical therapy?
Often, you will need medical therapy (chemotherapy) and sometimes even radiation therapy after the surgery. If you are not suitable for surgery, your doctor will determine which form of medical therapy is best for you.
What you should do now
You have a lot of doubt regarding your diagnosis of pancreatic cancer. My advice would be to seek a second opinion. You need to be at peace with the diagnosis before any treatment is started. Do not wait too long to seek the second opinion as delay in onset of treatment could be detrimental. Waiting for periods even as short as two months before starting treatment could been that a potentially curable cancer can no longer be cured.
about pancreatic cancer and what to expect during the course of your treatment.
Establish a good relationship with your doctor
Modern doctors are very open to discussing treatment options with patients. If you are not sure about something (or are uncomfortable with a treatment option), inform your doctor. Let him/her spend some time to help you understand exactly what you need to know.
Local treatment vs abroad
Any tests needed to be done to diagnose pancreatic cancer can be done locally and there is no need to travel abroad for that. Both NHIF and your health insurance should be able to cover the cost for this. You can choose to get treatment either locally or abroad. Most treatment options are available locally. There is, however, considerable delay in treatment in the public health sector. Ultimately, the choice is yours.
Cancer is not something you should deal with on your own. Get your family (or a close friend) involved in your care. Always go to the clinic with someone you trust. If you want to talk to someone who has been through a similar experience, there are several cancer support groups in Kenya and your doctor will gladly get you in touch with one of them.