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Case Study on Pancreatic Cancer

Topics: Cancer, Metastasis, Lung cancer / Pages: 5 (1227 words) / Published: Oct 8th, 2011
Patient LR, like so many of my patients, has an unusual background, with a graduate degree, study abroad, and expertise in art. Before we first met, he had worked successfully in business for many years. His very devoted wife had a Ph.D. and had, before retirement, worked as a college professor.
He had been in good health when in July of 1991, at age 70, a routine chest x-ray at the time of his yearly physical revealed a small right lung nodule suspicious for possible malignancy. A repeat x-ray in August 1991 again demonstrated “a parenchymal nodule in the right mid lung…” CT scan studies of the chest in late August 1991 confirmed a “6 millimeter nodule in peripheral lateral aspect of right upper lobe. It is consistent with bronchogenic carcinoma, metastatic lesion or granuloma…” In addition, the radiologist noted “an enlarged lymph node posterior to the ascending thoracic aorta…”
A CT scan of the brain in early September was clear, but a CT scan of the abdomen revealed extensive disease throughout:
There are about 4 lesions in the upper right lobe of the liver…An ultrasound examination is recommended for further evaluation…
There is a round enlargement of the right adrenal gland up to 2 cm in diameter. There is also what appears to be diffuse enlargement of the left adrenal…Both these findings are suspicious for metastatic disease. There is a mass in what may be the cephalad portion of the head of the pancreas or it is a mass or adenopathy just adjacent to the head. The mass measures about 4.5 cm in its greater diameter…
A bone scan the same day demonstrated:
Abnormal activity of the right hip and right shoulder suggesting metastatic disease…
Though the situation appeared dismal, the patient’s doctors still needed a biopsy specimen to confirm not only cancer, but also the most likely primary site. After reviewing the scans, they decided the lung lesion to be most accessible for tissue sampling, so in late September LR was admitted to his local hospital for mediastinoscopy and a limited right thoracotomy. In his admission note, the surgeon reports his belief that the situation was most consistent with metastatic pancreatic cancer, not lung cancer that had spread into the abdomen:
At some point, I suspect he will require oncology and radiation medicine consultation for what is most likely a pancreatic carcinoma with multiple metastatic lesions.
The lung nodule proved to be adenocarcinoma, as the pathology report describes:
Right upper lobe lung nodule, biopsy: Infiltrative moderately differentiated adenocarcinoma.
After surgery, an ultrasound revealed the liver lesions most likely represented metastatic cancer:
Areas consistent with metastatic involvement of the liver, the largest of which is approximately 3.4 to 4 cm in maximal dimension near the hilus. The second is just under 2 cm in the right lobe and possibly a third smaller one in the right lobe.
With the testing done, LR was told he had metastatic pancreatic cancer, perhaps two months to live, and that neither chemotherapy nor radiation would be of benefit. But, instead of giving up and getting his affairs in order as the doctors suggested, he and his wife decided to take the situation into their own hands. They both began reading voraciously about cancer, nutrition, and alternatives. He began ingesting large numbers of supplements, including vitamin C, vitamin E, even pancreatic enzymes
I first saw LR in December 1991. Despite his prognosis, he seemed determined to fight his disease, and talked as if he had absolute faith that he could get well on my therapy. He subsequently proved to be a very compliant patient, and the results, though gradual in coming, were gratifying. Within a year, his general health had improved substantially, and a CT scan of the abdomen in February 1993 – some 15 months after his initial diagnosis - showed no change in any of the lesions. Technically, the cancer hadn’t improved, but it hadn’t advanced, and he was still alive.
After that set of scans LR told me he wanted no more testing. Since he had already long outlived his doctors’ dismal predictions, he figured he didn’t care what the scans might show and wouldn’t change his treatment anyway. So he continued his therapy and enjoyed with his wife the retirement for which they had long planned.
In 1997, after he had followed his nutritional protocol for five years, he agreed – with some pleading from me - to allow radiographic studies. A CT of the abdomen in March 1997 showed two mildly enlarged adrenal glands and a single, very small, less than 1 cm mass in the dome of the liver. The other large liver lesions were gone. The radiologist in his report described the pancreas as normal – the previously documented large tumor had simply disappeared:
The liver demonstrated a single small hypodense area in the dome of the liver which has the appearance of a cyst, measuring well less than 1 cm. A metastatic lesion is still a possibility especially in view of the patient’s history of lung cancer and adrenal mass…The adrenal glands are both abnormal…The pancreas, the spleen and the kidneys are within normal limits. There is no evidence of periaortic lymphadenopathy.
Then sixteen months later, in July of 1998, nearly seven years after his diagnosis, LR agreed to undergo repeat scanning. The radiologist reports:
Reading the report from the 1993 study it sounded like the patient had obvious metastatic disease and the largest structure being a large porta hepatis and peripancreatic mass. No such masses are seen today. There is no adenopathy. The adrenals are prominent and there are two very small liver lesions that cannot be characterized because of their small size.
Thereafter, LR continued his program and continued doing well until he was in an automobile accident in 2004. Unfortunately, he required lengthy rehabilitation, followed by life in an assisted care facility. His wife, three years older, no longer able to care for herself at 87 years old, also entered an assisted care facility, where she recently died. But LR at age 85 years old is still alive, now more than 15 years since his diagnosis of terminal metastatic pancreatic adenocarcinoma.
His case does not require much discussion. He was diagnosed appropriately with terminal cancer and given two months to live. He did his program, the tumors went away, and he survived.

1. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo, DL, Jameson JL. Harrison’s Principles of Internal Medicine, 16th Edition. New York: McGraw-Hill; 2005:537.
2. DeVita VT, Hellman S, Rosenberg SA. Cancer: Principles and practice of oncology, 6th Edition. Philadelphia: Lippincott Williams & Wilkins; 2001:1127.
3. Burris HA, Moore MJ, Andersen J, Green MR, Rothenberg ML, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403-13.[Abstract]
4. Gonzalez NJ, Isaacs LL. Evaluation of Pancreatic Proteolytic Enzyme Treatment of Adenocarcinoma of the Pancreas, With Nutrition and Detoxification Support. Nutr Cancer. 1999;33:117-24. [Abstract]

Copyright © Nicholas J. Gonzalez, M.D.
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Nicholas J. Gonzalez, MD PC
Linda L. Isaacs, MD
36A East 36th Street
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New York, N.Y. 10016
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