Q: Please tell me all you know about pancreatic cancer. A close relative recently died of this and we need answers, as she was very secretive about her illness.
What are the symptoms? When do they show up? What causes the abdomen to bloat so early? What kinds of tests are done?
We only knew she had cancer about a month before she died. Later, she said it was all through her system, and two weeks later, she passed away. She did not have pain until just a few days before she died. Why? How long did she really have this before she died? Could anything have been done?
-- Name Withheld, Buffalo
A: I hope I can help you understand more about this devastating disease so you and your family can work out your emotional upheaval.
The pancreas is a very important organ involved in the secretion of insulin and digestive enzymes. It is located under the stomach and liver and next to the first section of the small intestine.
Carcinoma of the pancreas is a relatively uncommon but deadly cancer, numbering about 2 percent of all cancers, but the fourth leading cause of cancer death. The cause is unknown.
Jaundice, an enlarged gallbladder and, sometimes, diarrhea are seen in the early stages of carcinoma of the pancreas. Weight loss, inflammation of the blood vessels and pain in the upper abdomen that moves to the back are often seen later in the progress of the disease.
It sounds like your relative's tumor grew in size and restricted bile flow from the gall bladder before being diagnosed. Her bloating could have been related to the changes in digestion that resulted from this blockage. With respect to her lack of pain, almost one-third of people with this cancer have minimal to no pain at all.
Fewer than one in 20 people with cancer of the pancreas will live more than five years, and many people will die within the first six months regardless of attempts at treatment. Surgery may offer some hope if done before the cancer has spread (metastasized) beyond the pancreas to other organs and tissues. However, surgery is only attempted in about 30 percent of people with this disease. Combined radiation and chemotherapy is often used to relieve, but not cure, the disease.
Because of space limitations, I have only touched briefly on carcinoma of the pancreas. For further information, you may want to call the American Cancer Society at (800) ACS-2345.
Q: Please write something about lymphedema and breast cancer. I am a 60-year-old lady who had a lumpectomy for cancer on my left breast last year. They also removed 20 lymph nodes from under my left arm. I've recently had a mammogram, bone scan, CAT scan and Pap test, all OK.
My left arm is puffy and numb, and I have lots of soreness under that arm; I can hardly bend my fingers on that hand. My legs also ache from time to time, and yesterday I felt low back pain.
In July, I was told I have lymphedema. What I've read about lymphedema doesn't talk about pain, unless there's an infection. There is some talk of putting a sleeve on my puffy arm. Is this something you think will disable me for life or hurt forever?
I'm very concerned.
-- A.C., Deland, Fla.
A: Your pain and swelling may be symptoms of different conditions. I presume that you and your doctors have fully explored the possibility of other problems. Since you asked about lymphedema, I'll focus on that condition.
As you probably know, the infection-fighting lymphatic system is a circulatory system for lymph and white blood cells. It's a little like the cardiovascular system is for blood.
Lymphedema is caused by something obstructing the flow of lymph. That something could be from a birth defect or from an injury-, surgery- or disease-related disruption of the system.
When the flow of lymph is blocked, it has nowhere to go except to seep into surrounding tissue under the skin, where it accumulates, causing swelling known as edema or lymphedema. By itself, it's not usually painful.
This is a condition you can live with. It does become dangerous, though, when an infection adds to the problem. So it is very important to keep an eye out for any signs of inflammation, like redness or tenderness, and infection, like fever.
You can do a lot to alleviate the symptoms. You can help the lymph flow by keeping your arm raised periodically if the pain is not too bad. You mentioned the elastic sleeve, which may be recommended for use when you're up and about. You may want to ask your doctor about massage and pressure devices to remove the accumulated lymph.
As to medical treatment, diuretics, the drugs that promote body fluid excretion, may be recommended in some situations. Microsurgery procedures may be valuable in a few selected cases. Of course, immediate antibiotic treatment is critical if an infection starts.
The pain you feel under your left arm is probably not due to the lymphedema. It may be related to your recent surgery. In any event, all the health care professionals on your team (radiologist, surgeon, etc.) need to be kept up to date on your pain and other symptoms.