Inoperable Cancers

I found out today that a buddy has pancreatic cancer. My brother, who’s an MD, gave me the news and described it as inoperable. But he also said it apparently had not metastasized.

In late stages with rampant metastasis and tumors in diverse places I could see how surgery might be impractical, if only because you’d be taking out lots bits, some of them vital.

My question is why a localized, unmetastasized cancer can be considered imoperable?

The pancreas is an interesting organ. You can lose up to about 90% of it without any significant problems. But once enough is destroyed to cause symptoms, it’s too late: you’re doomed.

In this case, I’m guessing the cancer has destroyed sufficient tissue that there would be no point in attempting to remove it. They can only try to make your friend comfortable – which will be difficult, considering that pancreatic insufficiency is not a good way to go.

If metastatic disease has been ruled out by CT, AND the patient is a good surgical candidate (few other health problems, wants to live, nutritionally sound) surgery should be considered to assess whether the mass is resectable.

Survival 5 years after surgery ranges from 0% to 18% at experienced centres (up to 30% after more benign pancreatic tumours such as cancers of the distal bile duct, duodenum or ampulla of Vater).

Many patients though to have localized disease are found to have unresectable cancer at the time of surgery.

Thus in answer to your question:

  • patients with many diseases or poor nutrition are bad surgical candidates
  • patients with “local” disease often have diffuse disease
  • your friend may have had a biopsy of the cancer, and it is a type with poor survival rates (an agressive ductal carcinoma, e.g.)
  • surgery might still be an option

I think TVAA has it right - it’s related to size. Sometimes a tumour gets too large and takes over too much of the affected organ/area for surgery to be helpful.

Well, thanks all.

Of course, Dr_Paprika has it right on (and I will re-emphasize his comment that what seems to be “local” cancer often turns out on closer scrutiny to have spread).

I would like comment on TVAA’s points, though:

Pancreatic cancer rarely, if ever, causes “pancreatic insufficiency”. Moreover, the presence of a pancreatic cancer seldom has any effect on pancreatic function (albeit, there is an association between the onset of type II diabetes and subsequent cancer of the pancreas).

Pancreatic insufficiency, while not something I’d want, is hardly “not a good way to go”. At worst, someone would need to take insulin injections and digestive enzyme tablets before meals.

KarlGauss is quite right: that isn’t the term I was thinking of. My apologies.

Some basic research on the subject brings up some relevant information:

It appears I was mistaken about the effects of the cancers on the pancreas itself (which is precisely why I should always do research first to check my frequently faulty memory!). Thanks to Karl for the correction.

Cancers originating in the pancreas seem to be highly malignant for some unknown reason. Also, because the organ has such a high redundancy factor, the growth of the cancer can be extensive (entering other organ systems) before it’s ever detected. So I wasn’t wrong about that, at least.

Most treatments are palliative, unfortunately. Roughly 29,000 people are diagnosed each year, and only about 100 survive 12 months, according to the sites I came across. Doctors supposedly recommend radiation and surgery without bringing up the survival rate if they’re not directly asked.