Pancreatic Cancer: Treatment Options and Dietary Adjustments

About pancreatic cancer?

Hello, I am asking on behalf of my mother who is 50 years old, does not smoke or drink, and has a normal lifestyle.
A month ago, she was diagnosed with pancreatic cancer that has metastasized to the ovaries and colon.
Initially, she experienced abdominal pain and thought it was a gastrointestinal issue.
During surgery, tumors were found in the ovaries and colon, which were removed, but the pathology report indicated they were metastatic.
Now it is confirmed to be pancreatic cancer.
Since the surgery, she has had difficulty sleeping at night, experiences nausea without vomiting, and has bloating.
Before the surgery, she only had abdominal pain that made it hard to sleep, without nausea.
My mother used to drink coffee and had a history of acute pancreatitis that required hospitalization.
Two weeks after the surgery, pancreatic cancer was confirmed, and she underwent chemotherapy once, but has not completed a full cycle yet.
She will continue with chemotherapy.
Additionally, she has become particularly weak after chemotherapy and has developed a right thigh venous thrombosis, requiring anticoagulant treatment.
Is it true that pancreatic cancer patients cannot be saved? It is very hard to accept.
If we adjust her diet, could it improve her condition, or is surgery still an option?

Frank, 20~29 year old female. Ask Date: 2016/09/14

Dr. Lai Yicheng reply Oncology

According to your description, your mother has pancreatic cancer with metastasis to the ovaries and colon, classified as stage IV cancer.
Currently, she is post-surgery and receiving gemcitabine chemotherapy and thrombolytic therapy.
To address your questions in order:
1.
According to literature, the 5-year survival rate for stage IV pancreatic cancer is approximately 1%.
Although this rate is low, it is still important to fight for every chance.
2.
Gemcitabine is currently the first-line treatment with the least side effects.
I am curious about your mother's physical and mental condition.
If she is doing relatively well (at only 50 years old), it may be worth discussing with her oncologist the possibility of advancing to a more aggressive chemotherapy regimen, such as "gemcitabine combined with other chemotherapy agents" or "gemcitabine combined with targeted therapy," given her stage IV status.
3.
You mentioned, "I wonder if adjusting her diet could improve her condition or if surgery is still an option?" What do you mean by this? Hasn’t she already undergone surgery? My recommendations for you are: a) For postoperative pain and abdominal distension, in addition to medication control, she should get out of bed early to promote intestinal motility.
b) If she has a poor appetite, please ask the doctor to prescribe appetite stimulants (which may require out-of-pocket expenses).
c) Have a nutritionist assess her dietary status; during chemotherapy, her caloric intake should be 20% higher than usual.
d) Discuss with her oncologist the possibility of consulting a traditional Chinese medicine practitioner for herbal adjustments to her constitution.

Radiation Oncology Dr.
Lai Yi-Cheng

Reply Date: 2016/09/14

More Info

Pancreatic cancer is a particularly challenging diagnosis, especially when it has metastasized to other organs such as the ovaries and colon. Your mother’s situation, with her recent surgery and subsequent chemotherapy, is understandably distressing for both her and your family. It’s important to approach this situation with a combination of medical treatment and supportive care, including dietary adjustments, to help manage symptoms and improve her quality of life.

Treatment Options
1. Chemotherapy: As you mentioned, your mother has begun chemotherapy. This is often the primary treatment for advanced pancreatic cancer, especially when surgery is not an option due to metastasis. Chemotherapy can help shrink tumors and manage symptoms, but it can also lead to side effects such as fatigue, nausea, and loss of appetite. It’s crucial to communicate any side effects to her healthcare team, as they may be able to adjust her treatment or provide medications to alleviate these symptoms.

2. Surgery: In cases where the cancer is localized, surgery can be an option. However, since your mother’s cancer has spread, surgery may not be beneficial at this stage. The decision to operate depends on various factors, including the extent of the disease and her overall health.

3. Palliative Care: Given the advanced stage of her cancer, palliative care should be an integral part of her treatment plan. This approach focuses on relieving symptoms and improving quality of life rather than attempting to cure the disease. Palliative care can include pain management, nutritional support, and psychological support.

Dietary Adjustments
Diet plays a crucial role in managing symptoms and maintaining strength during treatment. Here are some dietary recommendations that may help your mother:
1. High-Calorie, Nutrient-Dense Foods: Since she is experiencing weight loss and decreased appetite, it’s essential to focus on high-calorie foods that are also nutrient-dense. Foods like avocados, nuts, seeds, and full-fat dairy products can provide the necessary calories without requiring large volumes of food.

2. Frequent Small Meals: Encourage her to eat smaller, more frequent meals throughout the day instead of three large meals. This can help manage nausea and make it easier for her to consume enough calories.

3. Hydration: Staying hydrated is vital, especially if she is experiencing nausea and vomiting. Clear fluids, herbal teas, and broths can be soothing and help maintain hydration.

4. Avoid Trigger Foods: Since she has a history of acute pancreatitis, it’s important to avoid foods that can trigger discomfort. Fatty, fried, or spicy foods may exacerbate nausea and should be limited.

5. Consider Nutritional Supplements: If she struggles to meet her nutritional needs through food alone, nutritional supplements like high-calorie shakes or protein powders can be beneficial. These can provide essential nutrients and calories in a more manageable form.

6. Consult a Dietitian: Working with a registered dietitian who specializes in oncology can provide personalized dietary advice tailored to her specific needs and preferences. They can help create a meal plan that addresses her symptoms and nutritional requirements.

Managing Symptoms
The symptoms your mother is experiencing, such as nausea, vomiting, and difficulty sleeping, can significantly impact her quality of life. Here are some strategies to manage these symptoms:
- Nausea Management: Medications such as antiemetics can help control nausea. Discuss with her healthcare provider about the best options available.

- Sleep Hygiene: Encourage practices that promote better sleep, such as maintaining a regular sleep schedule, creating a comfortable sleep environment, and avoiding caffeine, especially in the afternoon and evening.

- Physical Activity: Gentle physical activity, such as walking or stretching, can help improve mood and reduce fatigue. However, it’s important to tailor activities to her energy levels.

Conclusion
While pancreatic cancer is a serious condition, there are treatment options and supportive measures that can help manage symptoms and improve quality of life. It’s essential to maintain open communication with her healthcare team to address her concerns and adjust her treatment plan as needed. Dietary adjustments can play a significant role in her overall well-being, and seeking the guidance of a dietitian can provide valuable support. Remember, each patient’s journey is unique, and focusing on comfort and quality of life is paramount during this challenging time.

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