Lessons from the Treatment Course of a Late-Stage Pancreatic Cancer Patient

Doctor zhou November 8, 2022

In August 2020, the son of a 75-year-old pancreatic cancer patient surnamed Guo (with a history of diabetes) came to me, hoping I could help his father.

On June 4, 2020, the patient, for abdominal discomfort, underwent CT at the Affiliated Hospital of Yan'an University, Shaanxi (exam no. 2006040705, image no. p2006040339). Scans showed multiple nodular and round low-density shadows in the liver, the larger about 1.9 cm, with no obvious enhancement after contrast. The gallbladder was not enlarged, no obvious enhancing shadow in its lumen, and the common bile duct was poorly shown. An uneven, slightly low-density shadow was seen in the pancreatic uncinate process, less enhanced than normal pancreatic parenchyma, with unclear boundary with the descending duodenum; the main pancreatic duct was markedly dilated; the spleen was not enlarged with normal parenchymal density; no obvious ascites; some retroperitoneal lymph nodes. Impression: pancreatic uncinate-process carcinoma, possible involvement of descending duodenum, main pancreatic duct dilatation, multiple hepatic cysts. Tumor marker CA19-9 (sample no. Chang 502) was 55.35 (reference 0–27), markedly elevated.

After diagnosis, on July 1, 2020 the family invited an expert from Zhongshan Hospital, Fudan University, for consultation; the expert recommended PET/CT. On August 12, 2020, the patient underwent PET/CT at Shaanxi Provincial People's Hospital (exam no. 1859, outpatient no. 202008112296). Scans showed enlargement of the pancreatic head/uncinate process with a soft-tissue nodule, ill-defined, larger cross-section about 2.2 × 1.5 cm. Small retroperitoneal lymph nodes, the larger about 1.0 × 0.4 cm; a slightly dense right hilar lymph node with uptake, the larger about 1.8 × 1.1 cm. Conclusion: hypermetabolic space-occupying lesion in the pancreatic head/uncinate process with low biliary obstruction and main pancreatic duct dilatation, consistent with malignancy (possible pancreatic cancer); sigmoid-colon nodule, suspicious malignancy.

Given the patient's advanced age, high surgical and chemoradiotherapy risk, and poor prognosis of already-spread pancreatic cancer, the family requested conservative TCM treatment, hoping only to prolong life and improve quality of life. This expectation was rational, so I agreed to provide pure TCM treatment. The regimen is detailed in my article "My Practical Experience with a Multi-Target Broad-Spectrum Anti-Cancer Chinese Herbal Compound"; I treated this patient with the hundred-plus herbs mentioned in that article.

In October 2020, the patient developed abdominal distension, abnormal liver function, and high bilirubin from biliary obstruction; I recommended biliary-stent drainage to relieve obstruction. After drainage, abdominal distension gradually resolved, but feet swelled. I advised eating more diuretic foods like winter melon, radish, and Coix seed to address the edema dietarily; if not relieved, add spironolactone tablets.

After three months of such conservative treatment, symptoms clearly eased, and the patient no longer wished to take medicine; we respected his wishes. Only on November 6, 2022 did the family contact me again, saying the patient had recently become thin and fatigued but otherwise felt well, and asking for new treatment advice. I thus learned he was still alive. I asked whether he had any other treatment after stopping medicine in 2020; the family said he had had none. For over two years his quality of life had been acceptable, so when he refused treatment they did not press him.

This is a lucky patient; spread pancreatic cancer patients rarely survive this long. When he recently rechecked in hospital, the doctor who had examined him was surprised he had lived so long, and so was I. Most pancreatic cancer patients, through repeated treatments, have shorter survival and far worse quality of life. This patient was treated only three months, then did nothing after symptoms eased, yet survived far longer.

Why do actively treated patients progress faster, while this passively treated patient survived longer and better? I partly explained in yesterday's article "Understanding Cancer from an Evolutionary Perspective": anti-cancer treatment is like artificial selection on cancer cells—killing weaker cells while driving evolution of stronger-surviving offspring. Thus some anti-cancer failures progress much faster than the natural course; that is the risk and price of aggressive treatment.

This patient's experience provides an excellent illustration for my article on cancer-cell evolution. His treatment followed precisely the principle I advocated: for clearly incurable late-stage cancer, abandon cure fantasies, provide symptomatic supportive care, improve quality of life, and prolong survival—more beneficial, economical, and humane.

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