19th Year Anniversary

Webcam shots

L-I-F-E is the greatest Gift from GOD

Today is my 19th year anniversary as cancer survivor. I was diagnosed with peri-ampullary cancer in 1991 and had whipple surgery in May 16, 1991.

When I passed the 5-year marker for this type of cancer I rejoiced and my doctor told me to celebrate. The journey is not over yet. I looked at life through new eyes now and I take pleasure in the little things in life. I appreciate life and value my relationship

Above all I thank GOD and Mother Mary for my second life.

Rudy Fernandez and Peri-ampullary Cancer

June 7, 2008 - actor Rudy Fernandez passed away at age 56 after a two- year battle with peri ampullary cancer.

Why am I upset? Why am I affected? His friends, fans and everyone who knew him mourned his death. How am I related with Daboy, what is my connection to him?

What do we have in common?
The answer is Peri-Ampullary Cancer! Yes... we have the same illness. The only difference is he was diagnosed at stage IV in 2006 and mine was diagnosed early in 1991. We both have Whipple Surgery (pancreaticoduodenectomy).

Last year, I started this blog to write about food, recipes and my travels. When I learned about Rudy's CA, I decided to blog my experience with this type of illness which only a survivor could relate, explain, and feel what its like to be stricken with this rare type of cancer.

What is a Whipple operation?
In the Whipple operation the head of the pancreas, a portion of the stomach, bile duct, and the duodenum is removed. Occasionally a portion of the stomach may also be removed. After removal of these structures the remaining pancreas, bile duct and the intestine is sutured back into the intestine to direct the gastrointestinal secretions back into the gut.

Daboy will suffer no more.

Peri-Ampullary Cancer Survivor

Endoscopy pictures courtesy of GastroLab


Hooray !!! May 16 will be my 17th anniversary as a cancer survivor. Had a whipple operation (pancreaticduodenectomy) after DX of Peri-Ampullary CA in 1991.


I would like to write about this cancer which is rare type, if diagnosed early it would save many people from dying., when it's not discovered, it is usually advanced. Had I waited for the doctor to guess my disease, I would have died long ago. I was insistent and a demanding patient. I asked too many questions. Get 2 or 3 doctor opinions. I thank God that I had early symptoms.
I was a healthy, non-smoker/drinker female, but I recall that when I was younger, I disliked vegetables, milk, and picky on foods that I ate, irregular bowel movements, etc.

I never stop reading and researching about Pancreatic CA. There was no internet way back in 1991 so reading about this subject is limited to medical textbooks and medical journals only. I joined and read the forums of cancer organizations to see how survivors are doing and how they are coping with their health problems. People who have underwent whipples like me, will understand and feel what its like to be on the same boat. It's a tough ride, especially when you don't know yet your death sentence, but once you are diagnosed and staged of your Cancer, you'll feel relax but the battle is a long journey. Prayer is powerful, only God knows when our time will come. I highly recommend that surgery is the only potential curative treatment if its operable. CAT Scan is very expensive here in the Philippines but this is the fastest way to pinpoint the problem. I wish CTscan prices will be just like the ordinary X-ray test which is affordable.


FACTS:
Peri-ampullary
Around the ampulla of Vater. The peri-ampullary region is comprised of 4 structures; the ampulla, the duodenum, the bile duct and the head of the pancreas. It is sometimes difficult to tell which structure a tumor originated in. In such cases the diagnosis will be a peri-ampullary tumor.

Periampullary cancer, a pancreatic cancer affecting the ampulla Vater region, is a subgroup of pancreatic cancers. About 10-15% of all pancreatic cancers are located in this region. It is often impossible to decide if the tumour is arising from the distal bile duct or from the pancreas in an endoscopic finding like this. The typical symptom is obstructive jaundice.

Periampullary cancers constitute a distinct entity compared to the classical pancreatic head cancer. Their diagnosis and the approach to their treatment has improved considerably in the last two decades. Endoscopy, high-resolution imaging, and endosonography have resulted in improved diagnosis and staging. A pancreatoduodenectomy offers the only chance of cure and improves survival. Superior results are seen with high volume centres. While endoscopy plays an invaluable role in the palliation of obstructive jaundice in unresectable lesions, its role in preoperative stenting remains uncertain. Adjuvant treatment modalities have so far failed to significantly improve survival. These tumours carry a better prognosis than the more dismal pancreatic head cancer, possibly because of the activation of different molecular pathways in the process of carcinogenesis. This article reviews the current understanding and various treatment options of periampullary carcinomas other than the classical pancreatic head cancer.

Periampullary tumours are defined as those that arise within 2 cm of the major papilla in the duodenum. They encompass tumours of the ampulla of Vater, the distal common bile duct (intrapancreatic distal common bile duct), duodenal tumours (usually the second part) involving the papilla and tumours of the pancreatic head involving the ampulla.Thus, these tumours are classified on the basis of their tissue of origin. They constitute a separate entity from the classical adenocarcinoma of the pancreatic head. While these tumours can be benign, they are most commonly malignant and periampullary adenomas are well-known premalignant lesions. Periampullary adenocarcinomas carry a better prognosis than adenocarcinoma of the pancreatic head. While these tumours have different origins, the complex regional anatomy dictates a common operative approach. Malignant periampullary tumours are best treated by a pancreatoduodenectomy. Resection is the only option that improves survival. This review article discusses the current understanding about periampullary carcinomas, other than the classical pancreatic head cancer, and the various treatment options.

Historical Facts about the Pancreas
The pancreas was first described in 300 B.C by Herophilus of Chalcedon. In 100 A.D Aretaus described the term diabetes. It was Rufus of Ephesus who coined the term "pan-kreas" meaning 'all flesh'. In 1541 Andreas Vesalius first illustrated the pancreas and in 1642 Johann Wirsung discovered the pancreatic duct. In 1654 Francis Glisson of Cambridge described the sphincter mechanism at the end of the common bile duct. In 1674 Thomas Willis of Oxford described diabetes mellitus. In 1869 Paul Langerhans discovered the Islets of the pancreas where Insulin was made and in 1872 Alexander Danilewski discovered trypsin, the protein digesting enzyme, made in the pancreas. In 1922 Banting and Best discovered Insulin a hormone that controls blood sugar levels.

Pancreatic Surgery


Pancreatic surgery really started in 1879 when Thiersch first drained a fluctuating tumour in the abdomen which was a pancreatic cyst. The resulting pancreatic fistula eventually dried up spontaneously. However, the first serious pancreatic surgery began in the 1900s and in 1909 Coffey performed the first pancreatic anastomosis (join) to the bowel. In 1923 Jedlicka successfully anastomosed a pancreatic cyst to the back of the stomach and in 1946 Konig drained a pancreatic cyst into a Roux-en-Y loop of jejunum. In 1882 Trendelenburg carried out the first distal pancreatectomy (left sided pancreatic resection). The first successful removal of a peri-ampullary cancer was carried out by William Halsted in 1898 and this involved local excision.
The first true pancreatico-duodenectomy was carried out by Kausch in 1909 operating on a 49 year old man. This was a two stage procedure. Subsequently in 1935 A.O.Whipple performed a two stage pancreatico-duodenectomy. By 1940 he had perfected the single stage operation and by 1941 over 40 cases had been reported with an operative mortality of 27 %. To date there are many variations in the type of reconstruction of the Kausch-Whipple procedure. The procedure of pylorus-preserving pancreatico-duodenectomy was popularised by Traverso and Longmire in 1978.


Some symptoms of pancreatic cancer:
JaundiceThe head of the pancreas is located close to the common bile duct and small bowel (duodenum) so tumors located in the head of the pancreas may grow and block these structures. Bile duct blockage can lead to jaundice in 70-85% of patients with tumors in the head of the pancreas. Symptoms of jaundice include:
yellowing of the skin
yellowing of the whites of the eyes
light-colored (clay colored) bowel movements
dark-colored urine
itching
Nausea, Vomiting, Weight Loss Stomach emptying can be delayed when the small bowel is compressed. This causes a feeling of fullness and contributes to symptoms of nausea and vomiting. These symptoms are initially present in 35-45% of patients with pancreatic cancer. Patients sometimes have a loss of appetite and nausea that leads to weight loss.In advanced disease, up to 5% of patients have tumors that cause complete blockage of the small bowel. In this case, surgery may be done to bypass the blockage and improve digestion.
FatigueIn more advanced disease, patients can have a feeling of being tired and fatigued. There are many causes of fatigue in patients with cancer.
Abdominal Pain 75-90% of patients with pancreatic cancer have abdominal pain. This may be described as cramping or gas-like pain. Pain may also spread, or radiate, to the back and shoulders.
Blood Clots - There is an increased risk for blood clots in patients with pancreatic cancer. A blood clot can be a first symptom of pancreatic cancer. The cancer itself causes changes in the blood that increases the risk for blood clots. Some clots have no symptoms, but swelling, pain and redness can be present in the area of clot.
DiabetesThe onset of diabetes or difficulty in controlling blood sugar levels is also associated with pancreatic cancer. Diabetes may be diagnosed before or after the diagnosis of pancreatic cancer. Diabetes occurs when the body does not produce enough of the hormone, insulin, or is unable to use insulin properly. Insulin helps your body regulate the blood sugar level, so without it blood sugar levels are often high.
Pancreatic InsufficiencyThe pancreas secretes digestive enzymes, or juices, into the small intestine. These juices help digest food in the intestines. Patients with pancreatic cancer may not have adequate amounts of these enzymes, and food isn't digested normally. This is called pancreatic insufficiency.Symptom include diarrhea and cramping often after eating. This happens because food passes through the digestive tract not fully digested. As the indigestible food passes through, it pulls water into the intestines, causing diarrhea and cramping.


How is it diagnosed?
Patients with symptoms suspicious for pancreatic cancer will undergo tests to determine the cause of these symptoms. Below are some test and procedures used for diagnosis:
Ultrasound of the abdomen - An ultrasound can identify a tumor or mass in the pancreas or bile duct system that may be causing blockage or jaundice.
Endoscopic Ultrasonography (EUS)The EUS test is done with a lighted tube that is inserted through the mouth and placed into the stomach. Ultrasound images of the pancreas are obtained through the stomach wall. It is highly sensitive for diagnosing pancreatic cancer. EUS is particularly useful for detecting small (less than two centimeters) tumors which may not be well visualized by CT. It can also identify tumors that may involve important blood vessels. The procedure can provide details about the arteries and veins next to the pancreas.A biopsy with a small or 'fine' needle aspiration (FNA) of the tumor may also be performed during an EUS to diagnose pancreatic cancer. Intravenous sedation is used for this procedure.
ERCP (endoscopic retrograde cholangiopancreatography)An ERCP is done with a lighted tube called an endoscope to look at the bile ducts. It can also be used to place a stent or tube to open a blocked bile duct for drainage. Intravenous sedation is most commonly used for this procedure. The patient is not awake during the test. This procedure helps to determine what is causing the blockage.Some causes of these blockages include ampullary tumors, cholangiocarcinoma (bile duct cancer), inflammation or cancer of the pancreas. Bile duct juice and tissue samples may be obtained and sent to the pathologist to evaluate for cancer cells.
Computed Tomography (CT)The CT scan can show small tumors as well as important blood vessels that the tumor might be growing into or around. A CT scan can also look at surrounding organs for spread (metastasis) of the cancer into the lymph nodes, liver and other areas. The doctor may suggest a pancreatic mass CT to be done for the first clinic visit to better assess the tumor for size, location and involvement of surrounding vessels and organs. This is a special CT scan done at the Cancer Center that examines the pancreas very closely. A special dye is used for the CT, to give additional information to the radiologist; therefore a temporary IV (intravenous catheter) will be placed prior to the scan.
Interventional Radiology - In some cases the radiology department can perform needle biopsies using the CT or ultrasound technique to locate the mass (tumor) and obtain a tissue sample through the abdomen for a diagnosis. At the UM Interventional Radiology department, there are specialists who may be consulted to do one of these procedures.



Diagnosing pancreatic cancer can be a challenge. It is often difficult to get an adequate biopsy for the pathologist to look at under the microscope. It is frustrating for the patient and the doctor who want to move ahead quickly in making a diagnosis and beginning treatment.


What are the types of cancer found in the pancreas?
There are many different types of pancreatic tumors; however, pancreas cancer is mainly (95%) ductal adenocarcinoma. This type of pancreatic cancer arises from the lining of the pancreatic duct which is the exocrine part of the pancreas that produces the digestive juices.
Tumors may arise from the endocrine part of the pancreas in approximately 5% of cases. This is sometimes referred to as Islet (insulin producing) cell or neuroendocrine cancer. Even rarer tumors are sometimes found, such as sarcomas or lymphomas.


Ampullary Carcinoma
Ampullary carcinoma is suspected based upon demonstration of obstructive jaundice, often with dilation of the pancreatic and biliary ducts seen on abdominal imaging studies. A discrete mass may or may not be identifiable using standard transabdominal ultrasound or helical computed tomography (CT) scanning. Endoscopic retrograde cholangiopancreatography (ERCP) allows for direct identification and biopsy confirmation, although biopsy is not 100% accurate . Magnetic resonance cholangiopancreatography (MRCP) may allow identification of the lesion and obviate diagnostic ERCP. Endoscopic ultrasound (EUS) allows for more accurate diagnosis and staging of these lesions than CT, and also allows for forceps and fine-needle aspiration (FNA) tissue sampling. EUS may also allow selection of patients that can undergo local resection instead of pancreaticoduodenectomy (Whipple operation). Once the lesion is identified and staged, palliation of jaundice or operative resection for cure is similar as is discussed for carcinoma of the pancreatic head.



Sources: pancreatic cancer UK/indianjsurg.com/emedicine.com

Single Woman with Cancer

This is an informative article published by the American Cancer Society. As a cancer survivor, I went through the same situation although I have not had any chemo or radiation.

The Single Woman with Cancer
Getting through cancer treatment can be really tough for a single woman. You may not have a friend or family member who can be there for you like a spouse. Perhaps you also worry how a current or future partner will react when they discover you’ve had cancer.

Some of the scars left by cancer are public. These include the loss of hair during chemotherapy, the loss of a limb, or facial disfigurement. Others cannot be seen by a casual onlooker. For example, nobody would guess that a woman on the street has had a mastectomy. These private scars can be just as painful, though, since the few people who do see them are the ones whose acceptance matters most.

Perhaps the most private scar left by cancer is the damage done to your view of yourself. You may be wondering about how active you can remain and even how long you will live. If you had hoped to marry or to remarry, you may not want to involve a prospective partner in such an uncertain future.

Concerns about having children can also affect your new relationships. Perhaps you are no longer fertile because of cancer treatment. Maybe you can still have children but fear that cancer will not give you time to see your child grow up. Maybe you are worried about their future.
When dating, women or men who have had cancer often avoid talking about their illness. At a time when closeness is so important, it seems risky to draw a potential lover's attention to your problems. During treatment, you want to appear brave not complain. Even after the cancer has been controlled, you may try to forget that the illness ever took place.

Sometimes you can ignore the cancer. However, when a relationship becomes serious, silence is not the best plan. Before partners decide to make a strong commitment, they should discuss the cancer. This is true especially if the length of your life or fertility has been affected. Otherwise, cancer may become the "skeleton in the closet," or a secret that will limit your ability to confide in your partner. A loving partner needs to accept you as you are.

When to Talk About Your Cancer
It is always a delicate choice when deciding to disclose your cancer history to a new or prospective lover. Ideally, a couple should discuss cancer when a relationship begins to become serious. Try having a talk when you and your partner are relaxed and in an intimate mood. Ask your partner a question that leaves room for many answers. An example is, "You know I had leukemia many years ago. How do you think that might affect our relationship?" You can also reveal your own feelings: "I guess I hesitate to bring up my treatment for cancer because I’m afraid you’d rather be with someone who has not had the disease. It also scares me to remember that time of my life. What are your thoughts or feelings about my having had cancer?"
If you have an ostomy, mastectomy, genital scars, or a ¬sexual problem, you may be concerned about when to tell a new dating partner. There are no hard and fast rules. It is better to wait until you feel a sense of trust and friendship with your partner -- a feeling that you are liked as a total person before thinking about disclosing such personal information.

The Possibility of Rejection
The sad reality is that some potential lovers may reject you because of your cancer treatment. Of course, almost everyone gets rejected at some time. Even without cancer, people reject each other because of looks, beliefs, personality, or their own issues. The tragedy is that some single people with cancer limit themselves by not even trying to date. Instead of focusing on their good points, they convince themselves that no partner would accept them because of the cancer and the effects of treatment. Although you can avoid being rejected by staying at home, you also miss the chance to build a happy healthy relationship.
Here are some ways to help you make decisions about talking about your cancer:
Tell a potential partner about genital scars, an ostomy or sexual problems when you feel that individual already accepts you and likes you for who you are.
Discuss your cancer in depth when a new relationship starts to deepen, especially if you have life expectancy or fertility issues.
Prepare for the possibility of rejection by imagining the worst possible reaction of new potential partners, but don’t let fear of that reaction keep you from pursuing possible relationships that will work.

Improving Your Social Life
Try working on areas of your social life other than dating and sex. Single people can avoid feeling alone by building a network of close friends, casual friends, and family. Make the effort to call friends, plan visits, and share activities. Get involved in a hobby, special interest group, or adult education course that will increase your social circle.
Some volunteer and support groups are geared for people who have faced cancer. You may also want to try some individual or group counseling with a mental health counselor. You can take a more positive view of yourself when you get objective feedback about your strengths from others. Make a list of your good qualities as a mate. What do you like about your looks? What are your good points? What are your special talents and skills? What can you give to your partner in a relationship? What makes you a good sexual partner? Whenever you catch yourself using cancer as an excuse not to date, remind yourself of your assets.
If you feel shy about meeting new people, practice how to handle it. Talk to yourself in the mirror, or ask a close friend or family member to play the part with you.

You can even rehearse how to tell a dating partner about your experience with cancer. What message do you want to give? Try some different ways of saying it, and ask a friend for feedback. Did you come across the way you wanted to? Ask your friend to take the role of a new partner who rejects you because you have had cancer. Have your friend tell you what you dread hearing the most, and practice your response. Can you express your feelings in a dignified and satisfying way?

When you feel some confidence in your self-worth and your ability to handle rejection, you are ready for the real world. Then, when you start to meet people or to date, think of it as part of a learning process rather than a situation demanding instant success.

Pancreatic Cancer Awareness Month of November

I am a 16 year cancer survivor

I would like to share my story:

I was working in Abu Dhabi, UAE for over ten years, never been sick nor hospitalized not until April 20, 1991 when I was admitted in a gov. hospital because of fever, itching and yellow coloured eyes. It was also discovered that I have type 2 diabetes. I was evaluated by the hospital, had a complete blood check-up which revealed an elevated billirubin, my ultrasound revealed an enlarged gallbladder, dilated bile and pancreatic ducts. A CT Scan suggested an enlargement in the head of the pancreas so an arrangement was made by the hospital that I will undergo a surgical exploration at the end of the week.

My sister an RN, was not willing that I will be operated in Abu Dhabi because I had no relatives there. What if I'm gonna die? She requested that I will be moved to USA because of her confidence in the institution. I travelled from Abu Dhabi with a stop over in London for a few hours then to USA. After a series of test and biopsy it was confirmed and diagnosed of peri-ampullary adenocarcinoma.

A day before the surgery, my doctor talked to me and without any hesitation, he directly informed me that I have Cancer. It will be an open-close operation. This means that if cancer has spread he will just close it, if its not then I will have to undergo a Whipple surgery. I just could not believe it. It was not denial 'cause I feel that I was very strong. I lost my mother due to cervical cancer in 1988. I thought and prayed oh dear God, why me???? You took my parents and now me??? Please let me live, I'm still young I have so many things to do yet.

My surgery was in May 1991. They found a 3 cm. large mass involving the entire ampulla of Vater. However, there was no involvement of the pancreas nor any mets diseases . The surgery lasted for 6 hours.

I have a good recovery but the first few days after surgery was terrible with all those tubes and gadgets attached in my body, it was not easy getting up, moving and walking around doing my daily post operative exercise.

BACKGROUND:

Cancer of The Ampulla Vater

Carcinoma of the ampulla of Vater is a malignant tumor arising within 2 cm of the distal end of the common bile duct, where it passes through the wall of the duodenum and ampullary papilla. The common bile duct merges with the pancreatic duct of Wirsung at this point and exits through the ampulla into the duodenum. The most distal portion of the common bile duct is dilated (ie, forms the ampulla of Vater) and is surrounded by the sphincter of Oddi, which spirals upward around the terminal portion of the duct. Because of biliary outflow obstruction, carcinoma of the ampulla of Vater tends to manifest early, as opposed to other pancreatic neoplasms that often are advanced at the time of diagnosis.
Curative surgical resection is the only option for long-term survival. Surgical or radiologic biliary decompression, relief of gastric outlet obstruction, and adequate pain control may improve the quality of life but do not affect overall survival rate.
Pathophysiology: Ninety percent of ampullary tumors are adenocarcinomas. Neuroendocrine tumors, cystadenomas, and adenomas represent additional, but uncommon, histologic types. Tumors originate from ductal epithelial cells and usually invade into the substance of the pancreas. In more advanced disease states, peripancreatic tissue and the adventitia of large neighboring vessels, such as the superior mesenteric and portal veins, may be involved.
Lymph nodes metastases are present in as many as half of patients. Pericanalicular lymph nodes usually are the first to be involved. Nodes along the superior mesenteric, gastroduodenal, common hepatic, and splenic arteries, as well as the celiac trunk, are the second station of lymph nodes. Perineural, vascular, and lymphatic invasion are associated with a poor prognosis. Liver is the most common site (66%) of distant metastasis, followed by lymph nodes (22%). In advanced cases, lung metastasis also may occur.

Frequency:
In the US: Carcinoma of the ampulla of Vater is an uncommon tumor; fewer than 2000 cases are diagnosed per year. Ampullary cancer accounts for approximately 0.2% of all gastrointestinal tract malignancies and about 7% of all periampullary carcinomas. Adenocarcinoma of the ampulla of Vater is the second most common periampullary malignancy.
Internationally: Worldwide incidence is not known.