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D. Baron, MD
D. Baron, MD, Doctor (MD)
Category: Health
Satisfied Customers: 1040
Experience:  Physician with 27 years of experience.
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Last April my father was diagnosed with inoperable

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Last April my father was diagnosed with inoperable pancreatic cancer (stage four). He has since gotten very thin (very) and he has cancerous fluid that accumulates at a very rapid rate in his stomach (it's been removed 3 times (every 2 weeks). I'm not sure how my father's illness will manifest itself at the end of things. ...No one seems to say anything about that. I was told that the pancreatic cancer doesn't cause death, that something else does and we (my family) don't know what that means. Can you explain things more clearly? He is not in pain (tenderness in the belly and sometimes pain in his back). He's not being treated with any heavy duty pain meds yet...just tylenol. He is not jaundice either. He's very tired, weak, is now using a wheel chair to get around (this has all happened since mid April). At the time of diagnosis, the doctors said "6 months" but never let any of us know what to expect at the end. He's no longer taking chemo, just hospice care now. Please give clarity.
Submitted: 10 years ago.
Category: Health
Expert:  D. Baron, MD replied 10 years ago.
Since I don't know the results of his blood chemistries and tests I can only assume that the ascites (fluid that collects in the abdomen) is due to liver failure. When the liver fails, it can't metabolize protein properly, detoxify substances or produce the clotting factors necessary to clot blood and stop bleeding. The ascites fluid is rich in albumin (protein) and depletes the blood of albumin as well, thus reducing the volume of blood circulating. The failure to properly metabolize protein and detoxify the ammonia from protein metabolism causes ammonia to collect in the blood stream. The ammonia interferes with brain function and results in "hepatic encephalopathy". Patients become confused and unaware of their environment. The flip side of that coin is that it may be somewhat merciful. The lack of clotting factors makes the patient the same as somebody with hemophelia. They can bleed out from the GI tract, have bleeding into the lungs or even have a massive intracerebral hemorrhage. Any of those could end up being fatal. Decreased effective blood volume can lead to multiple organ system failure and/or cardiovascular collapse. Those are a few scenarios possible. I hope it was helpful and not too upsetting.
Customer: replied 10 years ago.
The cancer has not as of yet spread to the liver. I'm not clear as to the progression of this and if going to the liver is what will ultimately cause my father's death. He is weak, thin and can't eat much, although his appetite seems better than when he was taking chemo (but he still only eats a very small amount). The last scan showed that the most aggressively growing part of his cancer is in the stomach fluid. His tumor on his pancrease has not grown or gotten smaller. The liver seems to be, for now, not involved. Is that the next phase of things?
Expert:  D. Baron, MD replied 10 years ago.
I would need a crystal ball to predict that. Pancreatic cancer is not one that metastasizes to the brain, so that organ is out. Pancreatic cancer most often metastasizes to the liver and lungs. It can grow by direct exctension into the aorta and/or the vena cava and cause exanguination (bleeding to death). He probably has peritoneal implants that are partially causing the ascites. I really can't predict the next phase. I don't think his doctors can either.
Customer: replied 10 years ago.
Not understanding (implants). He has no implants. My dad has never been sick in his life..well, obviously he has but he's been undiagnosed. He has been (for years) diagnosed with irritable bowel syndrome Florida. Eventually we insisted that he be examined in NY and they found (from a contrast scan) the inoperable tumor.'s been down hill since. But there have been no implants. I truly appreciate your patience and advice, here.
Expert:  D. Baron, MD replied 10 years ago.
I'm sorry for the misunderstanding. By "implants" I didn't mean any device or instrumentation. I meant tumor cells that implanted themselves into the peritoneal membrane that lines the abdomen.
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