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Thread: too Low Hemoglobin in stage 4 pancreatic cancer please help!

  1. #1
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    too Low Hemoglobin in stage 4 pancreatic cancer please help!

    Hi everyone,

    My father 63 years old was diagnosed with pancreatic cancer and liver metastasis and gastric invasion in April 28.From may we started chemotherapy with Gemzar once per week for 7 weeks then break 2 weeks after we were changed chemo with irinotecan one per week for 4 weeks.At begining chemotherapy with irinotecan father felt very good, markers decreases,has no ascites, has no legs swelling and not fever for 2 weeks then hemoglobin has dropped from 9.4 to 8 made ​​again ascites and his legs swollen again and his fever came back.My father made ​​in June Aranesp 500 every 3 weeks and has already made three injections but nothing change with his hemoglobin which is still down.On August 4th was hospitalized and was given an infusion of parental nutrition,vitamins and was transfused with two units of blood and hemoglobin had reached 8.6 from 8 and on August 15th we hospitalized him because his hemoglobin was 6.9 of course he was again transfused. His albumin level is very low has the value of 2.5 his legs and belly and hands are swalled.Father has not much appetite and eat very poor.he has pains on the spine and middle and Dr. thinks it could bone metastases.On Tuesday we would do a scan.Has sombeody happens that whit hemoglobin?What happens in this case? The doctor says will change chemotherapy again because has his blood mess up and we will start on chemo pills. what pills I don't know yet? we near the end?(from the begining of his diagnosis his hemoglobin was low he was transfuzated 5/6 times by now)

  2. #2
    Moderator Top User BobInBonita's Avatar
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    I'm sorry your Dad is at this point. I think things are always worst before a scan. There are so many possibilities, better and worse. After the scan at least you know what you are dealing with.

    Low blood counts are really common with chemo. As you know, when they get too low transfusions are necessary. If a chemo regimen seems to be working, they will frequently try to reduce the dosage to minimize the side effects.

    You ask if you are near the end. There is no way that we can answer that. Even the Drs who are right there and have all the information are frequently wrong on timing.

    How does your Dad feel about continuing with chemo? If he wants to continue, then please support that. If he is approaching the point where he just doesn't want any more of the chemo side effects, please support that. How he feels, both physically and emotionally, is the most important thing. How we on this board feel about it, and how you feel about it, really shouldn't matter. It is not an easy discussion to have but one that can point a direction.

    Best of luck to both of you.
    7/12 DX stage 3 pan can (adenocarcinoma) @ 65 - borderline resectable
    8/12 - 10/12 Chemo (GTX) & Stereotactic Radiation
    12/12 Whipple - R0 margins, 2/29 nodes pos.
    1/13 - 5/16 Vaccine clinical trial - randomized to control group - vaccine showed no benefit
    2/13 - 8/13 Gemzar for 6 months
    Quarterly scans - no evidence of disease to 10/14 - spot on lung being watched - possible infection 2 months on antibiotics
    3/15 - spot larger - probable met - surgery planned
    4/15 - PET prior to surg - recurrence & lung mets - Surgery cancelled - EUS w/ FNA showed adenocarcinoma - Stage 4
    5/15 - 9/15 Folfirinox @ reduced dosage - Stopped treatment after 11 infusions due to neuropathy
    10/15 - 8/16 maintenance 5-fu every other week
    8/16 - stable disease on both CT and PET/CT - chemo holiday while other treatments explored
    9/16 - lung biopsy confirms pan can met,
    10/16 -NanoKnife to pancreatic bed -PET after Nano showed new met in hilar lymph nodes - SBRT to both lung & lymph
    4/17 - PET/CT showed significant disease progression, multiple lung mets, pancreatic bed tumor has grown
    5/17 - Started hospice care - striving for acceptance

    Stay busy and live life to the best of your ability.

  3. #3
    Moderator Top User ddessert's Avatar
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    You father's low red blood cell count is likely from the Gemcitabine chemotherapy treatment. That your oncologist moved him to Irinotecan was a good try to give his red blood cells a chance to recoup, but it didn't work in his case. The shots of aranesp was also a good move to try and get his bone marrow to generate more red blood cells. But that hasn't worked either. His bone pain is making the doctor question whether the cancer has moved into the bone marrow (where red blood cells are made) and is keeping the aranesp from working very well.

    More chemotherapy will continue to depress his red blood cell counts and the only way to boost them is through transfusions. The transfusions only work temporarily so he'd need to continue receiving them.

    A break from chemotherapy will allow red blood cell production to get better (assuming no bone metastases) but also allow the cancer to spread more rapidly.

    If there are bone metastases, some have found radiation treatments to help with pain. It knocks back the cancer and probably the blood cell production too.

    You can ask about some of the "encapsulated" types of chemotherapy. Xeloda (in pill form) is an encapsulated type of 5-FU chemotherapy that is supposed to become active in the tumor cells - saving the patient from some side effects. Abraxane is another one. These drugs might give his bone marrow a chance at recovery while still attacking the tumor.

    These two Romanian hospitals are doing pancreatic cancer clinical trials for pNET tumors. That is not the kind of tumor your father has, but perhaps they'll have other options for him:
    SC Oncolab S.R.L. in Craiova, Dolj, Romania, 200385
    and
    Institutul Clinic Fundeni, Centrul de Gastroenterologie si Hepatologie in Bucuresti, Sector 2, Romania, 022328

    In all, it sounds like your current oncologist is doing everything he can. From what you've told us, has good reasons for everything he's done to now.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-Nov 2017 - NED
    Mar 2013-present - NCT01088789
    @pancanology

  4. #4
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    Does bone metastasis show on ct scans
    October 2012 dx stage 4 pancreatic cancer mets to Liver
    November 2012 failed Whipple
    December 2013 Mom is septic put on a respirator no chemo fighting for her life _happy new year in hospital she Also is dx with c diff turns around with heavy duty antibiotics from January till March
    March-september 2013 DECIDE to start. Chemo CA 9-19 # 14500 dr decides to add abraxine to gemzar had everyside effect also stent change 4 times in and out of hospital many infection
    October 2013 Ct scans shows liver leisions gone put no change to pancrease change chemo to xeloda
    January 2014 tumor markers up
    January 24 cancer spread lungs , spine, abdomin, stomach liver and pc tomorrow all lit up on petscan so back on gemzar and abraxine.
    May 2014 no change everything stays the same after 18 rounds of chemo chemo brake
    August 2014 on chemo brake scans shows all tumors got bigger mom wants to continue chemo meeting with drs on the 28th Dr said if mom not strong enough no chemo.
    Xo Cathy

  5. #5
    Moderator Top User ddessert's Avatar
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    Yes, a bone metastases is detectable on an X-Ray and would be even more clearly seen on a CT scan.

  6. #6
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    Thank you so much for your answers and your interes of reading my post!!That means so much for me in this really hard sittuation!
    I know that the dr is doing evreting for helping my father but I am still worried because with each day that passed by my father is felling verry weak,he eats very little, he has a swallowed abdomen I think from the ascitis, he now told us that his whole abdomen is hurting him,he feels no hurt in his spine and back only in his abdomen.He lost weight and his contition is getting worse.But why that happend so fast?Irinotecan was working wonderful even the dr was surprised how good is working but after 4 sessions of Irinotecan we went in a break for 2 weeks and after one week my dad started to feel weeker and weekr and with back pain.Tommorow we will do the scan an see what's going on and after that he will be admited and receive more blood transfusin and the chemo pills also.
    Is good continuing with chemo at this point?I am so scared when I see him like that... Would he ever be better?Should I belive in an improvement?
    He now is brething very heavy, and does't want to talk to much,he just stays in bed or in the chair.Is good continuingwith Aranesp even nothing change?What should I expect from now on?

    God Bless everyone!

  7. #7
    Moderator Top User BobInBonita's Avatar
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    Quote Originally Posted by micaela17 View Post
    Is good continuing with chemo at this point?I am so scared when I see him like that... Would he ever be better?Should I belive in an improvement?
    He now is brething very heavy, and does't want to talk to much,he just stays in bed or in the chair.Is good continuingwith Aranesp even nothing change?What should I expect from now on?

    God Bless everyone!
    Everybody's situation is different, so I cannot tell you what to do, but.....

    You have talked about your Dad's condition (pain, weakness, etc) but you have not talked about his attitude. If he wants to continue with chemo, that is what is most important. If he doesn't want to continue, that should be the decision. Either way, he should make the call.

    You can help him with his decision by being factual about his situation and by telling him you love and support him either way.

    When it comes to helping him with facts, your Dr should be able to guide you because he is closer to the situation than we are. In general there are very few survivors of stage 4 pancreatic cancer. Some people get significant additional time from treatment, others do not. As an outsider it seems he is reaching the point where additional treatments may not help him very much and may only make him weaker. Everyone has to make the decision for themselves when to accept the outcome or to continue treatment. Some continue until death, others when they are just tired of being tired and weak.

    I wish your father the best of luck with both his decision and his outcome, and I wish you acceptance of whatever choice he makes.
    7/12 DX stage 3 pan can (adenocarcinoma) @ 65 - borderline resectable
    8/12 - 10/12 Chemo (GTX) & Stereotactic Radiation
    12/12 Whipple - R0 margins, 2/29 nodes pos.
    1/13 - 5/16 Vaccine clinical trial - randomized to control group - vaccine showed no benefit
    2/13 - 8/13 Gemzar for 6 months
    Quarterly scans - no evidence of disease to 10/14 - spot on lung being watched - possible infection 2 months on antibiotics
    3/15 - spot larger - probable met - surgery planned
    4/15 - PET prior to surg - recurrence & lung mets - Surgery cancelled - EUS w/ FNA showed adenocarcinoma - Stage 4
    5/15 - 9/15 Folfirinox @ reduced dosage - Stopped treatment after 11 infusions due to neuropathy
    10/15 - 8/16 maintenance 5-fu every other week
    8/16 - stable disease on both CT and PET/CT - chemo holiday while other treatments explored
    9/16 - lung biopsy confirms pan can met,
    10/16 -NanoKnife to pancreatic bed -PET after Nano showed new met in hilar lymph nodes - SBRT to both lung & lymph
    4/17 - PET/CT showed significant disease progression, multiple lung mets, pancreatic bed tumor has grown
    5/17 - Started hospice care - striving for acceptance

    Stay busy and live life to the best of your ability.

  8. #8
    Senior User naturehd's Avatar
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    it sounds like his oncologists are making the best steps possible for now. knowing what the doctors are doing is good and understanding what the treatment does is great. trying to grasp why the oncologist chooses to do what and why will drive you crazy. the best way to help with treatment decisions is to make note of any and all side affects and daily activities and report back to the oncologist as yall go. the best way to help your loved one is to help them stay ahead of current side effects. sometimes its giving them an extra pillow and sometimes its giving them one bite of something to try trigger an appetite. anything that makes them comfy and content is what you do. don't forget to pay attention to you as well, you need to be good to go for him. much love to you and yours
    april / 2013 pop passes away on mama's birthday
    march / 2013 mama has a colon resection due to benign tumor
    august / 2013 mama goes jaundice, has a stent put in bile duct, diagnosed with 2b tumor on the ampulla of vater stage 2
    september / 2013 mama has wipple procedure
    december / 2013 mama has a port put in for future chemo
    january / 2014 scans show no cancer with benign cyst on liver and kidney
    january /2014 gemzar - tarceva chemo treatment begins
    may / 2014 scans show cancer spread to liver stage 4
    may / 2014 abraxane replaces tarceva as palliative treatment
    october / 2014 xoleda replaces gemzar - abraxane treatment
    november / 2014 mama goes to heaven
    cancer sucks

  9. #9
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    Hello everybody,

    Thursday my father did the scan,there was no bone mets but there was 2 little lung mets.The situation isn't good,the pancreatic tumor invaded the stomach,he has a 11 cm tumor in the head of pancreas, mets on his liver ,a tromb on his portal vein ,little water in the lung ,stomach and heart.The water is little and the dr said to not remove yet.Because he has a gastric invasion and the tumor is seems to be bleeding on his stool( he lost blood and dr thinks that is in his stool).For the tromboze we already make injections of anticoagulant Clexane 0.6 mg,but a tromb is already there and the dr said that is a colateral effect and for that we cannot do anything.So in this condition we cannot take pills of chemo because is a major risc o internal bleeding.this week father was discarged home for a break because he is too week,with his disease in evolution and his is full of edema(on his legs,belly and hands).The next week we go to hospital the dr said he must be transfused because he probabily will have low hemoglobin(he must be transfused every week) and he will think if my father should recive or not chemo on IV ,because the benefit in this case is minim from the side effects.In the hospital he recived albumin,vitamins and blood.He also has fenatyl patches 25 mg.Yesterday his legs and hands has been normal.he also take diuretics to try to release some water.
    My father doesn't know the gravity of his disease and he want's to do chemo.He his feeling depresed because he is feeling sick, and he dosen't make any improvement.He sometimes doesn't want to take some much pills ,and last night he want that all ends up because he don't want to be a burden for us.His has a good day yesterday,he eat his favortie soupe,he was in no much pain on his ribs maybe from the patch..
    In this case I think I gave up too soon?The dr said that we won't gave up on him,and if we won't do chemo we will transfuze him, and he will recive parental nutrition,albumin,vitamins every week or when he can came to hospital.
    I think that I must also try with naturist herbs,what did you think about Essiac or Vitamin B 17?I thnik that I must try evrething..

    God bless you all for the suport!!

  10. #10
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    Pennsylvania
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    micaela17,

    I have such empathy for you right now. My mother was in about this same situation only days ago with the ascites, edema, pain and inability to eat. She could not even get a CT scan due to her kidney function being impaired from dehydration. There was upper GI bleeding detected only a day before she passed. She never gave up but in the end her poor body just could not go on and she did not want anything to prolong it since there was no chance of any meaningful recovery.

    For her too it seemed to come on fast after her first and only FOLFIRINOX treatment. I don't know if that really accelerated anything or not because things were getting fairly advanced. She was already not able to eat enough to maintain her muscles and that can only go on so long.
    10-27-13 : Mom (67) goes to hospital for intermittant abdominal pains. Had been experiencing for approx 1 month prior.
    10-29-13 : Diagnosed Stage IV PC w-mets to liver. Tumor 2cm
    11-22-13 : Started on Gem+Abraxane / also taking PSK supplement / CA19-9 = 6062
    01-03-14 : Pain gone, appetite back, CA19-9 = 912 / Neupogen shots starting next week
    02-19-14 : First CT shows stable disease, CA19-9 around 500 / Sticking with G+A for another cycle unless things take a turn for the worse
    04-23-14 : Rising CA19-9 (above 1000) prompts next CT ahead of schedule. Scan finds progression Now must decide on 2nd line treatment
    05-07-14 : Taking part in a clinical trial comparing MK-2206 and AZD6244 to mFOLFOX. (Shes getting the MK2206+AZD6244)
    07-15-14 : First CT after starting trial shows drugs had no effect -- progression in all areas. Now to FOLFIRINOX.
    08-22-14 : My lovely Mother passes after 10 short months. May she rest in peace.

 

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