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Monday, May 15, 2017

The dx from Hell: ICD-10 code C25.9

Pancreatic Cancer
Pancreatic cancer (PC) has the highest case-fatality rate of any of the major cancers, both in the US and worldwide. The disease is difficult to detect, rapidly metastatic, resistant to treatment, and often results in death. Pancreatic adenocarcinoma is also one of the most difficult cancers to study. Case-control studies may be inaccurate because patients with PC often die within weeks of their diagnosis. At the same time, prospective studies of PC are challenging due to the relative rarity of this type of cancer (~ 1% lifetime risk) and low prevalence due to short life expectancy. Consequently, PC etiology is often investigated by analyzing data from large-scale prospective studies or clinical trials for diseases other than PC, but limited numbers of cases and methodological heterogeneity (e.g., no or incomplete histological verification) affect the validity of these results.

The etiology of PC is widely acknowledged to be multi-factorial. The incidence of PC is greater in males than in females, and higher in Blacks than Whites. According to SEER 17 areas data, the age-adjusted incidence of PC in 2006 per 100,000 individuals was 11.61 (95%CI 11.34-11.88) for Whites and 15.57 (95%CI 14.57-16.62) for Blacks, with 16.56 for Black men (95% CI 15.08-18.61). Environmental or host risk factors shown to be associated with PC include cigarette smoking, obesity, type II diabetes mellitus, chronic pancreatitis, physical inactivity and blood groups A or B. Dietary risks may be related to low fruit and vegetable intake and increased intake of high-heat cooked meats (i.e., grilled/fried animal protein sources). Two separate, recent studies linked pancreatic cancer to high consumption of carbohydrates and alcohol. Unfortunately, these common risk factors have small effect sizes, so it is difficult to produce highly accurate risk models. For example, smoking yields a risk ratio of approximately 2. The risk of developing PC is recognized as being exceptionally elevated in certain genetically predisposed families (e.g., hereditary pancreatitis,), but only about 10% of all PC cases can be attributed to genetic causes...

Lightening strikes yet again. I've alluded briefly to this new circumstance here and there in prior posts.

On March 29th, the radiologist's report from a CT scan done at a Kaiser Permanente facility indicated that my younger daughter Danielle is afflicted with Stage IV metastatic pancreatic cancer, a finding confirmed by a subsequent liver biopsy. (She's given permission to go public with this horrific news.)

Our world has been turned upside down ever since. My KHIT efforts have been significantly hamstrung. Danielle started Folfirinox chemo (after first being accepted into and then, in the wake of some subsequent disqualifyingly elevated adverse labs, excluded from a UCSF clinical trial). Her severe side-effects reaction to the first chemo round landed her in the hospital, where my wife and I spent all of last week by her bedside in shifts.

Above, Sissy (top) and Danielle (bottom) in 1974 in Seattle, the year I got a divorce and custody of both of them. The backstory on my salt and pepper kids.

Needless to say, we are all reeling. One of her friends started a crowdfunding page for her, for which we could not be more grateful. She will need every dime. Danielle's out-of-pocket expenses to date alone are mind-boggling (KP membership notwithstanding). If her illness doesn't kill her, it will most certainly bankrupt her -- in relatively short order. She will shortly be the former Executive Director of The Stepping Stones Project (they've generously given her extended "medical leave," which, though, necessarily runs out by month's end).

We've moved her back home, and I will be breaking her lease and packing up and stowing her apartment shortly, and tending to the myriad piling-up logistical and legal assistance details.
And, get excused from the jury duty summons I just got.
So, yeah, I'm a bit behind the curve. My life the past seven weeks has been an endless recursion of "oh, SHIT!" moments.

Prior to this news. I'd been trying to finish out my "One in Three" book. Gonna have to scrap the title and cover photo and broaden the scope.

1980, Knoxville


More to come... dxFromHell

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