Liver Problems?

My mother in law, Bonnie (widowed, age 59), has pancreatic cancer.  The cancer is located on the head of the pancreas.  Her diagnosis was made in October of 2006.  Days later, Bonnie had to have a stent put in to treat her jaundice.  The surgeon we consulted said that the cancer was non-resectable due to the fact that it was wrapped around a blood vessel.  Our oncologist has worked with chemotherapy in hopes of shrinking the cancer so that Bonnie is more comfortable.  She was able to take Gemzar in November and December, but her health has steadily declined to a point where she became unable to take the chemo (aside from oral Tarceva, which she only likes because it helps her to sleep). 

Bonnie was admitted to the hospital almost 2 weeks ago due to an abscess on her liver.  (The oncologist found it on a CT scan and told us to get her in immediately.)  We were happy to get her into the hospital as Bonnie had pretty much stopped eating, was losing weight, was seriously dehydrated (despite me hydrating her every other day), was unable to get off a toilet and was in a lot of pain.  The oncologist even told us that the cancer has shrunk from 3.5cm down to 2.5cm.  A drain was inserted into her liver.  Unfortunately, there is an infection and now the drainage bag is full of bile.  Bonnie is going to be having her second ERCP today to hopefully deal with this issue. 

Here's where our family is in need of feedback and additional info: 

1)  Is it typical for pancreatic cancer to cause liver problems?  To our knowledge, the cancer has not spread into the liver (not sure what the latest scans showed, but a January CT scan did showed the cancer still only in the pancreas). 

2)  The gastroenterologist said that such issues were common in pancreatic cancer patients that were in the end stages of the disease.  The oncologist has never once said that Bonnie was this near the end.  According to all of the material that I've seen on-line, Bonnie seems to be in a relatively early stage of the cancer based on the size of it.  Who to believe? 

3)  Up until yesterday, Bonnie seemed weak but stable.  Yesterday was the first day since she had been in the hospital that she looked like she was losing the fight.  I saw her behave strangely- when I walked into her room it looked like she was having a nightmare (body contortions, stressed looks, eyes occasionally opening and rolling into the back of her head).  When she eventually woke, she was not lucid and didn't engage in conversation aside from maybe a word or two.  Bonnie kept falling back asleep and would rapidly go back into one of these nightmare episodes.  Sometimes she would mumble and do things with her hands.  It reminded me of what my father described of my grandfather's last days, so needless to say Bonnie's condition freaked me out.  When I returned a few hours later, she was awake and responsive, but still weaker than she had been in weeks.  Did anyone out there notice signs that the end was coming or a light bulb moment where they knew the end was near?

4)  Do most pancreatic cancer patients actually die from the cancer or from complications due to the cancer and weakened state? 

5)  Is there anyone out there who has done home health care?  In home hydration sounded great until we were told that I was responsible for it.  My husband thought he was lightening my load at the time- what a laugh!  We recently received the bill for it and it seemed like $15000 was kind of high for 3-4 weeks of service where I did most of the work.  A nurse came out once a week to change the port line and check vitals- the rest was on me!  Thankfully, Bonnie's insurance picked up the tab.  On the other hand, I had to put in the time (we live 30 minutes away from Bonnie- that's 2 hours per day in driving time alone!), effort and burn the gas.  It seems like home health care is truly designed for a patient who is living with someone.     

6)  Are there any other caregivers who feel terribly guilty for the time spent away from their kids?  My boys have been very understanding about how much time I've had to spend taking care of grandma, but I still feel awful about missing out on time with them.  Neither boy has ever given me a bad time about helping with grandma, helping to take care of her pets or helping to babysit their younger cousins so that their auntie can visit grandma alone. 

Anyhoo...that's my story and I'm sticking to it!  I appreciate any info you have- it's like a life line to me!

Joy

I understand so much of what you're going through.  My dad had a 2.5cm tumor in his pancreas last month.  I found a lot of answers in the history of sites like this, pancan.org, canceranswers.com, etc.  I can't answer all your comments, but yes, pc will affect the liver.  First, bile backs up which the liver can't completely flush out.  It begins to eliminate through the skin, causing severe itching.  Once in the hands and feet, it shows advanced stage.  The liver typically has fatty deposits as we age, but some of those can be cancerous.  They don't know 100% without a biopsy.   The pancreas is also responsible for regulating blood sugars.  If it's not doing its job, the liver supply of insulin will be affected.  Diabetic symptoms often appear.

My dad has a loss of appetite, common to pc patients.  He feels full alot of the time.  He makes himself eat, but is uncomfortable when he does.  He's taking pancreas enzymes to aid digestion.  They seem to help.  From what I've read, pc patients die of starvation.  I pray for mercy on my dad, that his last days won't be long and drawn out. 

I wish I could give you more hopeful info.  This is just one of those ugly diseases that rarely turn out good.  The survivors I've read about spend much of their last years in the hospital.  Dad didn't want that, so I hope he will be able to stay home with hospice care through the end.

I totally relate about feeling guilty.  I homeschool 4 kids, so even that is suffering.  My dad is far away, and the only way I have to stay in touch is by phone and computer.  I've been researching every chance I get, trying to find helps to make him more comfortable.  That's how I learned about enzyme replacement.  I want to be there with my dad, but can't now.  Maybe I'll get to go out again and spend his last days with him.  My kids are feeling the strain, but they try to understand.  This is temporary.  It may be a few months, but I want to give my dad the best I can. 

May you be touched by God's grace during this hard time with your family.  Pray for me, and I'll pray for you. rt