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HIV positive and pancreas cancern-- Help
Jun 9, 2003

I have a dilemma and I need your help. I went to see my doctor for hematuria and abdominal pain. An ultrasound that showed that I had a large mass near my pancreas. I went to the emergency room with chills and abdominal pain on April 16. I was admitted, and I had a CT guided biopsy, which was negative. I later had exploratory surgery and they also removed the cyst.I was told that the pathology test done at the hospital showed no malignancy, and I was discharged from the Hospital. I started to feel a sigh. I then got a call to come and see my Internist. He told me that because the labs were inconclusive at two centers, that they sent them to The Armed Forces Institute of Pathology in Washington D.C. and that they concluded that I have a low grade carcinoma consistent with solid pseudopapillary tumor of pancreas. I have a few questions for you.

1. Should I seek a second opinion? The entire time was hospitalized I was constantly told that my blood work and labs were so good that it didn't seem like any malignancy going on. Since two of the centers reported no malignancy its really hard for me to accept the final diagnosis. 2. Is pancreas of the cancer related to HIV infection? Everything I've read seems to point to no. I was looking over the report from the pathology center and it said that I am not consider as having AIDS. My CD4 Cell count is 630 and my viral load is undetectable. 3. What would be the standard treatment for this type of cancer in a patient who is HIV positive? I've read that since its low grade and solid pseudopapillary that the standard choice with be surgery (whipple operation) is this true. Also could a person who is HIV positive withstand this type of surgery? 4. Last, if Im placed on chemotherapy and radiation what type of harm will it cause to my T-cells?

I know that my letter is long, but I wanted to give you as much information as possible so that you could provide me with the best possible answers. I have been HIV positive since 1999. I have not had any OI's and I have been on Combivir and Viramune since January of 2000 without any complications.

Thank you so much for you time.

Response from Dr. Dezube

Your story is actually not all that unusual. Pancreatic tumors are particulary hard to diagnose in that the tumors are often enshrouded in inflammatory tissue/scar tissue. The Armed Forces Institute of Pathology is often the final say in terms of tumors. I can't tell from your query if you have seen an oncologist (a cancer doctor). Your tumor is unusual enough that I would recommend you see an oncologist, and particularly one who is experienced in pancreatic malignancies. Most major cities have such specialists.

With a CD4 count as robust as yours and a viral load under control, you would withstand any cancer treatment as well as HIV-negative folks would. Is does indeed pay to pursue treatment of this tumor as your life expectancy is quite bright. Given you robust CD4 count and controlled viral load, as far as I'm concerned, your health will be similar to HIV-negative folks. So the HIV shouldn't enter into your decision making picture. I can't recommend a specific surgery without first looking a bit more at your scans.

Lastly, with a CD4 count of 640 and this tumor, you do NOT have AIDS. Most likely the pancreatic tumor and the HIV disease are not related. That said, I have had HIV patients with similar tumors. GOOD LUCK.


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