How fast does adenocarcinoma grow??

One question to ask your doctor is to consider whether this is ascites?

Chiming in here from Lake Tahoe, CA where I am visiting a stage IV patient and getting a better care and treatment plan in place to improve the potential of a better outcome.

In replying to the question about treating actively growing tumor cells and those that are quiescent and have a "stemness" to them, chemotherapy works by various drug agents breaking DNA and intercalating into the damaged DNA. This shuts down vital processes of the cell. Each agent works at a specific point of the cell-either in the G2 growth phase, the synthesis phase where new DNA is being synthesized or during the phase of Mitosis where the tumor cell splits and becomes two daughter cells with equal amounts of DNA.

Tumor cells can go into a quiescent phase having a stem-like quality. They are in a G0 phase-essentially in a steady state of no growth or synthesizing new DNA. So it is for this reason that standard of care chemo regimens are not effective. The concern I had when I was under treatment was in trying to eliminate any minimal residual disease (MRD) and allow cells to reach this quiescent state. I never had a break, pause or delay in treatment. Low WBC counts were immediately addressed with Neulasta. Doing full-dose Folfirinox of 24 cycles and 22 cycles of 5-FU in groups of six may have eliminated most if not all MRD.

What oncologists feel was the "tipping point" who have familiarity with my case feel that the excessive amount of oxaliplatin converted the immunologically cold pancreatic tumors to immunologically hot tumors. This means the oxaliplatin component caused the tumor cells to express neoantigens (new protein clusters) on the cell surface making them visible to one's immune system cells such as macrophages, dendritic cells, antigen presenting cells and tumor infiltrating lymphocytes TIL's).

The TIL's develop long-term memory. Using dendritic cell vaccine therapy works in similar fashion whereby TIL's recognize these new proteins and have long-term memory. Researchers have discovered that tumor conversion can be achieved using cytokines and chemokines. This is much easier on the patient than massive amounts of oxaliplatin. Dendritic cell therapy is on the verge of now being effective in pancreatic cancer because of the discovery in how to convert immunologically cold tumors to hot ones. Keep an eye open for trials using dendritic cell therapy. PennMedicine/Abramson Cancer Center at the Hospital of the University of Pennsylvania is likely going to become a leader in this area.

I just stumbled across a good paper with some good references on growth rates. I can't write a proper summary at the moment, but include some quotes and links below:

The paper: https://pmc.ncbi.nlm.nih.gov/articles/PMC4520782/

Quotes:

"Evidence based on mutational analysis predicts that pancreatic cancers are confined to the pancreas for many years, perhaps a decade or more before spreading beyond the pancreas."

"Clinical experience indicates that most patients with advanced stage pancreatic cancer progress rapidly."

"We find, after adjusting for factors associated with age at diagnosis, the average age differences of patients with larger versus smaller T stage tumours is small and often not statistically significant, suggesting that most pancreatic cancers rapidly progress from lower to higher T stages."

"We estimate that the average T1-stage pancreatic cancer progresses to T4 stage in just over 1 year."
[ Good reference on tumor sizes (T1-T4) using the TNM scale at: https://www.cancer.org/cancer/types/pancreatic-cancer/detection-diagnosis-staging/staging.html ]

"This undetectable period of growth may represent the majority of the overall time to progression, since a founding cancer cell has to undergo many tumour doublings to become a detectable tumour (a 1 cm diameter tumour contains ∼1 billion cells), but only a few more doublings to grow into an advanced-stage tumour. The most relevant timeframe for early detection purposes is the time from when a cancer first becomes detectable by diagnostic tests up until it begins to progress beyond stage I disease. Although pancreatic cancer has a poor prognosis overall, patients with small stage I cancers have a better outcome than most patients with resectable cancers (mostly stage IIB)."

"Several studies have estimated the growth rate of various cancers using serial tumour marker measurements or serial CT scanning,21 but only limited data of this kind is available for pancreatic cancer. One study that measured serial serum CA19-9 and carcinoma embryonic antigen (CEA) measurements in patients with advanced stage disease estimated the average tumour doubling time of pancreatic cancers to be ∼40–60 days."
[Reference below]

"consistent with the hypothesis that once a pancreatic cancer is detectable by diagnostic tests, its growth and progression to more advanced stage disease is rapid. "

"We also found that larger primary pancreatic ductal adenocarcinomas were more likely to be poorly differentiated. There is evidence that tumour hypoxia which is likely to be greater in larger tumours contributes to the differentiation state of the tumour."

"In conclusion, we find using the adjusted average ages of patients with localised or locally advanced pancreatic cancer at diagnosis that disease progression is rapid, with an average estimated time of 14 months for a T1 pancreatic cancer to progress to the T4 stage."

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Reference for the "~40-60 days" tumour doubling time:
https://pubmed.ncbi.nlm.nih.gov/10404129/
Results: The doubling time of CA 19-9 and CEA could be calculated in 90.2% and 58.5% of patients with inoperable pancreatic cancer. CA 19-9 doubling time was clearly associated with survival time in inoperable and palliatively operated cases, but not with sex, age, site of the lesion, or liver metastasis, and was significantly correlated with the tumor volume doubling time.

Conclusions: Examination of CA 19-9 doubling time may be useful in clinical evaluation of the prognosis for patients with pancreatic cancer and could possibly prove valuable in terms of the analysis of the growth process in this disease.

I was thinking the same thing. When I had ascites, that is what it felt like.

@tomrennie
How did you get rid of the ascites? I believe I have thst now.

@mnewland99 So sorry to hear that. I had three paracentesis to drain the fluid. Afterwards, it never returned. The chemo starting working allowing my pancreas and liver to begin working properly again. Are you getting symptoms?

@tomrennie
Yes, I am. Until I read symptoms online it took me awhile to figure out what that pressure and tightness was that made me very short of breath and made it impossible for me to do my walks around the lake. Now I just have to let my oncologist team know that that's what I suspect.