Survivor Triumphs Over Pancreatic Cancer

Jan Castle has defied the odds.

It has been more than 10 years since her diagnosis and surgery for pancreatic cancer, a form of cancer that in 1990 had only a 2% survival rate. At 53 years old, she feels that more than just luck brought her this far. Her religious faith and skilled healthcare professionals also played instrumental roles.

"I was not afraid after my diagnosis because of my strong faith in God. I believe things happen for a reason," Castle said. "And, 10 years ago, information was not readily available – on the Internet and such – so I learned by listening and trusting my doctors."

She also learned a little from TV and magazines. Actor Michael Landon was fighting pancreatic cancer the same time Castle was being treated. Landon, however, lost his battle with the disease in 1991.

This year, an estimated 28,300 new cases of pancreatic cancer will occur, with 28,200 cases resulting in death, according to the American Cancer Society. The one-year survival rate is 19%, and the five-year survival rate is 4%.

Very little is known about what causes pancreatic cancer or how to prevent it. The disease is generally "silent" or without symptoms until it is in the advanced stages.

"The biggest challenge in pancreatic cancer is to find better methods for early detection," said Dr. Douglas Evans, professor of surgical oncology at The University of Texas M. D. Anderson Cancer Center.

"Unless a tumor is located adjacent to the bile duct and causes blockage, which results in jaundice, symptoms are otherwise subtle," Dr. Evans said.

Castle has a history of cancer in her family, but cancer didn’t occur to her as the cause of her chest discomfort in early 1990. She saw a doctor for pains in her sternum, experienced particularly after eating. A series of tests determined a dysfunctional gall bladder. Anxious to fulfill her commitment as music director for her church, Castle scheduled her surgery after an upcoming concert.

However, before the concert, she became jaundiced. "I was just as yellow as I could be standing in front of the church leading the choir," Castle said. "My doctor was shocked when he saw me the next day and admitted me to the hospital for immediate surgery."

The surgeon found not only a dysfunctional gall bladder that had to be removed, but also a large mass in her pancreas and blockage to the bile ducts. Three of six biopsies sent to M. D. Anderson revealed pancreatic cancer.

Castle was referred to M. D. Anderson where she was one of the first patients to try chemotherapy and radiation before surgery for pancreatic cancer, according to Dr. Evans.

"The recovery from surgery of the pancreas is not quick. This is a major surgery. By starting chemotherapy and radiation prior to the surgery, we had a better chance of a successful outcome," said Dr. Evans, who was Castle’s surgeon.

This operation, the most common surgery performed for pancreatic cancer, was named for Dr. Alan O. Whipple who first described the procedure in 1935.

During the Whipple procedure, the head of the pancreas and the duodenum is removed, along with the gall bladder, the lower section of the stomach and the upper section of the small intestine. The remaining portion of the pancreas and the bile duct from the liver are re-sewn to the small intestine, which is then sewn directly to the remaining stomach. The resection allows the small intestine to digest food in place of the duodenum.

This procedure has been significantly improved over the years, Dr. Evans said, and now has a relatively low mortality rate.

Castle said she had some ups and downs after the surgery. Side effects included occasional vomiting and an abscess that had to be drained by needle. Eating again and restarting the stomach presented challenges that she tackled head on.

"I am a success story. I beat the odds and I am proud of that because it has been an enriching and fascinating trip," she said.

Castle is studying to be an emergency medical technician near her home in Hempstead, Texas. Additionally, she takes time to talk to other pancreatic cancer patients and their families, explaining her own experiences as a patient.

Castle shares her experiences as a caregiver to cancer patients as well. Five years ago Castle supported her sister during her battle with breast cancer. Her sister beat the cancer, but their mother wasn’t so lucky. Last year their mother lost her two-year fight with rectal cancer.

To honor their mother, Castle, her sister and her brother, who grew up singing gospel music in three-part harmony, began singing at Hempstead-area churches. Plans are underway to record their music in honor of their mother.

Cancer has changed her life in many ways and helped her realize what is important – her family, her faith and making a difference.