面对胰腺癌：如何在希望与现实之间寻找平衡？

昨天稍稍从父亲患癌的震惊中缓过点神来，心情还是非常沉重，也没有什么心思用在工作上，都在网上查询相关的信息。我问遍了ChatGPT、国内的Kimi AI等人工智能助手，也在视频网站上搜索相关的视频，想找到一丝希望。但不得不说，胰腺癌"癌症之王"的名头果然是名不虚传。

十年前，母亲患癌的时候，主要是父亲在病房里照看母亲，那次同样也是非常凶险的消化道癌症——肝癌。当时我和我老婆正在准备结婚的事情，母亲也想能够拼一拼，多活几年，尽量帮助到我们。而且查出患癌时才61岁，按现在的老年人来说，算是非常年轻的，我们也想救一救。就接受了介入化疗，结果在接受治疗前的精神状态尚可，虽然食欲欠佳，但是也能够正常进食。可是接受治疗之后，病情并没有发生好转，反而因为强烈的副作用不能进食。从那之后，病情就一直急转直下，不到两个月就去世了。

父亲经历了这一切，这一次轮到他自己身上，他倾向于不接受治疗。因为他不想重蹈我母亲的覆辙，担心接受治疗后不但没有收益，反而会让身体直接垮掉。不得不说，这是个很难反驳的观点。从网上的信息来看，胰腺癌确实对放疗化疗都不敏感。不过他昨天才做的增强CT，结果要过两天才出来，等结果出来后，再和医生交流交流，根据具体情况再做决定吧。

通过查阅资料得知，除了放化疗之外，现代科学治疗癌症最大的进步，是通过基因检测使用靶向药，但靶向药必须有相应的基因突变才能使用。所以要对肿瘤组织进行穿刺活检，这也是种有创伤性的检查。因为胰腺部位特殊，穿刺活检的成功率并不是百分之百，可能采集不到样本。目前比较成熟的用于胰腺癌的靶向药所对应的基因突变，在胰腺癌病例中只占20-30%。这样看来，这也是一种创伤性的，有风险，但收益很不确定的治疗方案。

在比较新的药物中，有一种叫MRTX1133的临床试验药物，可以用于携带特定Kras基因突变的患者，这种基因突变在胰腺癌患者当中的的比例还比较高。如果符合条件，不知道能不能在国内参加临床试验。当然试验也可能是服用的安慰剂。此外还有免疫疗法，通过阻断受体欺骗免疫细胞，让免疫细胞去攻击癌细胞，这也许是可以尝试的疗法。具体治疗方案，还要等下一步检查结果再定。。

Yesterday a little from the shock of my father suffering from cancer to a bit of God, the mood is still very heavy, there is no mind to work, are on the Internet to inquire about the relevant information. I asked AI assistants such as ChatGPT and domestic Kimi AI, and searched related videos on video websites to find a glimmer of hope. But I have to say, pancreatic cancer "the king of cancer" of the name is indeed true.

Ten years ago, when my mother was suffering from cancer, my father was mainly in the ward to look after my mother, which was also a very dangerous cancer of the digestive tract - liver cancer. At that time, my wife and I were preparing to get married, and my mother also wanted to fight to live a few more years to help us as much as possible. And when I was diagnosed with cancer, I was only 61 years old, which is very young according to the elderly nowadays, and we also want to save it. Received interventional chemotherapy, the results before the treatment of the mental state is OK, although poor appetite, but also able to eat normally. However, after receiving treatment, the condition did not improve, but could not eat because of strong side effects. After that, his illness continued to decline, and he died less than two months later.

Dad had been through it all, and this time it was his turn, and he tended not to get treatment. Because he did not want to repeat my mother's mistake, worried that treatment will not only have no benefit, but will make the body directly collapse. I have to say, it's a hard argument to argue against. According to the information on the Internet, pancreatic cancer is indeed not sensitive to radiation and chemotherapy. But he did the enhanced CT yesterday, the results will take two days to come out, and when the results come out, and then communicate with the doctor, according to the specific situation to make a decision.

According to the data, in addition to radiotherapy and chemotherapy, the biggest progress in modern scientific treatment of cancer is the use of targeted drugs through genetic testing, but targeted drugs must have the corresponding gene mutation to be used. So a needle biopsy of the tumor tissue is performed, which is also a traumatic examination. Because of the special location of the pancreas, the success rate of puncture biopsy is not 100%, and the sample may not be collected. Currently, relatively mature targeted drugs for pancreatic cancer correspond to gene mutations, which account for only 20-30% of pancreatic cancer cases. In this way, it is also a traumatic treatment with risks and uncertain benefits.

Among the newer drugs is a clinical trial drug called MRTX1133 that can be used in patients with a specific Kras gene mutation, which is found in a high proportion of pancreatic cancer patients. If qualified, I do not know whether I can participate in clinical trials in China. Of course, the trial could also be a placebo. Then there's immunotherapy, which tricks immune cells into attacking cancer cells by blocking receptors, and that might be something to try. The specific treatment plan will be determined after the next test results.