The classic of world literature Lev Tolstoy, due to his talent, observation, and analytical skills, was able to reconstruct the accurate history of the disease and death of a patient with pancreatic cancerin the novel “The Death of Ivan Ilyich”. The prototype of the novel’s main character was Ivan Ilyich Mechnikov — the elder brother of Ilya Ilyich Mechnikov, prosecutor of the Tula district court. Lev Tolstoy precisely described such “minor” symptoms of the disease as severe general weakness, depression, sudden weight loss, irritability, insomnia, taste perversion, loss of appetite. Paraneoplastic manifestations are explained by the direct and indirect influence of the tumor process on the metabolism, immunity and functional activity of the body’s regulatory systems, as well as the production of various hormonal and pro-inflammatory agents by the tumor. According to the description of the disease, a differential diagnosis can be made: “pain in the left side” is possible upon cancer of the pancreas, colon, and stomach. Absence of vomiting, even at the latest stage of disease, indicates against cancer of the stomach, while the absence of intestinal obstruction — against a tumor of the colon. Location of a pancreatic tumor can be suggested, namely body or tail of an organ. Jaundice is typical for pancreas head cancer, which is not mentioned in the novel. It is amazing how the writer Lev Tolstoy, who had no relation to medicine, described the progression of a severe disease with such incredible accuracy and made readers feel the tragedy of human loneliness in illness, agony, and death.
2. Дворецкий Л.И. Паранеопластические синдромы.Consilium medicum. 2003. Т. 3. №3. С. 63–78.
3. Джулай Г.С. «Смерть Ивана Ильича» Л.Н. Толстого как клиническое описание синдрома малых признаков злокачественных опухолей. Верхневолжский медицинский журнал. 2016. №1. С. 37–39.
4. Мечников И.И. Этюды о природе человека. М., 1961. С. 7.
5. Толстой Л.Н. Смерть Ивана Ильича. Собрание сочинений в 12 т. М.: Правда. 1984. Т. 11. С. 42–96, 553–556.