Chemo break: how quickly do tumours grow back?

My understanding also. What limits ongoing chemo that is working is side effects. One participant on this forum continued for 24 treatments with chemo with stage 3 or 4 disease and has been a long term survivor. There is chemo which is given as "maintenance" chemo.

@montyd , Nobody ever put it (the stage) writing, and the first surgeon to assess said "it depends" (citing a lot of variables).

It was initially measured during EUS as 2 cm, which is the size boundary between 1a and 1b (with no detected spread to lymph nodes).

Stage 2a did not apply (per https://www.cancer.org/cancer/types/pancreatic-cancer/detection-diagnosis-staging/staging.html ) because it was smaller than 4 cm.

Within AJCC Stage 2b (T1N1M0 and T2N1M0) it was also at the 2cm boundary between those two TNM size values. There was uncertainty on all MRIs about one possible lymph node (3 or fewer on TNM scale is N1), so 2b was a possibility as well,

During Whipple surgery after 12 Folfirinox, the tumor had shrunk to under 2cm and the lymph node was confirmed negative, which actually qualifies as 1a (T1N0M0).

So, as the surgeon mentioned originally, "It depends." 😉

As far as recurrence, the first detection was on MRI at the anastomosis between the remnant pancreas and the section of jejunum it was reconnected to. So basically, yeah, right where the surgeon quit slicing. His first slice showed cancer and "funny cells" at the margin during the intraoperative pathology, so he cut about another 1/2" of pancreas off and saw clean margins in that one. He said unfortunately they miss stuff in the pathology. 🙁 Another surgeon told me the same thing. Of course there's also the possibility that other remaining pancreas tissue simply turned malignant after the surgery, but I doubt we'll ever know exactly which happened.

@spicerpa , Gotta say I love the Aussie sense of humor and outlook on life. Good onya, mate. Stay strong!

I was the patient that did 24 cycles of the original version of Folfirinox used from 2011 through 2017 that was 20% higher in concentration than today’s (m)Folfirinox. I also did 22 cycles of 5-FU/Leucovorin as resting cycles from the Folfirinox to let my body recover and lessen the impact of peripheral neuropathy from the oxaliplatin. This alternate dosing every six cycles helped as cold therapy to prevent chemo induced peripheral neuropathy (CIPN) was not yet known.

Why did I advocate in doing 46 cycles total? Before I even realized I was stage IV, I knew the statistics for the different stages. I was age 55 and dying from pancreatic cancer was not an option. It was essentially “do or die” as my goal was long-term survival-not buying some time. I had nothing to lose and everything to gain even if I ended up with long-term or permanent issues in doing excessive chemo. I would find out a way to deal with the “new normal”.

I’ve pushed myself hard before and was not hesitant to do it again and see just how much the human body can endure when you set goals and are not afraid to try. I followed all the advice of my care team in using medications to prevent/ameliorate side effects. I continued my daily activities of full-time work and exercising. This helped physically, mentally and emotionally. I’ve exceeded 11.5 years and just had my routine exam and blood work yesterday (Monday) as having participated in a clinical trial for maintenance monotherapy after standard of care chemo. I will be followed for life by clinician-scientists. The physical exam and blood tests indicate I remain healthy and NED with an excellent quality of life and no residual effects from the chemotherapy.

Everyone is different, as we all have discovered!
I had a break of almost six months before my metastatic tumors in my peritoneal cavity were discovered by PET scan. No involvement in my pancreas or liver! Now I am about 3/4 finished with a second (last!) chemo regimen of Abraxane and Gemzar. It is not easy but the C19-9 has dropped a lot. I see the oncologist this week and will have him schedule a new PET scan. Nothing showed up on frequent CT scans, so I don’t have as much faith in them as I once did.
Hope it all turns out good for you!