@qq1 , If I may attempt to summarize:

1) Patient was diagnosed w/ ampullary cancer from tissue taken in 2023?

2) No treatment (other than palliative) has been proposed, and no cancer team has been formed?

--> Ignore all other considerations and get a second opinion!

Sorry you have to form your own team, but this is what is has come to. You may have to ask her current oncologist exactly why they consider it stage IV. You should also ask the treating oncologist (and any other doctors she has access to) for prompt referral to a pancreatic center of excellence (CoE). Absent a timely referral, you can also start making those phone calls yourself.

If you're able to get to a CoE, they may also do additional testing, including MRI instead of PET or CT. Sometimes it takes a different set/kind of eyes to see what's really going on; specifically whether it's a treatable stage II/III condition or a stage IV condition that could be "managed" or treated palliatively per the patient's decision.

Mayo might be the quickest approach since they've already seen the tissue, but there are plenty of other CoEs that might be quicker and/or closer to home.

While you're searching for that second opinion, do all you can to get copies of the records the second-opinion provider would want.

Wishing you all the best!