1. < Pancreatic Cancer

Why surgery first vs chemo/radiarion first?

Posted by happyjack @happyjack, 6 days ago

I had a tumor push closed my liver and pancreas duct. My gastro doc placed a stint via endoscopy to open the liver duct and the pancreas duct is still closed. A surgeon was brought in and said no need for any more testing as I have all the classic textbook cancer signs of the tumor imaging and blood cancer markers are high. I am scheduled to have Whipple surgery July 12th. And then as soon as I recover from that Chemo.

The question I have is why I am having surgery first rather than Chemo and radiation of the tumor? My stepsister had a small cancer in her breast and the did Chemo and radiation first and killed the cancer before removing it with surgery. And I see others on this site that have Chemo and Radiation first and then Whipple surgery.

Not that it makes any difference as I will follow my doctors' advice it is just something I would like to understand.

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silver182 | @silver182 | 3 days ago
In reply to @happyjack "My surgeon said my cancer level would be 1-3 as they have not found any other..." + (show)
@happyjack

My surgeon said my cancer level would be 1-3 as they have not found any other cancer yet. And from imaging he would guess I have level 2 or level 3. I have had symptoms for 6 months of fat not being digested. Actually, a lot longer than that it just went to full steatorrhea last December. And I am on blood thinners and the blocked pancreas duct not only stop me from digesting fat I was not getting any vitamin K. Caused my blood to get supper thin and a hospital trip for that. Blood test in the hospital showed super high Bilirubin and sonagram showed budging ducts in my liver. Bilirubin was climbing every day I was in the hospital, and I was very Jaundice. My tumor was at the junction of the liver and pancreas ducts and had pressed them both closed. A stint was placed via endoscopy to open the liver duct in the pancreas. The pancreas duct is still blocked by that stint. The morning after the stint was placed my Bilirubin was down from 20 to 11. I was put on Creon pancreas enzyme medication months ago and they help but are not 100%. I still show symptoms of fat not being digested. I am controlled to the point where I can leave my house and my bathroom without not eating for 24 hours. There was talk of another endoscopy with an ultrasound probe and biopsy. The surgeon advised no other tests were needed and that to move on with Whipple surgery as soon as possible. Guess I am a bit farther along in this than you were. And it seems the surgeon thinks I am close to the cancer spreading and doesn't want the tumor poked and prodded any more for fear it would trigger it to spread.

I think this is a long shot that the cancer has not spread. But it is the only chance I have.

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Have your Whipple surgery as soon as you can! Godspeed..

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silver182 | @silver182 | 3 days ago

The Whipple surgery is a dramatic surgery. It will take a lot of your strength from you but just press on. The main thing is to nibble and eat as soon as you can after the darn thing is over with and keep on eating, whatever you can after that. I wouldn’t let them tell you what you can eat and what you can’t just eat what taste good what you want and you have to do 10 times a day like a bird if necessary!

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silver182 | @silver182 | 3 days ago

Sounds to me like your Whipple surgeon is excellent press on as soon as you can you need to be as strong as you possibly can before the surgery.!!

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happyjack | @happyjack | 2 days ago
In reply to @silver182 "Have your Whipple surgery as soon as you can! Godspeed.." + (show)
@silver182

Have your Whipple surgery as soon as you can! Godspeed..

Jump to this post

It is scheduled for the 12th of July or 2 weeks from tomorrow morning. I check in at the Hospital at 5:30 AM and surgery is to start at 7:30 AM.

All the best for you going forward with this.

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happyjack | @happyjack | 2 days ago
In reply to @silver182 "Sounds to me like your Whipple surgeon is excellent press on as soon as you can..." + (show)
@silver182

Sounds to me like your Whipple surgeon is excellent press on as soon as you can you need to be as strong as you possibly can before the surgery.!!

Jump to this post

I asked the surgeon about my weight loss and not getting the nutrients because of the blocked pancreatic duct. He said to drink 3 protein shakes a day like the Boost shakes I drink about 5-6 a week. So, I did that, and I do feel a lot better and stronger. Thing is there is a lot of vitamin K in them, and it took over an extra week to get my INR in range and stop the large painful Enoxaparin shots I have to take when stopping and restarting my blood thinners. I had to cut the shakes back to 2 a day and even missed a day to get my INR back to the 2-3 range. I was stuck at 1.5. I am feeling like doing some work around the house now. After surgery I will try to do the 2 shakes a day to help with healing.

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happyjack | @happyjack | 2 days ago
In reply to @silver182 "The Whipple surgery is a dramatic surgery. It will take a lot of your strength from..." + (show)
@silver182

The Whipple surgery is a dramatic surgery. It will take a lot of your strength from you but just press on. The main thing is to nibble and eat as soon as you can after the darn thing is over with and keep on eating, whatever you can after that. I wouldn’t let them tell you what you can eat and what you can’t just eat what taste good what you want and you have to do 10 times a day like a bird if necessary!

Jump to this post

My doctor actually said the same thing. I just have to remember to eat one thing in my meal and wait an hour then eat another until it is time to start over with the next meal. I will have to ask about having someone bring up the Boost protein shakes. I will be in surgery ICU for a while and not sure how soon they will want me to eat solid food. Dr. said the same thing about picking at food like a bird. And to do so all day long. To avoid eating a large meal all at once. Not sure what I will do with my Creon enzyme replacement meds. I am taking 2 24k capsules when I start eating 3 times a day. Maybe get some smaller dose capsules and take them every hour or so.

Sound like my doctor and yours trained at the same place. My doctor is Dr. Ali Ahmad in Wichita KS.

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stageivsurvivor | @stageivsurvivor | 2 days ago

Your surgeon is likely opting for surgery first due to the tumor impacting the bile and pancreatic ducts. In my case the tumor was thought to be very close to my portal vein and conventional wisdom was to prevent the tumor from further impacting critical structures and becoming inoperable. There is no guarantee the chemo regimen used (generally Folfirinox) for curative intent will be therapeutic. If it is not and the tumor progresses, then the opportunity to perform surgery is lost and it comes down to trying another chemotherapy regimen and doing aggressive chemotherapy. Presently there are only thee, first-line regimens.

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1 reply
happyjack | @happyjack | 1 day ago
In reply to @stageivsurvivor "Your surgeon is likely opting for surgery first due to the tumor impacting the bile and..." + (show)
@stageivsurvivor

Your surgeon is likely opting for surgery first due to the tumor impacting the bile and pancreatic ducts. In my case the tumor was thought to be very close to my portal vein and conventional wisdom was to prevent the tumor from further impacting critical structures and becoming inoperable. There is no guarantee the chemo regimen used (generally Folfirinox) for curative intent will be therapeutic. If it is not and the tumor progresses, then the opportunity to perform surgery is lost and it comes down to trying another chemotherapy regimen and doing aggressive chemotherapy. Presently there are only thee, first-line regimens.

Jump to this post

I did find a video that mirrored my story. It would seem the tumor I have that pushed closed the ducts is common enough that a video was made. https://www.youtube.com/watch?v=4Zxvm3MSb8k I have no information on what Chemo I will be given.

I just read your profile and see you are a 12 year stage 4 survivor and had the Whipple surgery. Thank you for the information you posted and best of luck to you going forward with this,

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