Recurrence at SMA Lymph node

Posted by kslayer @kslayer, Jan 25 9:47pm

Hi all,

My father is currently suffering from recurrent pancreatic cancer (moderately differentiated adenocarcinoma). He is diagnosed and underwent Whipple surgery in July 2023 which is staged 2B (T3N1M0) with close margin status and had underwent 6 rounds of mFolfirinox together with radiation which is completed on Jan 2024. he has been NED until January 2025 where his CA 19.9 had increased to 118. A pet scan is conducted and its said 'new hypermetabolic focus in hepaticpancreatic anastomotic site as marked by the hyperdense surgical sutures, granulomatous inflammatory from early recurrence needs to be excluded by histopathology or closer serial follow up monitoring with ca 19.9' . Our surgeon that conducted whipple surgery said that it is unable to biopsy or re resection as it showed an ill defined lesion at the root of mesentery, which is most compatible with SMA lymph node recurrence. May I know if are there still a chance to conduct surgery if chemotherapy is successful ? Or Chemotherapy is the only way to deal with the recurrence? Meanwhile, may I know if there are any survivors out there that are successful in battling recurrences ? Thanks a lot for your help!

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marienewland | @mnewland99 | Jan 26 8:13am

@kslayer
Reoccurrence is actually the norm for this type of cancer. I was also 2B when diagnosed in 2022 though mine was in the mid and tail section of the pancreas so I had distal surgery. I had 12 rounds of 5FU chemo after surgery, and then after 4 months without chemo it returned to liver, but was caught early. In January 2024 I started GAC chemo (though I learned in September the cisplatin wasn’t necessary and dropped it). I had good response with both chemos, but had a stubborn 0.9cm in liver that I decided to do MRIdean (focused) radiation and it appears the results are good. My CA19-9 was at 8, and now at 13 following chemo and radiation. I just had Guardant 360 and there’s no detection of KRAS mutation in this liquid biopsy; only TP53 mutation which test noted there is no clinical significance (at this time). I’m getting needle biopsy on Tuesday just to ensure that radiated nodule area in liver is no longer cancerous. I’m 67 years old and fairly active, but neuropathy in foot is starting so I ordered the cold pack booties and mittens for next chemo session. I’m on my 3rd oncologist (they say the 3rd is always the charm!) now and at city of Hope in Irvine, California. He seems to be very thorough and also caring. Long response to your question, so yes there is hope even with metastases. For me the solution was to be aware of your symptoms early and get help and to know your mutations and to get the right oncologist or surgeon, etc (it takes a village). Please keep reading this thread to see others say and I wish you and your father a good road ahead. There’s also a vaccine from city of hope that has shown some success for KRAS mutations for a 1 year extension of life (I’ll take it! but no kras for me now so I guess not?) . Trial has been completed and they are just putting the data together now.

marienewland | @mnewland99 | Jan 26 8:32am

I wanted to add that I had been getting the GA chemo 3 times per mi th with my last oncologist (it does make you tired for a couple of days or overall compared to when I didn’t have PAC), but my new oncologist is decreasing it to 2x per month and possibly deescalating it since no KRAS in my Guardant360 test and I’m sure he’s also going to wait and see the results of my liver biopsy before taking that next step, but there will be some type of step based on the fact that I’m starting to get neuropathy in extremities. I’ll keep posting if I get off chemo for a bit.

kslayer | @kslayer | Jan 26 11:21pm

In reply to @mnewland99 "I wanted to add that I had been getting the GA chemo 3 times per mi..." + (show)

Thank you very much for your reply and I hope you will have continuous success of your treatment! My father is currently asymptomatic and he will start Folfirinox next week since it has been a year after the adjuvant chemo stopped so our oncologist decided to use Folfirinox again hoping to shrink the affected Lymph node. Other than this forum I did also see other survivors successfully dealing with recurrences for years and are still fighting! Hope we can all overcome the hurdle together!

marienewland | @mnewland99 | Jan 27 1:40am

3 thoughts I’ve learned from this site:
1. If the chemo didn’t work on this area before, then it might be time to try another chemo type.
2. Know your mutations (dad’s) because it will direct the type of chemo drugs to be used.
3. GA or GAC is commonly used for metastases, but it really depends on what your mutations are.