Cancer cells found after surgery

I am just reading your post now and wondering why you would "demand" surgery. I would hope you have developed a repor with your oncologist that includes a level of trust. I do not believe any doctor would deliberately steer you in the wrong direction . There is plenty of studying, and research that goes into the decisions and plans that they present for treatment . Please try to steer your energy into healing rather than questioning ,

Wishing to have any cancer fully removed is a legitimate request and if desired should be voiced. Any respectable surgeon will provide all possible and recommended treatment options. It is up to each individual to weigh those information and determine their care. I can empathize with that request regardless of how it is expressed. I hope that they are able to provide a surgical solution for them.

@akrhodes7320, how did your appointment with the surgeon and your cancer team go? What are next steps for you?

They want me to do two more months of chemo then follow every three months with “liquid biopsy”. If you have not heard of that check it out. It’s very interesting. Thank you for asking.

I’m trying to understand the situation here when he surgeon says cancer was detected in the duct? What is this exactly referring to as there is the main pancreatic duct and side branch ducts of the pancreas and the bile duct from the liver to the intestine.

When a surgeon does the Whipple procedure or a distal pancreatectomy, they remove all visible signs of cancer and take surgical margins surrounding the tumor as a precaution for potential microscopic disease. When a surgeon says they got it all, that only means what they can see visually using magnifying lenses.

What is not guaranteed is minimal residual disease-that which remains after neoadjuvant chemotherapy, surgical resection and even after adjuvant chemo. A patient can advocate for consideration of next treatment steps. I did after micrometastatic disease resulted in a diagnosis of stage IV one week after my Whipple. I advocated for very aggressive treatment with Folfirinox and it resulted in 13.5 years now as a survivor. Taking an approach of “demanding” generally doesn’t get a patient very far. A softer approach of being assertive in a respectful manner and preparing your arguments in a thoughtful manner and able to back them with examples will go much farther. Treatment decisions are not made by a single person. They go before a “Tumor Board” made up of the surgical oncologists, medical oncologists, N.P.’s Hematology/Oncology Pharmacists. Radiation Oncologists and others where each case is evaluated, discussed and an action plan developed.

When cancer returns in the remnant pancreas, one option may be a total pancreatectomy. It is not a trivial surgery and sequela is lifelong and issues of quality of life have to be addressed. I do know three patients that had a total pancreatectomy after a Whipple or distal pancreatectomy was performed. One of those is a 31 year survivor and manages well with slow acting insulin and pancrealipase.

@stageivsurvivor
it has not made sense to me since she told me the first time. I was always under the impression that everything was checked before the incision was closed. I think, honestly, she just made a mistake. No one is perfect but I just want the truth.

@akrhodes7320 A surgeon can not detect micrometastatic disease which is all to common with pancreatic cancer. The surgeon removes all visible traces of the cancer…tumor and sentinel lymph nodes. Adjuvant chemo is common to address the strong possibility of minimal residual disease-that which likely remains after surgery. Even with adjuvant chemo, the recurrence rate is 80% within two years. This is why no surgeon would ever say to a patient they are cured. Cancer-free and No Evidence of Disease in no way implies cured.

Metastatic disease was detected in my liver seven days post Whipple. I was treated aggressively for 24 months with chemo administered every 15 days. It was no fault of my surgeon that I was now stage IV…. metastatic disease and recurrence are hallmarks of pancreatic cancer. I dealt with it by advocating for aggressive treatment. It was 8 years after finishing treatment that the first oncologist felt confident in declaring me cured.

That’s what I’m trying to say. I thought this was verified by pathology BEFORE the incision was closed up. Something just isn’t right.

Or am I wrong in assuming it would all be verified before closing?

Hello! I had my Whipple in 2024 for a cancerous cyst on the head of my pancreas (Stage 1A). Through 2024 post-Whipple, I was monitored every three months with contrast CT and blood biopsies (Signatera). Through 2025, I have been monitored with contrast CT scans and blood biopsies (Signatera) as well.
I don't believe doctors are able to visually detect cancerous cells that may be circulating in ones blood stream They analyze the resected tissues till they get negative margins, but in order to detect cell that may or may not be circulating in the blood stream very sensitive diagnostic tests are required.

@stageivsurvivor
Wow, you are lucky and fortunate indeed from my nursing perspective and you are one determined person. Good for you!
I’m not sure I would have the fortitude to do two years of chemo that often.