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.