At initial diagnosis using CT and brush cytology with an EUS, it was believed I was stage IIb. An ERCP followed to insert a stent. This all occurred over a span of three days ending on a Friday. Monday morning I was opened in the OR and it was observed the tumor (4cm x3cmx3cm) was involved with the portal vein. Pathological examination showed invasion of malignant cells through the vascular wall. One week after the Whipple, another CT was done and this time the radiologist noted in the report suspicious areas were noted in the liver. Subsequent scans repeated that finding and after three months on Gemzar, there were six sizable tumors in the liver and one was biopsied to confirm metastatic disease.

It wasn’t a case that metastatic disease first developed one week after the Whipple. It was already there but too small to be detected by conventional methods imaging methods in 2012. The resolution of a CT scan then was 4mm best.In 2022, Siemens and GE scanners can resolve down to 1.3mm. Oncologists and surgeons familiar with my case concur metastatic spread was already present at the time of the initial CT scan on 6/12/2012. Fifteen days later when the second CT was done ( 1 week post Whipple), the aggressive nature of the tumor type (PACC) had grown enough to be picked up by the scanner and noted by the radiologist. A review of the initial scan did not show it.

Questions I have is whether having the Whipple procedure reduced the tumor burden to help my immune system in conjunction with aggressive chemotherapy and a PARP inhibitor contribute to reaching NED or if surgical resection had not been done and just treated with SOC, would I have achieved NED and have a fully intact and functioning pancreas? I personally know two woman that were stage IV and non-resectable, treated aggressively-one was with Folfirinox. The other woman was treated with multiple drugs 24 years ago when Folfirinox did not yet exist. Both are long-term NED survivors with functioning pancreases.