Hello, I’m so sorry you are going through this. As you know, my Mom also had ovarian mets and then had palliative cytoreductive/debulking surgery to remove them recently. First off, I want to say that palliative care doesn’t mean everything is ending- all that it means is that the treatments going to be given now are non-curative, meaning they are provided for prolonging life and reducing symptoms. There are pancreatic cancer patients out there that have been on palliative care for numerous years living good lives! In fact, my mom’s surgeon told us before her surgery that this would be a palliative surgery, meaning non-curative. We were totally fine with that because it greatly reduced her symptom burden and removed the mets. As of her scan a few weeks ago, she is doing overall well and returning to her normal life, thank God, but there is a little cancer still left in her, which explains the notion of “palliative” v. “curative.” In the meantime, we are keeping a close watch on her to remove any new growths and also waiting for a clinical trial to open up that potentially could be very effective treatment for her. Just because they are using the word “palliative” now, doesn’t mean the end at all. Please do not equate the two as the same. Normally, once the cancer comes back in a different part of the body, any treatment is considered palliative because the cancer cannot be cured anymore- but it can be contained for a long time potentially.

I would suggest the following: 1) Do a full genomic and fusion panel to identify any gene mutations or fusions that can be acted upon through new medicines; 2) Find a different surgeon that is open to doing a cytoreductive/HIPEC/debulking surgery to remove the ovarian mets and the peritoneum/omentum (my Mom’s cancer also had spread to her peritoneum, and they removed the omentum during the same surgery for the ovarian mets). The reason why the surgeon is probably saying no in your case is because the cancer is on a non-peritoneal organ (ovaries). According to textbook practice, this disqualifies a pancreatic cancer patient from that type of surgery. However, there are surgeons out there that are willing to think of the box and try different things. The only thing to watch out for is if your Mom only has one kidney and has other health issues or is of old age, the surgeons may shy away from the surgery because the surgery will be pretty intense and recovery time will be a few months overall. You have to remind the surgeon that your pancreatic cancer is not the regular aggressive type, as it re-appeared three years later, which is a long time. As a result, doing the surgery could potentially do a lot to keep the cancer at bay for some time. Get second, third, fourth surgical opinions if necessary. Emphasize the three year NED time you had; 3) Try different chemo regimes that are not the regular types (it could be that her tumors respond well to a different regime); 4) Look for clinical trials, especially those that target the tumor’s specific genetic mutations. Clinical trials can take time to join, as there is a lot of paperwork involved and testing etc., so please begin research on this right away. All in all, please do not lose hope. Palliative care is not a bad thing at all and can potentially keep the cancer at bay for a long time. Do not give up hope! Please let me know if there is anything I can do to help- I can help research trials, suggest hospitals etc.

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