Abort chemo Rx & go straight to surgery while I am still Stage 1?

In reply to your questions, see these two excerpts from my late May CT scan results.

Vascular Contact - "Conventional hepatic arterial anatomy. The mass does not make contact with the celiac, common hepatic, or superior mesenteric arteries. The mass makes less than 180 degrees of contact with the superior mesenteric vein, causing subtle tethering of this vein."

Size of Mass - "3.8 x 3.1 x 2.7 cm. The mass previously measured 2.3 x 2 cm (series 3 image 29 of the comparison scan)."

This from my most recent CT Scan interpretation of 3 weeks ago: "Slight decrease in size of the mass in the pancreatic head/uncinate process with unchanged abutment of the superior mesenteric vein."

In sum, in my situation, my neo-adjuvant treatment has been positive to date. My tumor has shrunk somewhat, no further entanglement of large veins/arteries, no indication of metastasis, and biomarker levels have fallen significantly.

Indeed... good luck to us both. I'm curious to see what you decide tomorrow and what path you follow. Thanks.
Warren

Hers are a few of the videos:

I’d go to Moffitt given your options. Vein involvement requires a good surgeon. You need margin from vein for survival. Ask surgeon their approach to vein involvement - some won’t do surgery and some will - that may dictate your decision for you. I had open surgery, 8 folfirinox before surgery with four week break. Infection during surgery prevented post surgery chemo - would did not heal. Vein was bisected during surgery.

Here was my situation when diagnosed in 2012. The CT showed the tumor in the head of the pancreas very close to the portal vein. The surgeon said I had a small window of opportunity and he was prepared to do the Whipple the next morning-a Saturday. I was at a high -volume center in NYC and my surgeon at that time had done over 1500 Whipple surgeries and in addition performed liver transplants so he was trained as a vascular surgeon and proficient at handling vascular involvement.

When I was open up and examined, it was noted the tumor was in contact with the portal vein. A portal vein resection was done and the surgical pathology revealed the tumor had penetrated completely through the vascular wall. A week after the Whipple, a post surgical CT was done and found metastatic disease was present. It was not seen two weeks prior because it was too small to be detected and the resolution of a CT in 2012 was about 4-5mm whereas today it is 1.3mm. So because I just had surgery, I had to wait 8 weeks to heal to begin chemotherapy. That meant no treatment of the metastatic disease and to make things even worse, when I did get chemo, I had no response to the first chemo regimen.

Had I been in the position to have neoadjuvant chemo and assuming I would have received Folfirinox, it likely would have addressed the micrometastatic disease when it is easier to treat. Neoadjuvant chemo has shown better outcomes. I could not do neoadjuvant even if was available in 2012 because the compression of the bile duct and the close proximity of the tumor to the portal vein made the situation “time is of the essence”. I was fortunate in the outcome of now being an 11 year survivor and N.E.D. after having stage IV disease. It required 46 cycles of adjuvant chemo with 24 cycles of full-dose Folfirinox and 22 cycles of 5-FU/Leucovorin in alternating groups of six cycles every 15 days for 24 months with no pause. It makes me wonder if I would have needed that much chemo to knock out the disease and achieve N.E.D. had neoadjuvant chemo been a possibility for me?

Wow, great concise videos . Thank you for sharing and I wish you the best going forward.,
Marilyn

Thank you for your feedback. When you state “ask the surgeon what their approach is to vein involvement,” are you meaning to verify that they are willing to do vein surgery if needed? I believe the surgeon in Ohio and Florida both have told me that they would/could.
I’m sorry you had that infection during surgery. How long ago was that? Have you restarted chemo? How are you doing now?
When you say your vein was bisected, was that because only a small amount of tumor was found there and they were able to bisect it rather than having to have an entire portion of the vein removed and reconstructed ?

Marilyn - This morning my wife found the following discussion at a Mayo Clinic link. The intended audience is medical professionals and the topic is "Optimizing outcomes for patients with non-metastatic pancreas cancer". The discussion was recorded in February 2023 and is up to date, as opposed to many similar presentations/discussions that are somewhat dated. The four physicians panelists are associated with the Mayo Clinic.

One's ability to understand and follow the discussion depends on extent of familiarity with medical terminology and pancreatic cancer. I post it here in the event it helps you in your immediate decision making, as well as to make others aware of this very helpful discussion. (As a former health professional [RN/MICParamedic] who left that career in the late 1980s, I can follow most but not all of the discussion.) Give it a look. It's quite informative IMHO.

I look forward to watching it. So appreciate you sharing this with me, thank you!

I had a distal pancreatectomy and splenectomy in July 2022, and cancer was found in the resected portion of the pancreas, but had not advanced anywhere else that was detectable. I had 12 cycles of Folferinox, and the cancer still ended up spreading to my liver. After six months of Gemzar/Abraxane, the liver tumor had still grown, and now there was lymph node involvement. Doctor stopped the Gemzar/Abraxane because it didn't seem to have an effect. I wonder if more chemo would have made a difference or not? I wonder how much time on a treatment is enough?

Hi, I greatly enjoyed your videos.
Love your humour and down to earth attitude.
Thanks