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@markymarkfl

Did they do a biopsy on the liver spots, or only the pancreas?

What was my CA19-9 level at the biopsy (and on any past or more recent tests)? How often will they retest your CA19-9?

If cancer, which type (liver/pancreas) and subtype (e.g., PDAC, Acinar Cell Carcinoma, Mucinous, PNET, etc)?

Did they send out tissue for next-generation sequencing? (detailed biology and genetic tests) Can they create a Signatera circulating tumor DNA test from the tissue they have?

Can you get a germline (family hereditary) DNA test (e.g., from Invitae) asap to see which mutations you may have inherited?

Can you get a somatic (random damage, not inherited) DNA test (e.g., Guardant 360) to see if the tumor has targetable mutations, fusions, deletions, etc, and what drugs or clinical trials might be appropriate?

Is the next step a PET and/or CT and/or MRI to check for metastases?

What stage is the cancer? (Could be 1-4 on the clinical scale, "resectable / borderline resectable / non-resectable" on the surgical scale, or "TxNyMz" on the "TNM" scale)

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Your new oncologist is probably a medical oncologist, not a surgical oncologist or radiation oncologist. If it's a big practice, they might have one of each, and your medical oncologist would refer you to one as appropriate.
I don't know if your oncologist is a pancreas specialist, but that's who you want if you can find one. New patients normally just get referred to a local oncologist first, and don't realize that person might not be a specialist in pancreatic cancer. If you are getting referred anywhere for surgery (especially a Whipple procedure), you absolutely want to get it done by a very experienced surgeon at a pancreatic cancer center of excellence. Don't worry about offending anyone by asking for the referral -- it's a complicated procedure with much better outcomes at high-volume centers!

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Odds are if you do have cancer, they'll want to start you on a systemic chemotherapy first. They might be able to do the first infusion or two in your arm if they need to start right away, but the next question is whether you need to get a chemotherapy port implanted in your chest. Probably yes.

There are some surgeons who would attempt to remove the tumor right away if it has not spread, but the trend is not to, but instead to do 3-6 months of "neoadjuvant" chemo before your surgery. There is no right answer there, and a lot of debate on the topic.

If they want to start you on chemo right away, ask which regimen (which combination of drugs) it will be, how often you'll get it, how they determine if that's the best drug combo for YOU, and how often they check (with scans, CA19-9 and ctDNA tests) to see if the drugs are working. If you're not seeing improvement in the scans and CA19-9 tests within 2-3 months, you should ask if they can switch you to a different regimen.

We all wish and like to think we'll get the latest/greatest whiz-bang combination of drugs from recent clinical trials, but the sad fact is almost everyone gets one or two attempts at a "Standard of Care" treatment first, unless you're starting out at Stage 4 and being treated at a research facility. The general chemo standards of care for PDAC are usually based on Folfirinox (if you are younger and otherwise healthy) or Gemcitabine if you are older. The Folfirinox regimens produce better results statistically, but there's a minor issue possible there with selection bias (because younger/healthier people tolerate it better), but also the unknown factor of whether it's best for any particular mutations YOU have that "average" patients don't.

If you find out you will eventually be headed for surgery, there are some other questions that might be helpful to get answered in this thread: https://connect.mayoclinic.org/discussion/which-questions-should-i-ask-my-surgeon-i-think-whipple-is-likely/

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Forgot to add: Did they test your blood sugar and lipase levels at the biopsy or any other time recently? A failing pancreas is often associated with sudden-onset diabetes. I found out I was newly diabetic at the same time I learned I had cancer. Also, if you're having digestive difficulties (especially digesting fats, getting oily orange stools) you might ask if a prescription for Creon or other enzymes might be appropriate for you.

Wishing you the best in this!

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This is amazing! Wow! Thank you. I appreciate all of the time and thought you put into this!