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Ampullary Cancer -Chemo first or go right to Whipple
I am 57 years old and am getting mixed messages from two amazing whipple surgeons. One wants me do another biopsy before to see if one lymph to see is cancerous and would do chemo before. The other doctor said she would not have even done the PET scan and isn't concern about the lymph now and she would just do the Whipple and then biopsy everything and then I may have to Chemo. This hospital would be a hour away but is teaching hospital and this Dr. has great reviews as well. I already had a stent put in and have been eating well since then. For those who had the whipple for this kind of cancer how has your recovery been? Did you go back to work in 8 weeks? Any advice would be great. What are you able to eat now?
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I was diagnosed with ampullary cancer a few weeks before my 58th birthday. They only biopsied the mass, not any lymph nodes, before surgery, and found it to be malignant. After surgery they found evidence of spread to a number of lymph nodes so they recommended chemo, the same regimen as for pancreatic cancer. I was out of the hospital in 5 days after surgery. I started chemo within 6 weeks of surgery. I probably could have returned back to work in 8 weeks post surgery but with chemo on top of it I found it difficult to stay alert and focused and opted for an extended leave of absence, returning to work full time within about 6 months. A month or two after completing the folfirinox regimen I did another several weeks of radiation, which was a walk in the park, comparatively. From surgery to treatment completion it took about a year for me. It’s now been about 17 months since completing treatment. I have had to deal with lingering digestive issues and moderately awful neuropathy in my feet but I’ve chosen to focus on the positives and use a healthy diet, exercise, and selective supplementation to manage the negatives. And I feel better every day. I take digestive enzymes and I am able to eat anything I ate before. However, I find eating a Mediterranean style diet suits me best and I prefer not to eat overly large or fatty meals. One upside of this whole ordeal is that I’m finding it relatively easy to maintain a lean, moderately muscled physique!
One other thing regarding the PET scan. A PET scan was a mandatory requirement before surgery was approved in my case. It was my understanding that if the PET scan had shown significant signs of metastasis I would have been offered chemo as palliative care instead of surgery and one doctor advised avoiding the pre-surgery PET scan if possible for this reason. Surgery appeared to be the only chance I had of surviving this. It turned out that the PET scan showed inconclusive activity in my thyroid and liver. The thyroid activity was viewed as a separate issue and I was conditionally approved for surgery. The lesion on the liver was biopsied while I was under awaiting the Whipple surgery. Fortunately, it proved benign and the surgery went ahead as planned. Clean margins but the 19 lymph nodes removed were all biopsied after surgery and 8 of them showed signs of cancer. Thus the recommendation to follow up aggressively with chemo and radiation. (The thyroid was biopsied at a later date and also proved benign. And, fortunately, all subsequent scans have shown NED.) Anyhow, I hope this helps answer your questions.
Thank you for your replies.