Is a second opinion needed?

For 2.5 years, I have been on chemo due to liver metastasis. Surgery was not an option because of a compromised liver.

Zero medical training on my part here, but...

A second opinion is almost always worthwhile. Try to get one with a pancreatic cancer center of excellence as soon as possible. That might take a while, so you should also try to consult with a GI/liver specialist to ask what might be the fastest/best way to get her liver ready for surgery if possible (especially if liver treatment has to overlap with chemo).

The fact that she was offered surgery suggests there is no evidence of metastasis, which is a great thing if true.

Chemo is not necessarily brutal (2.5 years for me and not fun, but not brutal either), but it might be the bridge treatment she needs to get surgery eventually. The longer she goes untreated for cancer, the greater the chance of it spreading to other organs, which would rule her out as a candidate for surgery.

Chemo rarely cures pancreatic cancer, but it may control or delay it long enough to make surgery possible.

Don't delay! Wishing you both the best.

Second opinion always good. We had a second opinion on whether to have surgery or chemo first and surgeon2, who gave second opinion, agreed with surgeon1. We had the surgery done by surgeon1. Chemo is manageable with a variety of meds to help with side effects; so if it is chemo first on doctors' advice (1st and 2nd and/or 3rd), then go on it soon.

2nd opinion always advised. No matter what you hear from first doctor.
Rarely is surgery the first course of action unless one is diagnosed a version of stage 1.

Chemo may not be as brutal as you think. Today , there are many combos of pre-meds that can be given to ease things; especially if one is healthy otherwise.

What chemo treatment are you on?

A second opinion with a Pancretic specialist is always the best course of action if she was considering surgery, Dr. Douglas Evans at Freter’s in Wisconsin is the best pancreas surgeon in the United States. He does second opinions for free on Zoom. This certainly needs to be considered, you said the liver function Was off, but you didn’t say metastasis that needs to be considered if you have metastasized or meeting your wife that probably take surgery out of the question.

Get a second opinion. I have stage 4 pancreatic cancer. They told me that surgery is not possible, and I'm on chemotherapy and the tumors have shrunk.

Translate DeepL

When there is liver dysfunction, a second opinion will not change the situation. Liver function tests such as AST, ALT, ALP, GGT, Bilirubin give a clear indication. The liver plays a vital role in metabolizing medications, filtering the blood and most importantly, maintaining homeostasis between blood clotting factors and anti-clotting factors. Attempting surgery when a liver is compromised puts a patient at grave risk and a surgeon will not risk their career in doing surgery when diagnostic testing indicates liver dysfunction. You can go for multiple consults but if there is no change in LFT’s indicating a compromised liver, another surgeon is not going to jeopardize a Patients quality of life when risk outweighs benefit.

I started off on 9/1/22 with CAPTEM which is capecitabine and temozolomide. After 13 cycles of going 2 weeks on and 2 weeks off, I was put on a decreased amount of just capecitabine. I have been on it ever since. These are in pill form, so I can conveniently take them at home.

What criteria are you using to determine that Dr. Evans is the best pancreas surgeon in the United States? I am curious.