My Sister's Battle with pancreatic ductal adenocarcinoma (PDAC)
Well, we are now at about 10 months from the time she became jaundiced.
We got to Mayo within ten days or so, had full workup and the assessment was that it was borderline resectable. So, back home for eight two-week cycles of folfirinox followed by chemo enhanced radiation therapy. Between each set of four chemo cycles we returned to Mayo for assessment – the tumor had shrunk to where it was not really visible, and her CA 19-9 marker tests had improved, but were not normal. Following the chemo-radiation, she had a month off (normal planning) – during this time she developed ascites, but we returned on time for the planned surgery – dreading the answer. It was as expected – CT and PET/MRI showed spread to liver, hepatic arteries and omentum had nodularity.
The ascites had become significant with paracentesis every ten days or so – 6-7 liters. A Pleurx drain was installed and she began at home drainage with assistance of home health nurse, sometimes as much as two liters ever other day.
At the same time she returned to folfirinox treatment and made it through two cycles before becoming ill – very low white cell counts (400!) – and, she was hospitalized for 7 days, then discharged to a local care facility. She was given Neupogen to increase white cell output and it worked – from 400 to 8000 in five days. Other blood work numbers were not so good. During the two cycles she continued to drain off 1-2 liters every other day, then about the same in the hospital. The last two days in the hospital the quantity of ascites fluid slowed significantly – and, when she discharged to the care facility the rate of discharge was limited.
Her intent is to improve her condition in the rehab facility and restart chemo to buy time, but is switching to Gemcitabine-Abraxane due to milder side effects.
I don't know if she will make it to more chemo – so very sad.
One confusing factor is the lessening of ascites fluid – I can't find anything discussing this – has anyone seen a reference to this effect? I am concerned it is reflective of a significantly damaged liver, but really don't understand.