Help and Suggestions please

My 63 year old husband recently had ERCP with stent placement into the bile duct to allow the flow of bile into the intestine to eliviate a blockage. He had consults with 2 different doctors from different hospitals.

With all of his symptons and tests they both said it is most likely pancreas cancer. Doctor "A" wants to do the Whipple surgery hoping it is removeable and to see what we are dealing with because my husband is otherwise in good heath & is also waiting for a blood test to come back April 21.  Doctor "B" said NO surgery now and wants to get pancreas biopsies and if cancer, refer him to an oncologist with no surgery; maybe surgery later.  No one knows for certain if it is cancer or how bad. 

 Any suggestions regarding this decision.  We are very worried and torchured not knowing.  Thank you

Hi,

My mother was dx with PC and unable to have a the whipple. From what I have read so far. Anything on the pancreas is bad. But please view this website for information.

 http://pathology.jhu.edu/n.web?EP=N&FL=PANCREAS_CHAT

 

 

 

Hello Lostsmiles.........Please take a look at the following website. There is a link to the full text as well. Very hopeful for pancreatic cancer. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&d

On 4/17/2007 Lostsmiles wrote:

Hi,

My mother was dx with PC and unable to have a the whipple. From what I have read so far. Anything on the pancreas is bad. But please view this website for information.

 http://pathology.jhu.edu/n.web?EP=N&FL=PANCREAS_CHAT " target="_blank" rel="nofollow">http://pathology.jhu.edu/n.web?EP=N&FL=PANCREAS_CHAT " target="_blank" rel="nofollow">http://pathology.jhu.edu/n.web?EP=N&FL=PANCREAS_CHAT " target="_blank" rel="nofollow">http://pathology.jhu.edu/n.web?EP=N&FL=PANCREAS_CHAT

 

 

 

 

On 4/17/2007 Nancie2007 wrote:

My 63 year old husband recently had ERCP with stent placement into the bile duct to allow the flow of bile into the intestine to eliviate a blockage. He had consults with 2 different doctors from different hospitals.

With all of his symptons and tests they both said it is most likely pancreas cancer. Doctor "A" wants to do the Whipple surgery hoping it is removeable and to see what we are dealing with because my husband is otherwise in good heath & is also waiting for a blood test to come back April 21.  Doctor "B" said NO surgery now and wants to get pancreas biopsies and if cancer, refer him to an oncologist with no surgery; maybe surgery later.  No one knows for certain if it is cancer or how bad. 

 Any suggestions regarding this decision.  We are very worried and torchured not knowing.  Thank you

Most patients are not eligeable for the Whipple due to the location of the tumor or to metastatic disease at diagnosis.  However theWhipple is the only realistic chance for a cure in PC.  If your husband has localized disease and the surgeon believes he can get negative margins then thats his best hope.  The worst case scenerio would be to have the Whipple with all its complications and then still have the cancer recur.  How many Whipples does this doc do?  How many does the hospital do?  A doc and hospital with a lot of experience in this surgery is key to a positive outcome.

 

 

Thank you for responding.  Both docs are tops of this field at Cleveland Clinic and University Hospital here.  We referred to them because of the Whipple and experience, however, the doc at Cleve Clinic is about 20 years older.

That is our dilema because the younger doc says he is a candidate and the older says "no" but to do pancreas biopsy then see.  I would hate to have him go through Whipple and then be determined terminal OR not do the Whipple and never know if it could have been treated or stop spreading.  Until we get a blood test back Mon. from the younger doc or do the pancreas biopsy April 30 with the older doc,  what would you do at this point, Whipple or not?

 

Nancie 2007

I suggest you proceed with the Whipple ASAP.  Pancreatic cancer is very aggressive and may be metastasizing even as I write.  Educate yourself, call PanCan and find out all you can about this cancer so you can be an advocate for your spouse.  Also go to the Johns Hopkins support group website; those folks are very knowledgeable and helpful.  The site also has bios of survivors.  My 75 yr old spouse had a Whipple with a surgeon who is very experienced in that procedure (experience is extremely important in PC) and his portal vein was involved so a piece of his jugular vein was harvested to use in place of the piece of portal vein that was resected.  He recovered well for 6weeks, had 28 days of radiation & 5 FU, rested for 1 month and is now undergoing Gemcitabine once a week for 3 weeks then 1 week off.  This will go on for 6 months after which we believe he will be in a vaccine program bein g run by his surgeon.  Please do your homework, you will find the doctors not very optimistic so you will need to find your own optimism and support.  Good luck!

Joan L 

Nancie 2007

I forgot to tell you that my husband is bowling 3-4 days a week, fixing dinner some nights and generally living his life as he did prior to PC.  No one knows what tomorrow will bring, but while he is able to do so, he is living his life.  PC isn't always an automatic death sentence, but you must be educated and determined to live!

 

Joan L 

When was your husband's doctor's point of recommending surgery for him, was it after certain test results, did he do a pancreas biopsy or just a blood test?  Did he do any type of treatments before he did surgery?

 What is PanCan, I would like to contact them and what is 5 FU, I am not familiar with these terms.  What affects did the Whipple have your husband's life/health after the surgery and how is he today.  I hope he is doing well.

We are in Cleveland, OH, are you familiar with any docs here?

Thanks again

 

On 4/18/2007 Nancie2007 wrote:

 

Thank you for responding.  Both docs are tops of this field at Cleveland Clinic and University Hospital here.  We referred to them because of the Whipple and experience, however, the doc at Cleve Clinic is about 20 years older.

That is our dilema because the younger doc says he is a candidate and the older says "no" but to do pancreas biopsy then see.  I would hate to have him go through Whipple and then be determined terminal OR not do the Whipple and never know if it could have been treated or stop spreading.  Until we get a blood test back Mon. from the younger doc or do the pancreas biopsy April 30 with the older doc,  what would you do at this point, Whipple or not?

 

PC can be hard to diagnose.  To me,  a biopsy is not always necessary for diagnosis.  If you have jaundice, weight loss , pain and a mass on the CT scan, then thats usually enough.  A helical CT scan may help to ensure there are no mets prior to surgery.  Again, if you can find someone who will do the surgery AND he has experience at it, then thats his best hope for any long term survival.  The best chemo is now showing 9-12 months survival while a Whipple is more like 18-24 months with a "cure" at least possible if the cancer is truely localized.

 

Also, see what the Ca19-9 says on Monday.  That should help ensure it is actually cancer.