CancerCompass message board discussion started by jamiek on 2/17/2008 http://www.cancercompass.com/message-board/message/all,21040,0.htm Sun, 07 Sep 2008 00:00:00 GMT Sun, 07 Sep 2008 00:00:00 GMT http://backend.userland.com/rss RSS.NET: http://www.rssdotnet.com/ Dear All,My mum has recently had the whipple procedure to remove cancer in the pancreas area. The operation went well, and she is recovering well. Luckily we had the best surgeon in the UK, and that made a massive difference. When the surgeon removed the tumour, it was touching a vessel, and he couldnt confirm that there was no cancer cells on the vessel. Normally they liked to be able to have a distance of a few millimetres between the tumour, and the vessels to confirm it is all removed. He believes that he did remove it, but like all surgeons will not confirm it is the case.I do have some questions that I would love if you guys could help me.1) Can pancreactic cancer come back after the whipple procedure? 2) What treatment can be done on the pancreas area to get rid of any possible cancer cells around the area? I have heard of something called SIRT, can this be done?3) During surgery, the surgeon found a milli cancer cell on the liver. Does this mean she has secondary cancer on the liver from the pancreas?4) Can she have a liver transplant to avoid liver cancer? The surgeon believes that cancer in the livid is imminent, so, we would maybe look at SIRT on the liver, or maybe a transplant.I would appreciate any help you guys can give.RegardsJamie jamiek Sun, 17 Feb 2008 00:00:00 GMT  On 2/17/2008 jamiek wrote:Dear All,My mum has recently had the whipple procedure to remove cancer in the pancreas area. The operation went well, and she is recovering well. Luckily we had the best surgeon in the UK, and that made a massive difference. When the surgeon removed the tumour, it was touching a vessel, and he couldnt confirm that there was no cancer cells on the vessel. Normally they liked to be able to have a distance of a few millimetres between the tumour, and the vessels to confirm it is all removed. He believes that he did remove it, but like all surgeons will not confirm it is the case.I do have some questions that I would love if you guys could help me.1) Can pancreactic cancer come back after the whipple procedure? 2) What treatment can be done on the pancreas area to get rid of any possible cancer cells around the area? I have heard of something called SIRT, can this be done?3) During surgery, the surgeon found a milli cancer cell on the liver. Does this mean she has secondary cancer on the liver from the pancreas?4) Can she have a liver transplant to avoid liver cancer? The surgeon believes that cancer in the livid is imminent, so, we would maybe look at SIRT on the liver, or maybe a transplant.I would appreciate any help you guys can give.RegardsJamieJamie, I am not a doctor or an expert but will try to help with my understanding of the situation.1.  Yes, unfortunately the cancer comes back after the whipple most of the time.  It may recur on the pancreas portion that is left, the liver, or almost anywhere else.  That is why post op treatment is usually recommended.  I know this is extremely disturbing but the whipple is usually the only chance to beat/control this beast so it is still the way to go if you qualify.2.  I'm told that post whipple, one would want some time of Radiation Therapy to treat the localized area for stray cancer cells.  Also, Chemotherapy to get any distant cells that have traveled via the blood or lymph system.  Basically, radiation therapy is for possible local spread and chemotherapy is for possible systemic spread.  At least in our case, it was extremely difficult for DH to get on his feet post op and move right on to chemo and radiation....can be so hard on the body.3.  Yes, that does likely mean spread to the liver.4.  As far as liver transplant goes, I really don't know anything about that.  If the pc is going to spread, the liver is the most usual first stop for it.  I've never heard of a liver transplant to avoid cancer but then again, could be.Best wishes to you and your mum. AnniePG Sun, 17 Feb 2008 00:00:00 GMT Hi Jamie,I'm sorry for your Mom's troubles.The surgeon who did the Whipple procedure told me that even with complete removal of the tumor from the pancreas, it is possible for the cancer to return.  Statistically, the chances of recurrence are significant.If there is any doubt they were unable to get all of the tumor removed, typically they will refer to an oncologist for follow up treatment.  Usually radiation and / or chemotherapy depending on the patients specific circumstances.I believe a diagnosis of pancreatic cancer will prevent any consideration of liver transplant.  There are too few organ donations, with long waiting lists, so they select the patients most likely to have the longer term benefit of the transplant.  If may be possible for cancer patients to receive transplants in other countries, but to my knowledge, not in the U.S. Hope your Mom continues to do well with her recovery from the surgery.    AliveInOldeTown Sun, 17 Feb 2008 00:00:00 GMT Hello-I am a nurse and I can tell you that unfortunately, liver transplants are not appropriate for cancer patients.  Once it has mets somewhere else, it is considered systemic and a transplant would be futile.  The new liver would have the same chance of getting cancer as the old liver. Do investigate other alternatives though such as radiation, etc.-you never know if she'll qualify. Chrisobrn Sun, 17 Feb 2008 00:00:00 GMT Hello,  It is good you are trying to educate yourself about PC.  Sometimes information can be depressing,so please be carefull.  Yes, we have a high rate of cancer coming back.  I have heard from a few people who live a long time.  That would be great.  I like raising money to help fund researchers to help find a cure or bring more awareness to this horrible disease.  It is a shame this is where we go to find our most of our information.  PanCan.org has information on their website, especially about educating our congressmen or the government to give out more money for PC research.Anyway, sorry for the soap box.  I have Stage IV PC which mets to my liver.  My surgeon pinched it off and took our lymphs and 3 of them were positive.  I was told because of that, I need to keep getting scans to catch anything, if cancer does come back.  I did not have radiation or chemo.  I asked my doctor why every one else gets to have it and I didn't, not like I wanted to.  The oncologists told me because I had the slow growing PC, chemo would not effect it at all.  So now I am in a waiting game.  What kind of treatment after the whipple: Mostly what your oncologist thinks is best, or seek out other doctors for more opionins.  Alternative medicine with what your oncologists says to do  probably wouldn't hurt either.  Best of everything,  Dawnella Dawnella Mon, 18 Feb 2008 00:00:00 GMT Jamie, I am sorry to about your Mom.  The info from the prior responses is fairly accurate.  You did not mention what type of cancer your mom had.  There is adenocarcinoma and islet cell/neuroendocrine.  The prognosis for adneocarcinom is not very good, as it is usually very agressive and does not respond to chemo very well.  There are several types of islet cell.  From what I have found is that they can be low, low to moderate, moderate to high, and high grade.  This refers to to the growth rate.  If the tumor is somatostatin expressing they will be able to track growth and mets with an octreotide scan.  Also a ct or mri will be needed to measure the size and interval growth.  One the cancer has spread from the original site there is very little chance of a cure.  If the growth is limited to the liver and the cancer is of a low grade, the prognosis is pretty good.  There are several modes of treatment that can lead to many years of normal life.  There is radiofrequency ablation, cryo ablation, SIR Spheres, oral chemo and if somatostatin expressing PRRT. They take a somatostatin molecule and combine either Lu 177 or Y90 (radioactiveivity)to it and it attaches to the tumor.  The radiation is localized to the tumor and causes damage to the cells (ie cell death) and hopefully the tumor will shrink while sparing the rest of the organ.  PRRT has been available for years in europe and has had very promising results.  It is expensive, I was told that it was about 30 K USD.  The only trial in the US that I know of is @ the University of Iowa @ Holden Cancer Center, however this study is limited to those under the age of 25.  Supposedly, there is a submission to the FDA for a multicenter trial in the US per my oncologist @ Moffitt Cancer Center, Tampa fl.  I contacted the FDA, and that was like talking to the wall.  They would not say anything except that if there was  a submission, they would have to respond withing 30 days and that the delay was from an incomplete submission.  I don't what is available in the UK.   You may want to check out the following:  www.pancan.org; http://www.prrt.nl/index.php?lang=en;http ://www.carcinoid.org/medpro/docs/Y90andLU177trialResults2005.pdf .  Wes Wesley1 Mon, 18 Feb 2008 00:00:00 GMT Hi Wes,Your message was pretty amazing, your knowledge is fantastic, and I am keen to talk further to you.Do you have any instant messenger, i.e. Msn, Yahoo, Skype etc? I would love to talk to you, and I really need your help. My knowledge is getting more extensive, and speaking to you would be invaluable.Can you please email me directly at:--Message edited by CancerCompass staff. For personal protection, email address removed. Consider private reply. Please review CancerCompass Member Guidelines at http://www.cancercompass.com/common/guidelines.html-- I look forward to hearing from you :) jamiek Mon, 18 Feb 2008 00:00:00 GMT