Chemo before or after surgery?

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Chemo before or after surgery?

by mas126 on Tue Feb 26, 2019 08:08 PM

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Hi Everyone,

My mom was recently diagnosed with Stage 2 adenocarcinoma. Her CT shows that it is borderline resectable and the tumor is "kissing" the blood vessel in the pancreas. Her CA 19-9 is also elevated.

She saw one surgeon who suggested the Whipple be done ASAP to remove the tumor and then afterwards, she could go for chemo. She got a second opinion at a cancer hospital and they recommend chemo and/or radition first and then, depending on the response of therapy, going for the Whipple procedure.

I've been doing a lot of research on both of these approaches and it seems like there are pros and cons to both. 

If anyone has any advice or feedback I would greatly appreciate it. We are really struggling to decide how to proceed. Thanks in advance!

RE: Chemo before or after surgery?

by bushy on Wed Feb 27, 2019 09:36 AM

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mas126 During recent chat with my oncologist she explained chemo before Whipple gives a greater chance of longevity after a Whipple ,and can also can shrink tumors so Surgery can go ahead, your body finds it harder to recover from the surgery and have chemotherapy at the same time side effects can be much harsher with the person unable to finish chemo .But borderline resection adds another factor in what decision to make.Very tricky decision ,all you can do is as you are talk to the medicos and make an informed decision.Best wishes with what you decide.Unfort unately I don’t personally know of any who had chemo before Whipple.In my day it was Whipple then chemo.

RE: Chemo before or after surgery?

by mas126 on Thu Feb 28, 2019 05:20 PM

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bushy Thank you so much for your reply. Right now, she's leaning towards chemo first, then surgery. She wants to get a PET scan and speak with a medical oncologist before making her final decision. It's so hard to know which is the right choice. We are fortunately to live close by to several well respected hospitals so we know whichever she chooses, she is in good hands.

RE: Chemo before or after surgery?

by Waldo1 on Thu Feb 28, 2019 05:37 PM

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Hi there...

I'm so sorry you are all going through this - My husband was diagnosed with Stage 4 Ampullary cancer 11 years ago (I've posted his story on this blog in the past..)  Since he was Stage 4 he was considered inoperable, so at that point chemo was our only option - At this point John's CA19-9 was extremely high and he was losing weight rapidly - his original oncologist had given us about 8 month survival at the most...

We went to Dr. Ko at UCSF who said he would not take the Whipple off the table if we were able to get his primary tumor to shrink with chemo - and this is what we were praying for and gave John hope!  ...Fortunately for us the chemo got rid of the cancer completely and the Whipple ended up not being necessary - and I know this was a highly unusual case, and for whatever reason these particular drugs worked on John - but he is still cancer free (it will be 11 years in August) without a Whipple and I thank God (and Dr. Ko!) every day!! :-) 

I know there are pros and cons for having chemo before or after the surgery -  and this is such a HUGE decision - but if you are able to get the tumor to shrink a bit BEFORE the surgery it just seems to make sense that this would be a plus - I would think it would depend on how aggressive the tumor(s) was - if it is borderline resectable of course you don't want to wait until surgery is no longer an option...  However, John's primary tumor and the inumberable tumors in his liver were visibly shrinking after two treatments... verified by endoscopy and a CT scan - perhaps a short course of chemo would tell you how the tumor responds to the specific treatment, which would also be a plus in knowing what chemo to use after surgery...

I hope your Mom comes through all of this okay - don't let her give up!!

RE: Chemo before or after surgery?

by Taddo on Thu Feb 28, 2019 06:12 PM

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I had the same diagnosis in the Fall of 2017. I had nine chemo treatments and then the Whipple at Sunneybrook Hospital in Toronto. After two weeks of healing, I had another nine treatments of chemo. After many prayers and a lot of positive thinking, I have been clear for the past year. I feel great, my energy is back. All the best to you as you make your decision. Taddo

RE: Chemo before or after surgery?

by artsylady on Thu Feb 28, 2019 09:21 PM

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My partner was diagnosed with pancreatic cancer. He was resectable with no metastasis or lymph node involvement. We were advised to undergo five weeks of radiation accompanied by oral chem. Then a month rest followed by a distal pancrectomy.. Another month rest and now midway thru twelve treatments (six months) of the break-thru aggressive chemo treatment (falfurinol). Lots of unpleasant side effects but this cancer is a rough one and we are choosing to fight.

RE: Chemo before or after surgery?

by JaniceMN on Thu Feb 28, 2019 10:10 PM

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I was diagnosed with pancreatic cancer with the tumor close to my spleen. Prior to surgery I had 3 months of chemo to hopefully shrink the tumor. This was successful. Initially they had dicussed a whipple but with the shrinkage of the tumor, my surgeon opted to remove 2/3 of my pancreas as well as my spleen and gallbladder. After surgery I had another 4 months of chemo and to date there are no signs of cancer.

There is always so much information and it's so hard to know what to do. I put all my trust and faith into my oncologist and my surgeon and glad I did. If there's any chance of reducing the tumor and avoiding a whipple it's worth going the chemo route prior.

I wish you all the best and hope everything works out well for your mom. Tell her it's a tough battle but stay optimistic. It's worth the fight.

RE: Chemo before or after surgery?

by artsylady on Thu Feb 28, 2019 10:16 PM

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How long ago did you have the diagnosis.

RE: Chemo before or after surgery?

by kwoods on Fri Mar 01, 2019 07:05 PM

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On Feb 26, 2019 8:08 PM mas126 wrote:

Hi Everyone,

My mom was recently diagnosed with Stage 2 adenocarcinoma. Her CT shows that it is borderline resectable and the tumor is "kissing" the blood vessel in the pancreas. Her CA 19-9 is also elevated.

She saw one surgeon who suggested the Whipple be done ASAP to remove the tumor and then afterwards, she could go for chemo. She got a second opinion at a cancer hospital and they recommend chemo and/or radition first and then, depending on the response of therapy, going for the Whipple procedure.

I've been doing a lot of research on both of these approaches and it seems like there are pros and cons to both. 

If anyone has any advice or feedback I would greatly appreciate it. We are really struggling to decide how to proceed. Thanks in advance!

I had chemo and radiation for 6 months prior to Whipple with the same diagnosis That was 4 years ago and it was very succesful for me I came through whipple with totally clear margins and the surgeon said there was very little cancer left at whipple. Hope whatevewr decision you make has a good outcome

RE: Chemo before or after surgery?

by Treasure on Fri Mar 01, 2019 08:25 PM

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Them before Whipple is usually recommended because the tumor is to near a portal vein or as n your mms case it's near the blood vessel. Having chem before, shrnks it enough so that the surgeon can go in and remove the entire tumor leaving nothng behind! Chemo gven after a Whipple is usually recommended if cancer was located in other areas. Either way, the do have great drug to help you through chemo . It's important to eat before chemo and drink lots of fluids also. .it's not wise to take any suppliments whilst n chemo . You can take ensure as it's loaded with the proper amount a nutrients the body needs. I can tell you, when I was on this journey, I knew .needed some mighty powerful help and so I asked God to take this journey with me because I wanted this cancer gone once and for all! Chemo is just a treatment, but it's God that brought me through to victory! It is going on 8 years since I was told 5-6 months to live. .it's God that can do what man cannot!

Blessings as you both start this journey!

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