David, Mish and jdooley, thanks for the replies. Good point on getting opinions and updates from top cancer centers and getting chemo treatment locally. In fact, if my mother gets to a point that she is well enough for chemo, we are thinking of getting it at a local hospital, instead of traveling 40 minutes to CINJ. She can continue to see her oncologist at CINJ for potentially additional treatment options (clinical trials if that's possible).

My mother is 74 years old and prior to the diagnosis, she had always had some minor health issues. I feel (and she knows too) that she isn't a strong candidate for aggressive chemo therapy even when she was healthy. She had indicated to me and the doctors that she didn't want the chemo and I do want to respect her wishes, knowing the standard chemo regiments are generally not very effective against adenocarcinoma. But I have been telling her that you never know how you will react to the treatment unless you give it a try. I do like a recent quote I saw, that "when we are treated like the median, we tend to become the median". So I'm holding out hope that with a bit more information and education, she will agree to try the chemo and with any luck she will be able to have a much longer progression-free and decent quality of life period than the median suggests.