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Thread: Pancreatic Cancer Metastasis to Lung

  1. #1
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    Question Pancreatic Cancer Metastasis to Lung

    Has anyone experienced Pancreatic Cancer post Whipple procedure with metastasis to lung. Would you be willing to share this progression with me and how the Oncologist proceeded with therapies and or cyber knife?

    I was diagnosed 11/15 3.4 cm X 3.1 cm mass at head of pancreas. Biopsy and bile duct stint 11/13/15, followed by Whipple 11/30/15. Surgeon took 40% pancreas, bile duct, duodenum, peritoneum, multiple lymph nodes, several feet of small intestine and remnants of gallbladder surgery.

    My 8/28/17 CT Scan showed micronodule within the left lower lobe unchanged. However, there is a new subsolid subcentimeter focus of opacity within the right upper lobe. Report suggested possible inflamation/infection, yet my Oncologist did not prescribe antibiotics or albuterol for nebulizer. He has scheduled next CT Scans 3 months out.

    My research indicates that at or around the 2 year mark mets to lung in upper lobes can begin with 1 area, followed by several new ones within 3-6 mos. of first one. I hate waiting games, and I believe knowledge is power.

    I am well aware of my % chances of survival rate and I am somewhat at peace with a disease that there is no cure for. I am currently in a clinical trial, which included Gemzar alone and Gemzar plus a drug used for stage 4 patients on stage 2 and 3 patients. I received Gemzar alone for 6 mo. ending 6/15/16.

    Sooo...for this to show up just before my 2nd anniversary of diagnosis, my Oncologist not prescribing for concern for infection or inflammation, and the CT Impression: 1) New subcentimeter subsolid focus of opacity within the right upper lobe, favored to represent a small focus of infection or inflammation, 2) No "definite" evidence of metastatic disease within the thorax (whereas prior Impressions only said No evidence of metastatic disease, and now says no DEFINITE evidence) leads me to believe the Doctors are in a wait and watch mode. I have made it clear to my Oncologist that I wish to be proactive in my treatment and not reactive. Maybe, it doesn't make a difference if the outcomes are typically the same.

    Thank you in advance for any information and advice from forum members on this subject.
    Last edited by cbay38; 09-13-2017 at 05:24 PM. Reason: addition & typo

  2. #2
    Moderator Top User ddessert's Avatar
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    I have a very similar finding at 4.5 years after surgery. The oncologist asked me if I was getting over some cough or cold, but I wasn't. My new opaque node joins several other nodes that have been stable throughout the years. I comfort myself that I have other, non-cancerous nodes in my lungs for the last years, as do probably just about everyone else. They just don't get CT scans to see that. It seems reasonable that if I have some, that new ones will also appear.

    I think XStacey (also from N. Texas) was told by her oncologist that we get these more often in this part of the country.

    I'm on a vaccine clinical trial where I have to demonstrate that I do not have a recurrence to continue. Despite this new finding, they kept me in the program and gave me the next treatment. Hopefully if it is real, the vaccine will do its job and wipe it out.

    Regardless, I knew there was nothing else they would recommend except to wait for the next scan. It's a rough initial few weeks thinking about it, but it doesn't dominate my thoughts any more. I've decided to get back to my exercise and diet and be as healthy as possible in case it is a recurrence. That can't hurt.

    I also bumped up the timing of my next scans so that I'll have the answers before I choose my next insurance plan for 2018. I'm in the individual marketplace and while pre-existing conditions are covered, the hospitals and doctors that treat those conditions are often not contracted by the insurance companies. That kicks me out into the 'regional' hospital setting instead of the NCI centers. So I'm building up my oncologist/surgeon contact lists in case I need referrals or advice. Some regional centers are not up-to-date with the latest treatments.

    It's part of why I chose Johns Hopkins for a clinical trial. I was treated at MD Anderson and am doing the trial at JHH. Two of the best places that should give me advice. It's part of my personal plan to make myself valuable to the medical system so that I can get what I want - if I need it.

    Based on my genetics, I have several good treatment options waiting. None are the 'standard' offerings most patients will get. So the expert advice and referrals could come in handy convincing a regional oncologist to not pull the play straight from the PanCan playbook.

    Also, in case of recurrence, I'm pretty up to date on the tumor testing options. I may want to get that ball rolling quickly. But if I can't get that biopsy, I'm still feeling good about my original plan.

    So I guess my planning goes well beyond the emergency right in front of me. I've been preparing for this for the last 6 years. Hopefully I never need to call in the chips, but I know where they are.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-Dec 2016 - NED
    Mar 2013-present - NCT01088789
    @pancanology

  3. #3
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    Unfortunately, my husband had the same thing; multiple small, slow growing nodules in both lungs. We have been watching them for over 2 years now, and a recent wedge Biopsy confirm that the two in the right lung are Adenocarcinoma. A PET scan showed the one in the lung is cancer too. Pathology reads:The small spiculated left lower lobe lesion demonstrates mild FDG uptake, suspicious for a low-grade adenocarcinoma or adenocarcinoma in situ. He is 5 years out from his Whipple.

    We are currently seeing a new doctor at UT Southwestern. Dr. Beg recommends starting chemotherapy soon. We are doing molecular profiling on the tumors just removed and will base further treatment on those findings. We are also waiting on the tissue sample from MD Anderson, where he did his Whipple to confirm that this is a recurrence and not a new primary lung cancer.

    I sincerely hope that your news is much better than ours. Apparently, non cancerous lung nodules from infections are pretty common here in Texas. Hopefully in Oklahoma too.

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    I'm. Re to this site. I can't figure how to post. Thanks

  5. #5
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    My husband found out last week that he has a suspected recurrence in his lung. He was diagnosed in May 2015 and had a Whipple in Feb 2016. We were concerned because his CA19-9 had risen significantly so weren't altogether surprised that something showed up on his latest CT scan.
    He is having a PET scan and biopsy to confirm the diagnosis. Then the plan is to start chemo (Gem/Abraxane). We are in the UK and sadly molecular profiling doesn't seem to be an option.

  6. #6
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    cbay38, please see my post under the thread - lung mets to treat or not - we don't have the exact same situation but hopefully you can find some helpful info there. Chris
    9/25/16 - Distal pancreatonomy to remove growing "cyst" on tail of pancreas
    9/30/16 - Path confirms PDAC, 0/16 lymph nodes, clear margins, categorized 2A
    11/06 - start Chemo - Gemcitabine/Xeloda
    5/15/17 - Scan show growth in previously unidentified lung nodules. 1 in each lung
    5/30/17- Lung biopsy confirms PDAC in lungs
    7/17 - awaiting to be placed in immunotherapy trial at MSKCC
    7/17 - began Clinical Trial of KO-947, an ERK inhibitor
    9/19/17 Taken off trial, not doing anything
    9/21/17 considering FOLFIRINOX followed by some local treatment for lungs. CA-19 21
    9/21/17 also considering clinical trial at NIH

 

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