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Thread: Recurrence 2 years after Whipple???

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  1. #1
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    Recurrence 2 years after Whipple???

    My 79 year old MIL had the Whipple procedure in June 2017. She initially had some complications but those resolved and for the past 2 years she has had a pretty normal life. No post Whipple chemo or radiation at all and she has had scans every three months.

    Her latest scan in July showed a 20mm spot in the pancreas which was not seen on the scan in March. She was supposed to have a brush biopsy yesterday, but the surgeon backed out because he felt it was too dangerous considering how the previous Whipple changed things in that area. He has recommended her to have a PET scan instead.

    My question is....will the PET scan be as definitive as a biopsy? Also, are there any good treatment methods for recurrence after Whipple?

    MIL'S Pacreatic Journey
    5/16 Abdomin/back pain
    6/16 Scans/tests confirmntumor in head of pancreas 3 cm
    8/16-10/16 6 rounds of Gemcitabine
    11/16 SBRT radiation
    12/16-4/17 13 rounds of Folfirinox
    6/17 Whipple procedure; all tissue samples clear
    7/17 Complications from Whipple; fluid still draining from abdomen 4 weeks later, also being treated for peritonitis infection. No appetite and on IV nutrition at night
    8/17-6/19 No symptoms; regular scans every three months, no recurrence noted. Careful of what she eats, but a normal life for 2 years.
    7/19 CT Scan shows 20mm spot on pancreas. Brush biopsy was ordered for August
    8//6/20 Brush biopsy was cancelled because surgeon felt it would be too dangerous; PET scan has been ordered.

  2. #2
    Super Moderator Top User ddessert's Avatar
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    I think the median time for a recurrence after the Whipple is 18 months, with most happening between 12-24 months after the Whipple.

    If the PET scan comes back negative, then they may say to wait for the next scan to see if it grows or goes away.

    I’ve heard of a few cases where they could go back in for another surgical resection. But at age 79 they’ll be reluctant to do that even if they could. Seems like with a recurrence in the pancreas that the surgeon did not “get it all” and they owe you one. Surgeons all to often proclaim definitive success when the real recurrence rate is 75%.

    Post surgical (adjuvant) chemo is what is supposed to “mop up” any leftover tumor cells. It doesn’t always do that, but it does seem effective at further delaying recurrences.

    With a recurrence in the surgical bed, radiation might be an option, but it sounds like she already had her lifetime dose.

    You could ask if the pathology department still has any of the tumor from the surgery so that molecular/genetic testing can be performed to look for good treatment options.
    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 - IMRT+Xeloda
    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-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919
    @pancanology

  3. #3
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    Thank you for your detailed response. Yes, even though her tissue samples were clear after the Whipple, the odds are it is going to appear again. I wondered why they never did adjuvant chemo...but she had 13 rounds of Folfirinox before the surgery so maybe they didn't want to do any more. She was also weak for a long time after the Whipple, so treatment might have worsened that. She will be 80 in a few weeks, so I doubt they would even consider surgery again. She will have the PET scan next week, so will see what the results are of that.

 

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