Anyone else been diagnosed with adenocarsinoma stage 3.(duodenum extending into head of pancreas and

smile2003

My dad was diagnosed with adenocarsinoma ( Ca of duodenum exptending into the head of pancreas and 1 lymph node. He did great through his whipple procedure on Aug 26, 2009. He is so weak. He is scheduled to start chemo with a 24 hour pump and radiation this week. It is my understanding radiation is being used this time because it was found in one lymph node. I also stated this time because my dad was diagnosed with colon Ca stage 2 in 2007 just finishing chemo NOv 2008. I am just so confused as to if these are related or just missed. Looking for answers.

JamesP

similar condition
Hi, it sounds like I am in a very similar position as your dad. I had the pylorus preserving whipple (take no stomach but do take the head of the pancreas, duodenum, gall bladder and associated duct) a little over 6 weeks ago and am currently having my first infusion of chemo while typing. My tumor was in the head of the pancreas and had made its way into the duodenum. The pathology lab declared mine as stage IV with negative margins in the surrounding tissue and I had 2 positive lymph nodes. I am also having a 24hr pump for 5FU, a shot 3 times a week and radiation everyday for around 7 weeks. My understanding is that this cancer type is very virulent and the follow up treatment helps to try and prevent recurrence. I am in a clinical trial and I suspect irrespective of lymph node interference I would still be following the same course of action. I see this as a short term inconvenience for the prospect of hopefully not having recurrence. Both my surgeon and oncologist have a lot of experience and believe the combination of surgery and adjuvent rad/chemo are imperative for successful outcomes.

smile2003

JamesP said:

similar condition
Hi, it sounds like I am in a very similar position as your dad. I had the pylorus preserving whipple (take no stomach but do take the head of the pancreas, duodenum, gall bladder and associated duct) a little over 6 weeks ago and am currently having my first infusion of chemo while typing. My tumor was in the head of the pancreas and had made its way into the duodenum. The pathology lab declared mine as stage IV with negative margins in the surrounding tissue and I had 2 positive lymph nodes. I am also having a 24hr pump for 5FU, a shot 3 times a week and radiation everyday for around 7 weeks. My understanding is that this cancer type is very virulent and the follow up treatment helps to try and prevent recurrence. I am in a clinical trial and I suspect irrespective of lymph node interference I would still be following the same course of action. I see this as a short term inconvenience for the prospect of hopefully not having recurrence. Both my surgeon and oncologist have a lot of experience and believe the combination of surgery and adjuvent rad/chemo are imperative for successful outcomes.

Thanks for your reply. Good
Thanks for your reply. Good Luck with your treatment. I am very confident with his doctors and the hospital I really can't complain but I still think there is something else or maybe we missed this last year with his colon ca. No one every looked. My dad did have a ERCP done this past April at another larger hospital. About a year ago during a CT there was a "shadow" on a duct that was suspicious. So after his chemo was finished they finally got around to look into it. An ERCP is similar to an upper GI scope but it is smaller and can go into the ducts of pancreas, and amall intestine shoot dye and take pictures. Well in APril they suposively didn't see anything. How can this now show up to be so advanced that involes a lymph node when only 5months earlier nothing showed. I don' know what other steps to take or would it even help. Is this type of Cancer that fast growing? Did you have any tests to suspect yours? How was yours diagnosed? and Have you had any other type of Ca? They said my dad's originated in the duodenum. and it is actually thesame type of cell in the pancreas. not necessarily pancreas ca

JamesP

smile2003 said:

Thanks for your reply. Good
Thanks for your reply. Good Luck with your treatment. I am very confident with his doctors and the hospital I really can't complain but I still think there is something else or maybe we missed this last year with his colon ca. No one every looked. My dad did have a ERCP done this past April at another larger hospital. About a year ago during a CT there was a "shadow" on a duct that was suspicious. So after his chemo was finished they finally got around to look into it. An ERCP is similar to an upper GI scope but it is smaller and can go into the ducts of pancreas, and amall intestine shoot dye and take pictures. Well in APril they suposively didn't see anything. How can this now show up to be so advanced that involes a lymph node when only 5months earlier nothing showed. I don' know what other steps to take or would it even help. Is this type of Cancer that fast growing? Did you have any tests to suspect yours? How was yours diagnosed? and Have you had any other type of Ca? They said my dad's originated in the duodenum. and it is actually thesame type of cell in the pancreas. not necessarily pancreas ca

how I was diagnosed
I am 33 so fairly young for this type CA especially as there is no histology in my family, I don't smoke and don't drink heavily. I have never had CA before and a PET/CT I had would seemingly inidcate that this was localized to my pancreas and small intestine. It was Christmas last year when I started finding that eating caused me issue. After New Year I started to turn yellow and my 'normal' functions weren't normal. After flying home (we'd been at my wifes parents) I went immediately to the Dr's. They sent me for an ultrasound suspecting gall stones. Due to bloating in my stomach they couldn't see anything so had me go for a CT scan (luckily I got these on the Saturday that I had gone in). The CT showed no gall stones but a distended bile duct and a mass on the head of my pancreas. The following Wednesday I had an ultrasonic endoscopy and biopsy as they found a tumor in my small intestine. This was sent to the path lab and came back as positive. Now the first set of guys I went to believed this was a CA that eminated in the small intestine and made its way to the pancreas. When I went for a second opinion to PC specialists they believed it was PC and requested the biopsy which I believe they performed a simple test (I beleive a swab test) on to confirm this was the case. The initial guys were going to perform a whipple immediately so didn't place a stent. The second guys believed it was inoperable at that juncture and suggested placing a stent with neoadjuvant chemo due to abudment to major arteries in the pancreas. Based on expereience, despite wanting to go for surgery, I went the chemo route which luckily worked. When the suregon at the 2nd hospital initially reviewed my case the mass was like 1.9cm x 2.1cm. Before I started chemo (over 20 days after stent placement) I had a 2nd scan and although I was told it hadn't changed much it was at 2.7cm x 3.2cm. This kind of implies that this CA can be fairly agressive. I read some other information on these forums and people have seen dramatic increases in the mass over time. I think unless there was something visible with the ERCP when going through your fathers system they may not of found anything. The GI I initially saw used a the ultrasonic endoscopy (EUS) as he wasn't expecting to see anything but the mass on the head of my pancreas and his intent was to biopsy this by accessing it through tissue. I am not sure if an ERCP would allow a similar procedure. When I had the stent placed an ERCP was used. I had actually asked the initial GI if he could place a stent while performing the EUS as there was something clearly blocking my system due to the jaundice. He stated that he would need to use an ECRP for this which would be a seperate procedure.

RunnerCPA

My dad has been diagnosed with adenocarsinoma too
My dad has been diagnosed with adenocarsinoma too. We just found out last month. They can't operate on his. They can't find the primary source but he has it in his lungs, mediastinum and femur in his right leg. He started three types of chemo this week. In his port, they put paclitaxel and carboplatin. He is taking etoposide by pill for the next 10 days. He is having severe sharp leg pains. Does anyone know if this is normal or how to decrease the pain? Has anyone taken this type of chemo?

robjul

JamesP said:

how I was diagnosed
I am 33 so fairly young for this type CA especially as there is no histology in my family, I don't smoke and don't drink heavily. I have never had CA before and a PET/CT I had would seemingly inidcate that this was localized to my pancreas and small intestine. It was Christmas last year when I started finding that eating caused me issue. After New Year I started to turn yellow and my 'normal' functions weren't normal. After flying home (we'd been at my wifes parents) I went immediately to the Dr's. They sent me for an ultrasound suspecting gall stones. Due to bloating in my stomach they couldn't see anything so had me go for a CT scan (luckily I got these on the Saturday that I had gone in). The CT showed no gall stones but a distended bile duct and a mass on the head of my pancreas. The following Wednesday I had an ultrasonic endoscopy and biopsy as they found a tumor in my small intestine. This was sent to the path lab and came back as positive. Now the first set of guys I went to believed this was a CA that eminated in the small intestine and made its way to the pancreas. When I went for a second opinion to PC specialists they believed it was PC and requested the biopsy which I believe they performed a simple test (I beleive a swab test) on to confirm this was the case. The initial guys were going to perform a whipple immediately so didn't place a stent. The second guys believed it was inoperable at that juncture and suggested placing a stent with neoadjuvant chemo due to abudment to major arteries in the pancreas. Based on expereience, despite wanting to go for surgery, I went the chemo route which luckily worked. When the suregon at the 2nd hospital initially reviewed my case the mass was like 1.9cm x 2.1cm. Before I started chemo (over 20 days after stent placement) I had a 2nd scan and although I was told it hadn't changed much it was at 2.7cm x 3.2cm. This kind of implies that this CA can be fairly agressive. I read some other information on these forums and people have seen dramatic increases in the mass over time. I think unless there was something visible with the ERCP when going through your fathers system they may not of found anything. The GI I initially saw used a the ultrasonic endoscopy (EUS) as he wasn't expecting to see anything but the mass on the head of my pancreas and his intent was to biopsy this by accessing it through tissue. I am not sure if an ERCP would allow a similar procedure. When I had the stent placed an ERCP was used. I had actually asked the initial GI if he could place a stent while performing the EUS as there was something clearly blocking my system due to the jaundice. He stated that he would need to use an ECRP for this which would be a seperate procedure.

Sounds quite similar
JamesP... my husbands case sounds very similar. He is 45. We battled iron deficieny anemia a little over a year ago, had many test done, biopsy's performed on polyps from stomach, small intestine and colon all of which came back fine. Began iron therapy, which he responded well too for a while, then a gallbladder attack, so we thought. CT scan didn't really show anything confirmining initially, a shadow, but the ERCP found a tumor in the duodenum... traveled to a major cancer center that does many whipple surgeries each year, met with head surgeon there, scheduled whipple. Had a 25 day wait to get on surgery list... in that time, Rob became very yellow and lots of pain, traveled back to surgery center, this time CT and ERCP resulted in finding major vein involvement, so considered inoperable, placed stent in bile duct and in small intestine, began chemotherapy. Completed 3 rounds of oxilaplatin/xeloda... ct said basically stable, although measurements were somewhat larger... considered enlargement could have happened in the 3 weeks between stenting and getting chemo started. Had a sick spell, stent in intestine moved, became blocked, so have undergone surgery to make a new route for the stomach to empty and the bile duct to connect to the intestine. Changed chemo to Gemzar, have completed 5 of initial 7. Scheduled for scan on Dec 1. He is tolerating chemo ok, had some major nausea issues in the beginning of gemzar, but could have been from surgery as well. Has had major weight loss, so very weak. How are you doing now?

JamesP

robjul said:

Sounds quite similar
JamesP... my husbands case sounds very similar. He is 45. We battled iron deficieny anemia a little over a year ago, had many test done, biopsy's performed on polyps from stomach, small intestine and colon all of which came back fine. Began iron therapy, which he responded well too for a while, then a gallbladder attack, so we thought. CT scan didn't really show anything confirmining initially, a shadow, but the ERCP found a tumor in the duodenum... traveled to a major cancer center that does many whipple surgeries each year, met with head surgeon there, scheduled whipple. Had a 25 day wait to get on surgery list... in that time, Rob became very yellow and lots of pain, traveled back to surgery center, this time CT and ERCP resulted in finding major vein involvement, so considered inoperable, placed stent in bile duct and in small intestine, began chemotherapy. Completed 3 rounds of oxilaplatin/xeloda... ct said basically stable, although measurements were somewhat larger... considered enlargement could have happened in the 3 weeks between stenting and getting chemo started. Had a sick spell, stent in intestine moved, became blocked, so have undergone surgery to make a new route for the stomach to empty and the bile duct to connect to the intestine. Changed chemo to Gemzar, have completed 5 of initial 7. Scheduled for scan on Dec 1. He is tolerating chemo ok, had some major nausea issues in the beginning of gemzar, but could have been from surgery as well. Has had major weight loss, so very weak. How are you doing now?

Doing Well
I am coming to the end of my 5th week of adjuvent chemo/rad. It has been pretty tough and the 24hr pump is a real nuisance (lovingly reffered to as my little friend). I have managed to keep eating and drinking which has allowed me to avoid IV fluids which is usually required by the 3rd week for a similar regiment which utilizes cysplatin as opposed to oxiplatin. I pop anti naseau drugs pretty readily although feel I have tolerated this relatively well. Looking forward to the Christmas break now before I go back on the 4th Jan for a CT and to re-start my gemctabiene/docetaxel chemo maintenance regiment for 12 weeks (8 cycles).

I hope the gemzar does the trick with your husband. It sounds like he is borderline resectable. I found that after I had the stent placed I still struggled to eat for a while with some discomfort although after the chemo seemed to get a grip this deffinately helped. The suregeries all take there toll as your body is under a constant barage. Just try and feed him everything he likes and is able to tolerate. You can get some high protein shakes which a lot of people seem to go for. It is so important to try and keep a good level of nutrition although this can be difficult.

Hope you get some good news in December and have a great Thanksgiving and Christmas with your family.