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Peritoneal Carcinomatosis of Pancreatic Origin Prognosis?

utooley
Posts: 1
Joined: Sep 2017

First post here, because we have so many questions...

Dad diagnosed with un-resectable LAPC in Sept 2016. Underwent 12 cycles of FOLFIRINOX and one of SBRT, CA 19-9 started at 452 and trended down afterwards, prior to Whipple with a vascular reconstruction here at Stanford Hospital in April 2017 (where we relocated specifically for the surgeon). Complications following surgery included sepsis and intra-abdominal hemorrhage due to "friability" of arteries after radiation, preventing him from returning to home to DC (long plane rides seemed scary), but things were looking up until last week. 

Dad was just admitted back to hospital with sub-acute bowel obstruction of unclear origin, which hasn't resolved. CA 19-9 is elevated (~8000), although liver is clean on CT and cytology of ascites drained during paracentesis came back negative, our surgeon here fears peritoneal carcinomatosis or some other metastasis of recurrent pancreatic cancer is blocking the stomach from emptying. Endoscopy, upper GI series, and PET scan planned for Tuesday to investigate what's going on. We never started chemo after surgery because he was always on the tenterhooks of heading back to the hospital, and had planned to do it back home =[.

Does anyone have experience with peritoneal carcinomatosis (or other carcinomatosis) from pancreas origin? Assuming he's too fragile abdominally for CRS/HIPEC, so options are chemo probably, but we're afraid they'll say he's too fragile for intervention for the bowel obstruction even, or some such thing. He was doing great up until a week ago, but is incredibly stubborn and insisted he was fine even when he couldn't keep any food down. We had been planning to go back home soon. Any alternative treatments I haven't turned up? Assuming we'd want to start chemo immediately, but with the 3-day weekend and his stomach still blocked...it hasn't happened. Are there questions we should be asking the docs that we aren't? If they're talking palliative care, we want to at least try something before that happens, but are uncertain even where to start here.

Should we try to relocate to somewhere like JHU or MD Anderson or MSK? Will clinical trials for metastasized pancreatic cancer accept him with carcinomatosis, if indeed that's what it is, and does anyone have recs? How do you even do the hospital-to-hospital transfer, anyways? 

It seems like every day counts at this point, and he's not one to give up, so I'm trying to pull out all the stops. He'll want to be back home on the East Coast anyways if things look grim, that's where his other daughter and his brothers are...we're trapped on the wrong side of the country now.

Any advice or thoughts?!?

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Oneshot
Posts: 147
Joined: Jul 2009

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