Whipple after Stage 4 Adenocarcinoma - 1255909

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Whipple after Stage 4 Adenocarcinoma - 1255909

My Dad was diagnosed 2/12/13 with Stage 4 Adenocarcinoma with mets to liver. I am well aware that treatment for this stage is considered palliative, and once metastasized, the tumor is not considered resectable. However, through different forums and discussion boards, I have found several people diagnosed Stage 4 who received chemo until they were NED, and then went on to have the Whipple. I confirmed again that it was Stage 4 Adenocarcinoma originally. I'm try to find out what might have convinced a surgeon to operate in this case? By the way, these people are still alive (one five years past Stage 4 diagnosis at this point).



Reply To: Whipple after Stage 4 Adenocarcinoma


It's always difficult to know what exactly happened in the anecdotal reports of individual patients. The fact is that there are always some stage IV patients who do very well. The question that can't be answered is whether the surgery contributed to their improved survival, or if those patients just responded very well to chemotherapy, and would have done just as well without surgery, and without all of the difficulties of that surgery. From experience, oncologists have seen that surgery does not improve survival in stage IV pancreatic cancer. As Dr. Katz stated:

"According to the cancer staging systems, “resectable” pancreatic cancers are, first and foremost, those that are not associated with disease outside the pancreas. The reason for this is that the outcome following surgery—even if all disease can be removed—is not associated with a longer lifespan or better quality of life than that associated with chemotherapy alone when there is disease in sites such as the liver or lung. Simply put: patients with any amount of disease outside the pancreas live longer and better without surgery. This is a fact that neither I, nor any other pancreatic oncologist, would dispute." - http://cancergrace.org/pancreatic-cancer/2012/03/05/what-is-resectable-p...

Best wishes for good treatment results for your father.

Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: Whipple after Stage 4 Adenocarcinoma

Jim has distilled the key points here very well, and I think that having an expert pancreatic cancer surgeon clearly express that surgery for stage IV disease is really not an advisable approach should count for a lot. It's not that you can't find a surgeon to do the surgery -- if you search hard enough, you'll find someone to do almost anything, no matter how inadvisable the plan. But this really underscores the distinction between what can be done and what should be done. As Jim said, the fact that a very rare patient allegedly with stage IV disease is doing well years after surgery doesn't mean that they're doing well because of the surgery. They may have an exceptionally rare pancreatic cancer that grows extremely slowly or is exquisitely responsive to chemo, or the liver lesion interpreted as a metastasis was actually something else. And while I couldn't say with 100% certainty that someone with stage IV disease would absolutely never benefit from surgery, everything we know about pancreatic cancer is that heroic surgery would be exceptionally more likely to be harmful than helpful in this situation.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education