Dad’s pancreatic cancer recurrence

[u/Ok_Information_2125]

My dad was diagnosed with stage 2b pancreatic cancer in October 2024. He had a whipple on Halloween. He was unable to tolerate chemo and is down to 95 lbs, 5’9”. He found out this week that the cancer has come back in a localized area of the pancreas due to a positive signatera test and PET scan. There are other areas that the report says are highly worrisome, including surrounding lymph nodes. How worried should I be? I feel like his care team are not being transparent about how bad this is. They want to start radiation next week. I am losing my mind and just want answers. TIA

[u/Cwilde7]

I’m very sorry you’re here. No one here can really say, but if I were you I would be making the most of your time with him. At that weight, tolerating treatments could be very difficult. I’m always shocked when they want to start certain treatments in his state, but I’m not a doctor.

[u/Jorjetr80]

No answers for you, just wanted to send my thoughts and prayers for your dad and you.

[u/reremorse]

I’m so sorry. Probably a long shot, considering 95 lbs, unless he was always very skinny: Genetic testing might find some genetic mutations that enable new drugs to target the cancer much more directly than non-targeted chemo. Also look for clinical trials. If his doctor doesn’t answer satisfactorily, check the NCCN for standard protocols: (https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455 ; you’ll need to get a login which isn’t hard). If you can afford it, consider a well known cancer center. If you’re strapped, use an AI chatbot to make sense of diagnostic complexities, imaging results, treatment possibilities, etc. Even if it turns out there’s nothing you could have done, you may feel better having tried.

OTOH, his and your quality of life count too, and harsh pursuit of every conceivable treatment can also be toxic to peaceful progress.

Consider filming him talking and hopefully smiling, telling stories of when you were growing up, when he was growing up, anything that he wants to tell. Ask him what he’d like you to know now, and also later in the event he isn’t around to tell you. Old people know stuff.

You can still learn from people you knew and cared about who have died. Make him know you’ll grieve him but also that you’ll be ok no matter what. There are grief counselors who can guide you and him through what is or at least can be a remarkable spiritual journey. Strangely, it can be deeply sorrowful yet beautiful, in equal proportion. Best wishes with this horrible disease.

[u/Prestigious_Sign_476]

Not being able to tolerate treatment is usually a difficult sign. In situations like this, the care team is often weighing whether any treatment can be tolerated at all, and if so, whether it’s likely to provide enough benefit to justify the side effects.

For example, a common first-line option for pancreatic cancer is gemcitabine with Abraxane. If a patient is too frail, the oncologist may sometimes reduce the dose or remove one drug (such as giving gemcitabine alone) in hopes of making it more tolerable. The same principle applies to second-line settings: doctors look for a balance between quality of life and the potential for slowing the cancer.

The hard question is whether a reduced or modified regimen is still “worth it” given his condition. That’s not an easy call—it’s something his oncology team and your family have to weigh together.

Two things are certain right now: 1) You’re not in this alone as we’re all with you. 1) You should spend as much time with you with your father.

Hoping for the best for you and your family .

[u/MagicianOk4232]

If your Dad is having radiation he should have SBRT. It is only five treatments, versus fifteen to twenty-five, and ironically the side effects are not as bad!! SBRT is much higher doses of radiation at one time. My brother completed his last week. Please check on this for your Dad!!