Our Reason Why:
Kathleen had begun work in cancer research at Wake Forest Baptist Health (WFBH) in 2013, and by the later part of the year noticed her Mom exhibiting vague symptoms like upper abdominal pain that radiated between her shoulder blades and feeling full quickly during meals. Kathleen's Mom started losing weight because of these symptoms, and at the urging of her family she had made an appointment with her primary care physician who referred her to a community gastrointestinal (GI) specialist. An abdominal ultrasound (US) was eventually ordered and Kathleen's Mom received the results one Friday evening at 5pm; no gallstones, but a dilated pancreatic duct. A computerized tomography had been scheduled four weeks out from that time, but by this point several weeks had already gone by which had quickly turned into months. There didn't seem to be a rush for answers but Kathleen, knowing about pancreatic cancer, was alarmed and sought opinions from two specialized cancer surgeons she worked closely with.
Thankfully WFBH cancer surgeon wanted to see Kathleen's Mom in his clinic. She had lost approximately 20lbs over the past two or three months, so blood work was ordered (CBC and CMP) as well as tumor markers. A CT scan was performed, and Kathleen's Mom was scheduled for an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) to better evaluate her pancreas. Despite her symptoms Kathleen's Mom was still working full-time. She had just turned 60, and there had been no family history of pancreatic cancer. There were no risk factors except perhaps smoking cigarettes. Kathleen's Mom had never been hospitalized with pancreatitis before, but now had been admitted after each ERCP (for ERCP-associated pancreatitis). All tissue biopsies revealed atypical cells suspicious for adenocarcinoma which could be indicative of inflammation versus cancer, and so after three months of biopsies and resultant hospitalizations Kathleen's Mom was scheduled for a pylorus-preserving Whipple procedure for chronic pancreatitis.
On April 22nd, 2014 Kathleen's Mom underwent eight hours of surgery to remove the head of her pancreas, the 1st portion of her duodenum, her gallbladder and cystic duct - preserving her stomach's pylorus. My Dad and I stayed in Surgical Waiting the entire time, receiving information every 2hrs from an operating room nurse on the wall phone in the reception area. After the long day, the surgeon came out into the waiting area to speak with us: that was one of the scariest moments, not knowing what he'd say. Thankfully the surgery went as planned, but we were told Mom's pancreas appeared and felt abnormal. The surgeon told us he removed a mass in the head of the pancreas, but the surgical margin had a benign tumor called Intraductal Papillary Mucinous Neoplasm (IPMN) so another margin was taken. The second margin also contained IPMN, but the surgeon had already taken approximately 55% of the pancreas and did not feel comfortable taking any more.
Mom spent about two weeks in the hospital recovering. Her only complication was a surgical site infection that required bedside opening of her midline incision. Before discharge the surgeon communicated the final pathology report: Stage IA invasive ductal adenocarcinoma of the pancreatic head. The cancer was 0.4cm and was arising from a "benign" tumor (IPMN). There was IPMN at the surgical margin, and we were told that guidelines for adjuvant chemotherapy in this setting were not standard. Furthermore we were told chemotherapy would not treat IPMN. Given the insidious nature of pancreatic cancer, it was decided Mom's case would be discussed at a multidisciplinary tumor board to determine next steps.
Adjuvant chemotherapy was gemcitabine (Gemzar) was initiated soon after surgery, and six cycles were planned by Mom's medical oncologist. Soon after treatments began, Mom would go to the emergency department for fevers (neutropenic fever), but never needed to be admitted and it seemed this was a 'normal' stress response reaction to chemotherapy for her. However partway through treatment, Mom's kidney function started to deteriorate, and by the fifth cycle she had to receive blood products for acute kidney injury (AKI). Chemotherapy ended.
Days, months and years went by happily. Mom recovered from this massive surgery without issue. She recovered from chemotherapy without lasting effects. Life was happy, and we were all increasingly carefree as time marched on.