Another Appt for Oma with Pancreatic Surgeon

Oma STILL has not had surgery.  Apparently, the Gynecological Oncologist wanted to hold off until she had another CT and met with the pancreatic surgeon yet again.  We thought we were moving forward with at least the ovarian surgery, so we were a bit frustrated as we felt we could at least get one out of the way.  But it is what it is.

Oma had another CT of her abdomen yesterday, both with and without contrast.

We met with the pancreatic surgeon today.  According to the CT scan, the mass on the pancreas is still there.  Not only is it still there, but it is perhaps a little larger.  Not exactly what we were hoping for.

Additionally, both tumor markers came back elevated.  The CA 19-9 (a tumor marker test for pancreatic cancer) was 151, when anything above 37 is considered elevated.  An elevated score can also be caused by gallstones (which we know she has), pancreatitis (which we suspect she has), or liver disease (which she has had in the past from her auto-immune hepatitis).  The doctor indicated her Chromogranin A (a tumor marker test for a neuro-endocrine tumor) was elevated with a score of 7, but according to what I read online, anything below 15 was considered in the normal range.  Perhaps I misheard the score or perhaps I misunderstood what I read.  In any event, because the tumor markers are elevated and because the mass has grown, things are again very concerning.  Surgery is back on the table.  For tomorrow.

During surgery, they are going to remove the end portion of the pancreas (where the mass is located), lymph nodes in the area, and the spleen.  The mass is intimately associated with the vein and artery by the pancreas which goes to the spleen, which is why they have to remove both.

A big portion of the pancreas will be left behind which is usually sufficient to process sugars, but there is typically a risk of an increase in diabetes.  Since Oma is already pre-diabetic, this may push her over the edge to a full-blown diabetic.

After surgery is complete, there is a risk a leak can develop from the pancreas.  The leak rate is 20 to 25% of all cases.  She'll have a drain tube after surgery.  If she develops a leak, the drain tube will stay in longer until the leak stops (it won't require more surgery).  Surgery will take anywhere from 3 to 4 hours.  The Gynecological Oncologist will come in for the last 1/2 hour to remove the ovarian mass and ovaries.  (There is some confusion as to whether he is just going to remove the left ovary where the mass is or if he is going to remove both ovaries.  Oma wants both ovaries removed.)

Without a spleen, you can develop certain infections.  Oma will need a variety of vaccinations to help protect against those infections.  Anesthesia during surgery can also flare up her hepatitis.  Of course, there are all the additional risks that generally come with surgery as well.

Oma could be in the hospital about a week, although some patients have been discharged after 3 or 4 days.

The mass could be a neuro-endocrine tumor.  It could still be a benign cyst.  Or it could be adenocarcinoma (cancer).  Final pathology will take 2 or 3 days to come back.  If it comes back as cancerous, Oma will be referred back to the Oncologist for further treatment.  There are genetic links between ovarian cancer and pancreatic cancer, so if these come back as cancerous, we will all be referred to a geneticist.

Oma has to check-in at 7:00 a.m. tomorrow morning for surgery.  Wish her well.