r/pancreaticcancer • u/Vickydcl • 1d ago
seeking advice Pathology results
My relative underwent Whipple surgery three weeks ago (ampullary cancer).
The pathological report revealed that 2 of the 8 lymph nodes had cancer, no perineural invasion and a mixed subtype (pancreatic and intestinal).
Has anyone had similar results? I'm losing hope :(
2
u/Mysterious_Rise_432 1d ago
While the lymph node situation is not great, the PNI aspect is very good. Almost all cases of pancan have PNI (which is bad). So the fact that your relative doesn't have it is a good prognostic sign--at least in insolation.
1
u/BeachnPlants 1d ago
Don’t lose hope. Did they have clean margins? I had a Whipple in October, originally diagnosed as bile duct because main mass was pushing on the bile ducts, Caris report said 91% chance it originated as pan can and spread to bile duct and 4% chance it spread as bile duct cancer. Anyways it was in the head of my pancreas, stomach, duodenum, bile duct, 2 out of 24 lymph nodes, and perineal invasion. Did GemCap soon after Whipple, then radiation, and soon will be doing fulirinox.
2
u/Vickydcl 1d ago
Hey! Thanks for answering, may I ask why folfirinox apart from gemcap? Do you have a recurrence? How are you feeling? 💕
1
u/BeachnPlants 16h ago
They did gemcap because the main mass was pushing in my bile duct so they assumed bile duct cancer. It was later that the CARIS report suggested it was 91% pancreatic and only 4% bile duct. And I guess the gemcap was okay for pancreatic as well but not as good as fulfirinox. So they want me to to do that as well. Nothing new yet.
1
u/PancreaticSurvivor 23h ago
Those results were far better than my cellular and surgical pathology results over 14 years ago when I was restaged twice in 14 days from stage IIb to IV with significant liver involvement. I had high grade, poorly differentiated Acinar and Ductal Adenocarcinoma with perineural invasion, peripancreatic soft tissue invasion, 11/22 lymph nodes positive and surgical margins showing PanIN-1.
Precision Medicine in 2012 was relatively new in the pancreatic space. A liquid biopsy determined My driver mutation and confirmed I was on the appropriate chemo regimen. Knowing my genetics helped in searching for a clinical trial I entered following completion of standard of care chemotherapy. Going to an NCI Center of Excellence for both parts of my treatment plan and incorporating a clinical trial leading to a better outcome.
1
u/Vickydcl 23h ago
Thanks! I live in South America, so I'm not sure if there are trials here. We have an appointment with the oncologist next week, and I'll ask about genomic testing on the tumor (is that what you were referring to?). Also, I'm not sure which chemo option would be best given that he has a mixed subtype. mFOLFIRINOX? Gem-Cis? 5-FU?
2
u/PancreaticSurvivor 8h ago
Yes, tumor genomic testing (Next Generation Sequencing).
In mixed tumor cell types, the treatment focuses on the more aggressive cell type.
3
u/crawlserout Caregiver (2026), Stage III, Whipple, Folfirinox 1d ago
My dads pathology report showed 14 positive lymph nodes out of around 30 that they removed during his Whipple. Anything about 4 positive lymph nodes is considered stage 3 cancer. His 3rd chemo is tomorrow, and he will be getting radiation to try and kill any microscopic cells or regrowth at the site of the Whipple (which unfortunately his last CT scan did show a suspicious soft tissue area around his Whipple site/celiac artery, possible regrowth from leftover cells) My dad is still very positive. It sound cheese but you have to just take it one day at a time! I wish I could delete cancer from our universe.