Seeking for advice for a friend

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Seeking for advice for a friend

by terencek888 on Thu Nov 21, 2019 02:33 PM

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Hi all,

Posting this on behalf of a friend who was diagnosed with PDAC in April 19. Borderline resectable when first diagnose, so surgeon recommended Whipple but was aborted due to metastasis and proceeded with cholecystectomy which kinda screw things up for him now.
Following is his latest CT scan:

Large, lobulated necrotic mass involving the pancreatic head and uncinate process (5.6cm) (series 7, image 66), likely represents the primary tumor. There is dilatation of the pancreatic duct with atrophy of the distal pancreas. The intra and extrahepatic biliary ducts are dilated. There is focal dilation of the distal CBD up to 22mm. Pneumobilia is noted. The mass encases and possibly invades the superior mesenteric vein(SMV) and main portal vein with evidence of portal vein thrombosis, adjacent collaterals are noted. The mass also partially encases the superior mesenteric artery and abuts the common hepatic artery. The pancreatic mass is inseparable from the 1st and 2nd parts of the duodenum.

Multiple ill-defined hypodensities of varying sizes are seen in both lobes of the liver, suspicious for metastases. For example, in segment 8(2.9cm) (series 7, image 28 ) and segment 4B(3.2cm)

Other Findings:
The gallbladder is not seen, in keeping with prior cholecystectomy.
Right renal cyst at the interpolar region.Bilate ral non-obstructive renal calyceal calculi. No hydroephrosis. 

Currently he has a bile duct blockage but doctors are not able to drain it due to the way the previous cholecystectomy was done. He is having infections and in a lot of pain now. 
Due to the infections, his oncologist is not recommending any chemo treatment for him. He is schedule for palliative radiotherapy on coming Monday, 25th Nov. He has sent his tumor tissue for Next Generating Sequence hopefully he can be qualified for clinical trials.

May I ask for your advice what else can he do at the meantime? Also like to know the meaning of ‘necrotic mass’. Can it be interpreted as a dying tumor? 

Thanks in advance!

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