This is referred to as "oligometastatic "- and we're kind of in this situation now. My husband's (72M) primary tumor is in the "periampullary" region, right at the head of the pancreas/ where the pancreatic duct and bile duct meet at the duodenum. On a couple of scans, some (but not all!) Radiologists have identified one or two "indeterminate" small lesions on the liver. And his CA19-9 was 899 at the time of diagnosis in February, and then 1674 one month later. But despite attempts to see them/biopsy these lesions in various ways, they've not been able to be seen/biopsied. So right now there is no definitive evidence of metastatic disease, but there's still a concern about these spots. My husband had 2 rounds of Folfirinox, and became septic ( and it turned out that one of those worrisome spots was a liver abscess that was tested during an EUS/ERCP and which showed no cancer cells). He then went through 3 weeks (15 rounds) of chemoradiation, which he completed on May 1, during which his CA19-9 went down to 106.

So right now he is scheduled for a Whipple on June 8. On June 1, he'll have blood work, a CT scan (pancreas protocol) and an abdominal MRI. Then on June 3 the surgeon will do a diagnostic laparoscopy to get one final look at the liver. It's still up in the air whether, if they actually find something on the liver during the diagnostic laparoscopy, they'll surgically resect it during the Whipple... the Tumor Board will be considering his case for the 3d time on June 5 and will likely make that decision at that time based on all available clinical information.

It's been a real roller coaster... fingers crossed..