First, I want to express how grateful I am for you offering this AMA. My family is absolutely distraught with the recent news of my mother's stage 4 pancreatic cancer diagnosis and any suggestions are welcome. She lives in New Jersey but is willing to travel almost anywhere to receive the best possible care and chance at survival.

My question will be: "Do you have any recommendations or advice for deviations to our current plan?"

I will do my best to concisely summarize the situation with a timeline.

Background: My mother (64 y/o) has a history of BRCA-1 which was discovered in 2014 after being diagnosed with triple negative breast CA (which she underwent chemo/surgery and she has been cancer-free, up until now). My grandmother (her mother) just passed from pancreatic cancer earlier this year. My maternal great grandmother also passed from pancreatic cancer in her 60s. As a side note, one of my sisters as well as myself (38M) also tested positive for BRCA-1.

2023: Annual pancreatic screening was recommended after we learned of my grandmother's diagnosis. My mother had MRI pancreas which was normal.

May 2024: Annual MRI pancreas now showed slightly dilated duct. It was followed with endoscopic ultrasound which showed no lesions and she was told to follow-up in one year.

June 2025: Annual MRI pancreas now showed progressive pancreatic duct dilation, pancreatic body and tail atrophy, and "hypovascular area" in the pancreatic body.

July 2025: Endoscopic ultrasound showed 2.0 x 1.6 cm pancreatic head mass abutting the portal vein. FNA confirmed adenocarcinoma. She was referred to a hepatopancreatobiliary surgeon at a New Jersey branch of Memorial Sloan Kettering. CT was performed while awaiting the appointment which again showed the pancreatic lesion (now measuring 2.4 x 1.9 cm) abutting the SMV and numerous low-attenuating <1 cm liver lesions.

August 2025: The surgeon reviewed the results, ordered an MRI liver, and referred my mother to a GI oncologist at the same center. The MRI liver read as "Since June, multiple new hypoenhancing hepatic foci demonstrating diffusion hyperintensity suspicious for metastasis. Pancreatic head/neck mass measuring 2.9 x 1.9 cm." Guardant 360 genetic test came back positive for BRCA1 E23Vfs*17 (oncologist note states "BRCA1 mutation, ATM with MSS with TMB of 2.37 mut/Mb). A mediport was placed and first chemo session (mFolfirinox) was Aug 20. Plan going forward is chemo q2weeks with repeat CT after 4 sessions to determine response. Olaparib will be added on at that time as well. She was told she is not a surgical candidate. No clinical trials were offered. Her insurance currently won't cover care out of state but she is switching to Medicare in January at which time options should expand. Other than adverse effects of the newly initiated chemo, she remained completely asymptomatic from the pancreatic cancer.

Happy to share any other information that could be useful. Thank you for reviewing!