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Do a PET/CT scan? Sometimes a 'hot spot' of a small cancer growth might light up. But unfortunately, sometimes things light up that are not cancer - like arthritis, inflammation etc... so even that isn't a guarantee that cancer has returned.
Most will probably start following the CA19-9 much more closely. Like check again in 1-2 months for sure and possibly with another CT scan. If it is trending upward over time, that is the most concerning. If there is any new concerning symptoms, then that would also encourage an earlier check of CA19-9 and CT scan.
Most doctors will wait until they clearly see something concerning for cancer on the CT scan before they discuss starting treatment/chemo etc... The most aggressive chemo right now is FOLFIRONOX (5-FU, Irinotecan, oxaliplatin). It would also be a good time to look around for any clinical trials, in case there is something new. Or even go to Hopkins or MD Anderson or the best place to get a second opinion.
If the recurrence is a single nodule in the lung, some people have just had those removed. If it is in the site of the Whipple surgery, sometimes people can have more surgery.
At least a couple people on this board have started chemo even when the cancer wasn't seen yet, but the numbers were continuing to rise. Those tended to be the most aggressive, younger patients, if I recall correctly.... Or maybe the patient wasn't aggressive -- their doctors were!
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