Overview of Pancreatic Cancer Diagnosis and Management
Detailed account of a 74-year-old male presenting with symptoms of pancreatic cancer, diagnostic work-up, treatment including palliative chemotherapy, and progression with complications.
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Presentation Transcript
INTRODUCTION Mr. F 74M Presented to Cabrini Malvern ED Temp 39.6 Vomiting of food content, 3-4 hours post-prandial Other symptoms of delayed gastric emptying Abdominal discomfort Early satiety Anorexia Loss of weight Background of locally invasive pancreatic cancer Previously admitted for SBO Also had episode of febrile neutropenia requiring admission
HOPC On admission, developed focus of infection Pharyngitis Blood culture showed strep. pyogenes bacteraemia Managed on benzylpenicillin Concurrently, investigations for his gastric outlet symptoms Blockage at site of duodenal stent Could not restent, but opened obstruction
HOPC Pancreatic cancer diagnosed in Oct 2014 Period of increasing GORD symptoms and abdominal cramps Episode of vomiting and abdominal pain required admission under which a gastroscopy was performed Full stomach consistent with gastric outlet obstruction Follow-up CT demonstrated large pancreatic mass Stricture at D3-4 junction Endoscopic ultrasound and FNA cytology Suspicious of adenocarcinoma consistent with clinical and radiological presentation Duodenal stent
HOPC Referral to A/Prof. Gary Richardson Work-up CT and endoscopic US revealed locally invasive pancreatic cancer Lymph node biopsy did not show malignancy Staging T4N0M0 AJCC stage III
MANAGEMENT Palliative chemotherapy Abraxane/Gemcitabine Was not candidate for chemoradiotherapy or surgical resection
PROGRESS Complications Hydronephrosis required ureteric stents SBO requires restenting Febrile neutropenia Pancreatic insufficiency Steatorrhoea Weight loss and anorexia Euglycaemic CA19-9 From 800 s down to 122 in late Jan
PAST MEDICAL HISTORY Rectal polypectomy in 2007 Osteoarthritis on regular analgesics MS contin 10mg BD Panadol Osteo 665mg TDS Hypertension Hyperlipidaemia On Esomeprazole and nizatidine for symptoms of GORD NKDA
SOCIAL HISTORY Home with wife Two daughters Previously fit and IADL Golfed twice weekly Functional decline SOBOE and decreased exercise tolerance
SUMMARY Mr. F 74M Presented with pharyngitis and strep. pyogenes bacteraemia Treated with benzylpenicillin, d/c with amoxycillin Concurrent SBO from blockage at site of previous stent Reopened but awaiting restenting Some biochemical improvement with chemotherapy Ongoing complications of pancreatic disease and chemotherapy side effects
ISSUES 1 Pancreatic cancer and complications 2 Chemotherapy toxicity 3 Advanced planning 4 Social issues
