PANCREATIC CANCER

Mr. F 74MPresented 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

INTRODUCTION

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

HOPC

Palliative chemotherapy Abraxane/Gemcitabine Was not candidate for chemoradiotherapy or surgical

resection

MANAGEMENT

Complications Hydronephrosis – required ureteric stents SBO – requires restenting Febrile neutropenia Pancreatic insuffi ciency

Steatorrhoea Weight loss and anorexia Euglycaemic

CA19-9 From 800’s down to 122 in late Jan

PROGRESS

Rectal polypectomy in 2007Osteoarthritis – on regular analgesics

MS contin 10mg BD Panadol Osteo 665mg TDS

HypertensionHyperlipidaemiaOn Esomeprazole and nizatidine for symptoms of

GORDNKDA

PAST MEDICAL HISTORY

Home with wifeTwo daughtersPreviously fi t and IADL

Golfed twice weeklyFunctional decline

SOBOE and decreased exercise tolerance

SOCIAL HISTORY

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 eff ects

SUMMARY

1 Pancreatic cancer and complications2 Chemotherapy toxicity3 Advanced planning4 Social issues

ISSUES