Transcript Pancreatic cancer - Oncology Clinics Victoria

PANCREATIC CANCER
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
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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
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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
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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 ef fects
ISSUES
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Pancreatic cancer and complications
Chemotherapy toxicity
Advanced planning
Social issues