Ductal Adenocarcinoma of the Pancreas: Delayed Diagnosis and an Unlikely Surgical Candidate.

  • Donald von Borstel, D.O. Oklahoma State University Center for Health Sciences College of Osteopathic Medicine (OSU-COM)
  • Matthew Laurence Treiman, D.O., M.P.H Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
  • Kyle Franklin Summers, D.O. Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
Keywords: Adenocarcinoma, Pancreas, Ductal, Biliary

Abstract

Ductal adenocarcinoma of the pancreas is the most common malignant tumor of the exocrine pancreas and accounts for greater than 90% of pancreatic malignancies.1 Pancreatic cancer is an insidious entity, which is commonly asymptomatic until late in the disease course. The most common clinical signs and symptoms are progressive jaundice, weight loss, abdominal pain, and back pain.2 Common laboratory findings include disturbances in liver function tests indicative of biliary obstruction as well as elevated tumor markers, such as CA 19-9, CEA, and CA 242. Imaging is an important component of the diagnosis, with Computed Tomography (CT) commonly showing a poorly marginated hypoattenuating and non-enhancing pancreatic head mass with adjacent structural invasion. Surgical resection with pancreaticoduodenectomy or regional pancreatectomy is the only potentially curable treatment, however only 15 to 20 percent of patients are candidates due to late presentation with local vascular invasion and/or metastatic disease. We report a case of a 48-year-old female with an atypical clinical presentation that was treated for other causes without success, and ultimately presented with duodenal obstruction secondary to a pancreatic head ductal adenocarcinoma. The patient was a surgical candidate and had a pancreaticoduodenectomy for treatment of the disease. Prognosis is poor - overall survival is less than 10 percent, and less than five percent survive five years without surgery.

Author Biographies

Donald von Borstel, D.O., Oklahoma State University Center for Health Sciences College of Osteopathic Medicine (OSU-COM)
adjunct assistant professor
Matthew Laurence Treiman, D.O., M.P.H, Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
PGY-2 resident
Kyle Franklin Summers, D.O., Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
PGY-V resident

References

Basar O, Kadayifci A, Brugge WR. MALIGNANT LESIONS OF THE PANCREAS. doi:10.2310/7900.5468.

Stark A, Eibl G. Pancreatic ductal adenocarcinoma. Pancreapedia: The Exocrine Pancreas Knowledge Base. 2015. https://pancreapedia.org/node/9002/revisions/10362/view.

Freeny PC, Marks WM, Ryan JA, Traverso LW. Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT. Radiology. 1988;166(1 Pt 1):125-133.

Yu KH, Ahmad NA. Diagnosis and Evaluation of Pancreatic Ductal Adenocarcinoma. In: Endoscopic Oncology. Humana Press; 2006:295-302.

Haglund C. Tumour marker antigen CA125 in pancreatic cancer: a comparison with CA19-9 and CEA. Br J Cancer. 1986;54(6):897-901.

Ryan DP, Hong TS, Bardeesy N. Pancreatic Adenocarcinoma. N Engl J Med. 2014;371(11):1039-1049.

Low G, Panu A, Millo N, Leen E. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics. 2011;31(4):993-1015.

Al-Hawary MM, Francis IR, Chari ST, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology. 2014;146(1):291-304.e1.

Maithel SK, Maloney S, Winston C, et al. Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2008;15(12):3512-3520.

DiMagno EP, Reber HA, Tempero MA. AGA technical review on the epidemiology, diagnosis, and treatment of pancreatic ductal adenocarcinoma. Gastroenterology. 1999;117(6):1464-1484.

Published
2018-09-07
Section
Medical