Pancreatic adenocarcinoma

Today we discussed a case about an older woman who presented after subacute painless jaundice and chronic weight loss + fatigue + nausea, found to have new onset DM, mixed cholestatic and hepatocellular liver injury, and a large pancreatic head mass. She was diagnosed with pancreatic adenocarcinoma.

JAUNDICE FRAMEWORK

LIVER INJURY

  • The R factor (or R value) could be useful in helping distinguish cholestatic vs hepatocellular liver injury.

PANCREATIC ADENOCARCINOMA

  • Definitely be concerned in patients presenting with painless jaundice. But patients with pancreatic cancer can also present with abdominal pain.
  • Of the patient diagnosed with pancreatic cancer, up to 2/3 can develop new onset DM in the 36 months surrounding the diagnosis of pancreatic cancer.
  • Your illness script should include risk factors such as
    • Age > 50
    • Hx chronic pancreatitis
    • Obesity
    • T2DM
    • High red meat consumption
    • EtOH use disorder
    • Tobacco use disorder
    • Mucinous cystic lesions of the pancreas
    • Inherited conditions (e.g. Peutz-Jeghers syndrome, BRCA2 germline mutations, hereditary pancreatitis, Lynch syndrome)
  • CA 19-9 is the most sensitive (70-92%) and specific (68-92%) tumor marker with clinical utility.
  • Serial monitoring of CA 19-9 levels can be useful in following patients after potentially curative surgeries and for those receiving chemotherapy for advanced disease.
    Rising CA 19-9 levels usually precede the radiographic appearance of recurrent disease.

RESOURCES

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