PANCREATIC CANCER

 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 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 insufficiency  Steatorrhoea  Weight loss and anorexia  Euglycaemic  CA19-9  From 800’s down to 122 in late Jan PROGRESS

 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 PAST MEDICAL HISTORY

 Home with wife  Two daughters  Previously fit and IADL  Golfed twice weekly  Functional 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 effects SUMMARY

1Pancreatic cancer and complications 2Chemotherapy toxicity 3Advanced planning 4Social issues ISSUES