Ductal Adenocarcinoma of the Pancreas: Delayed Diagnosis and an Unlikely Surgical Candidate.
Keywords:Adenocarcinoma, Pancreas, Ductal, Biliary
AbstractDuctal 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.
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