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Pancreatic 1

Pancreatic – A CASE STUDY

Dr. Donato Perez Garcia

ADENOCARCINOMA OF THE PANCREAS

This is the case of a sixty-four year old female who developed scleral icterus in September of 1986. This was followed by the appearance of jaundice and symptoms of nausea and anorexia. In October the patient sought consultation with her physician about these complaints, and an ultrasound examination of the liver and bile ducts was done on October 22. This reported a normal liver parenchyma without evidence of metastasis, the presence of cholelithiasis, and dilatation of the intra and extrahepatic bile ducts due to extrahepatic obstructive jaundice. The differential diagnosis was cancer of the head of the pancreas versus cancer of the ampulla of Vater. On October 27 a CAT scan of the abdomen was done, confirming suspicions of a pancreatic cancer. The patient was apprised of the possible diagnosis and the poor prognosis under her circumstances.

In December, the patient went to the M.D. Anderson Cancer Center in Houston,Texas, to be treated for her condition. There she had a choledochoduodenostomy performed. During the intraoperative period a needle biopsy was taken from tissue in the head of the pancreas, and this reported an adenocarcinoma. Apart from this palliative surgical procedure (choledochoduodenostomy), the patient received no other form of treatment for the management of her disease.

In January, 1987, the patient presented to the Drs. Perez Garcia for treatment of her condition with IPT.

PHYSICAL EXAMINATION

The patient is a sixty-four year old female complaining of a three months history of nausea, anorexia, scleral icterus and jaundice, and a weight loss of 12 kg (27 lbs). She states that her jaundice has diminished somewhat since her surgery in December, 1986. Height: 5 feet 3 inches (1.6 m). Weight: 104 lbs (45.9 kg). Blood pressure: 190/130 mm Hg. Pulse: 90/ min. and regular. Temperature: 37.3o C. Respirations: 18/min. Head & Neck: There was some slight residual scleral icterus, otherwise the HEENT were normal. Chest: Several supraclavicular lymph nodes are palpable on the left and these are slightly tender. The lung fields are clear. The second heart sound is augmented in intensity, otherwise the heart sounds are normal without murmurs or extra sounds. The heart rate and rhythm are normal. Abdomen: Soft and scaphoid. No liver, spleen, or kidneys are palpable. There is a firm, tender mass palpable in the epigas trium. The bowel sounds are normal. Central nervous system: Grossly normal.

IPT treatments

On January 15, 1987, the patient began a series of IPT treatments. The medications administered included: regular insulin 12 units IV; Genoxal (Schering – cyclophosphamide 500 mg/25 ml) 0.5 ml IM; Methotrexate (Lederle – methotrexate 50 mg/20 ml) 0.4 ml IV; and Fluorouracil (Roche – 5-fluorouracil 500 mg/10 ml) 0.2 ml IV. The patient underwent a total of eighteen treatments which she tolerated without adverse effects – either from the chemotherapeutic agents or the insulin. Clinically, her condition improved with this therapy. All her gastrointestinal symptoms abated and she was able to regain her lost weight. Her abdominal exam became essentially normal, and the supraclavicular lymphadenopathy and scleral icterus likewise cleared.

On April 22, 1987, an ultrasound examination of the liver and bile ducts was done which reported a tumor in the head of the pancreas measuring 32 x 30 mm . A repeat examination done on June 5 reported the body and tail of the pancreas to be normal in size with areas present in the head of the pancreas compatible with tissue necrosis. Following the ultrasound examination in June, the patient began to take treatments on a once-a-month basis instead of once weekly. After her last treatment on October 2, 1987, this patient was lost to further follow-up. At that time, she was observed to be in a good state of health without any complaints or signs of her previously diagnosed condition.