A Patient With Pancreatic Cancer Presents With A 30-Pound Weight Loss Over 3 Months

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

An 83-year-old African American male (AAM) with a negative past medical history (PMH) came to the outpatient clinic with a chief complaint (CC) of weight loss of 30 lbs for 3 months and weakness.

He was not on any medications. His appetite was good but he continued to loose weight, he denied depression and any other symptoms apart from lower abdominal pain and constipation.

Physical examination

Vitals: WNL.
Abdomen: Mild suprapubic tenderness.
Rectal exam: mildly enlarged prostate.

What is the most likely diagnosis?

- cancer
- infection
- depression


Laboratory results (click to enlarge the images).

The initial CBC showed mild anemia – mixed picture of ACD and IDA.

The initial CMP was normal.

PSA 6.8
UA: suggestive of UTI
CXR: WNL

What would you do next?

The UTI was treated with Levaquin. Constipation resolved after patient took Castor oil PRN. But weight loss continued.

What happened?

He was scheduled for a colonoscopy and a CT of the abdomen and pelvis was ordered.

What happened next?

The CT scan of the abdomen showed an ill-defined density in the pancreatic head. A follow-up CT scan with pancreatic protocol showed a mass suspicious for pancreatic cancer and a low-density lesion in the liver.


An ill-defined mass around the pancreatic head and a dilated pancreatic duct (click to enlarge the images).


A hypodense liver lesion (click to enlarge the images).


The report of CT scan of abdomen and pelvis (click to enlarge the images).

The patient developed diarrhea and was admitted for treatment of dehydration. A colonoscopy showed a normal colon. IVF and Pancrease TID were started.

The patient refused a CT-guided biopsy of the pancreas and was discharged home after a 3-day hospital stay in stable condition. He expired 4 months later under hospice care.

Final diagnosis

Pancreatic cancer.

What did we learn from this case?

Think about imaging studies, e.g. CT scan of the abdomen early. Respect patient's wishes regarding goals of care and end-of-life care.

References

Pancreatic Cancer: Diagnosis and Management. AFP 2/2006.

Pancreatic neoplasm. Unbounded Medicine, 2007.
In the Former First Family of Jimmy Carter, Cancer Has a Grim Legacy. The New York Times, 08/2007.
Pavarotti out of hospital. USA Today, 08/2007.

Published: 03/11/2005
Updated: 04/25/2010

2 comments:

  1. WHAT ARE THEY THINKING WHEN THEY WANT TO DO A PANCREATIC PROTOCAL?

    ReplyDelete
  2. You have to ask your doctor why he/she thinks that you need a CT scan. In general, CT scans provide better imaging of a particular organ than X-rays and ultrasound. I hope this helps.

    ReplyDelete