Pancreatic adenocarcinoma

Presentation:
P.S., a 59 year-old female, had a routine colonoscopy at an outside hospital, which showed 2 polyps and a mass in her ascending colon.  A right colectomy for the mass was performed a few weeks later which was found to be benign per patient.  However, during her admission for the colectomy, the patient developed severe abdominal pain.  An MRI of the abdomen showed a 3cm mass for which the patient says she was told to follow up on as an outpatient.  Two months later she became jaundiced and was readmitted to the hospital for a biliary stent and further management.

Diagnosis:
An outpatient CT of the abdomen/pelvis showed a 6.5 x 3.7 cm mass involving the head and body of the pancreas, which encased and narrowed the superior mesenteric artery.  The patient then presented to the ER with constipation and abdominal pain.  She was diagnosed with locally advanced, unresectable pancreatic adenocarcinoma.

Treatment:
P.S. began treatment for pancreatic cancer with weekly gemcitabine (Gemzar®), which initially showed improvement, but the cancer eventually progressed through the chemo.  She then started second line therapy with FOLFOX chemotherapy, which she tolerated poorly, which nausea and vomiting with each cycle.  FOLFOX consists of folinic acid, fluorouracil and oxaliplatin.  To date, she has had a 30 lb weight loss since diagnosis.

On her last admission for abdominal pain and nausea/vomiting, a CT of the abdomen showed significant ascites and disease progression but was negative for small bowel obstruction.  A large volume paracentesis was performed, removing 6L of fluid.  She was then treated with albumin.

Outcome:
The patient will continue with FOLFOX chemotherapy as in inpatient for subsequent cycles due to severe nausea/vomiting with chemo.  She was instructed to continue an aggressive bowel regimen at home and to contact her doctor if she has no bowel movements for a week.  She will also continue her home PO morphine for pain control and diuretics to control her ascites.  In regards to pancreatic cancer, the American Cancer Society reports a one year survival rate of 20% and a five year rate of 4% for all stages combined.