Concluded Case

CA - Head of Pancreas

A 70 years old male with history of Anorexia Weight loss Increasing jaundice- obstructive jaundice USG - shows Pancreastic mass with Ascitis An ERCP done - there was,a long stricture lower end of CBD, - stricture was dilated and 10 Fr stent was placed in CBD stricture and brush cytology taken . CECT abdomen showed CA head of pancreas with local spread of lymph nodes CA - 19 - 9 - Pancreatic tumor marker was significantly raised more then 800 Treatment protocol welcomed

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Concluded answer

Vessels are encased by tumor, therefore it is inoperable tumor Palliative CBD stent placement done Now choice is between no treatment or chemotherapy Why no treatment or best supporting care - chemotherapy is expensive and do not results in survival benefit

All Answers

Vessels are encased by tumor, therefore it is inoperable tumor Palliative CBD stent placement done Now choice is between no treatment or chemotherapy Why no treatment or best supporting care - chemotherapy is expensive and do not results in survival benefit

Carcinoma head pancreas with blood vessel invasion with lymph node eanlargement with stent insitu in CBD Previously it was not possible to diagnose preoperatively as there was no good imaging modalities and diagnosed during operation only and then sometimes drastic step operative steps of resection was taken depending if the degree of vessel invasion and the vessel involved but survival rate was very low so in this case no surgery is justified. May be refd to oncologist for consideration of chemotherapy or radiation.

Ca pancreas with involvement of adjacent nodes Pet scan Opinion of oncosurgeon Adenocarcinoma Poor prognosis Radiation or pancreotomy or palliative

ADENOCARCINOMA head pancreas Metastasis + Adv panetrating radiation and chemotherapy

A case of CA Head of Pancreas with Lymphnode Spread & CBD Stent in Situ. Only Pallative Treatment

Needs to assess for systemic metastasis by whole body PET CT scan. If it is locally advanced even vein can be resected and reconstruction can be done. Patient will need neoadjuvant chemotherapy if no metastasis and performance status is good and bilirubin comes less than 2. Then based on response to chemotherapy surgery can be offered to the patient

Cbd stented already.. Ab for biliary sepsis,once Stabilised whipples procedure can be attempted.. if not planning for surgical intervention palliative supportive treatment.. Whipples procedure can have prolong d survival if patient not having much co morbids and in early stages of ca

Let the patient meet a medical oncologist and surgical oncologist for combined tumor board decision. We usually give modified Folfiri regimen if patient performance status is good

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