Pancreatic Cancer With Metastasis to Liver: Report of a Case

Abstract

Pancreatic adenocarcinoma is a malignant neoplasm of pancreas. It is the fourth leading cause of the cancer-associated deaths in the United States with only 6% survival rate within next 5 years of diagnosis and 45% of patients diagnosed with metastatic disease. It does not cause any symptoms in the early stage, and later symptoms are nonspecific, thus the disease is usually diagnosed when already advanced. We present a case of 60-year-old male patient presented to our department with complain of pain in abdomen, anorexia, malaise, scleral icterus and weight loss since 6 months. The patient never smoked, and has no past history of alcohol or drug abuse. On physical examination patient was in good health with scleral icterus. On palpation the abdomen was soft. No costovertebral tenderness was elicited. The bowel sounds were normal. Vital Signs were HR 88/min, BP 110/70 mm Hg, RR 18/min, Temp 98.8 F. Lab investigations were Hemoglobin, 13 g/dl; White blood cell, 9,800 cells/uL; Platelet, 205,000/mm3; total bilirubin, 11 mg/dl; direct bilirubin, 7 mg/dl; ALP 255 IU/L; ALT, 100 IU/L; AST, 80 IU/L. Viral markers were negative. Tumor marker were AFP 55 ng/ml (normal 0-8.5), CEA was 4.6 ng/ml and CA 19-9 was 55,000 U/ml (normal 0-37). Ultrasonography showed a hypoechoic mass in the head of pancreas. Pancreatic Cancer was the suspected diagnosis. An abdominal CT scan was done and it showed a mass in head of pancreas. It also showed dilated intra and extrahepatic biliary tree with stenosis of common bile duct and multiple round lesions on liver. A diagnostic and therapeutic ERCP was performed and a stent was placed in the common bile duct. ERCP resulted in a failure and jaundice did not get any better. The tumor was found to be inoperable because of liver metastasis. Pathohistological diagnosis confirmed the clinical diagnosis. The patient was referred to a cancer hospital and chemotherapy was started with Gemcitabine. CT with contrast after two treatment cycles showed shrinkage of the pancreatic lesion and liver nodules. This case an example of common, late-stage diagnosis of pancreatic cancer with a compromised biliary system and metastatic liver lesions. Metastatic pancreatic cancer patients should be offered more aggressive chemotherapy options, although chemotherapy is integrated in treatment protocols of different stages of disease progression. Gemcitabine monotherapy can be used for metastatic pancreatic cancer with liver and biliary tract involvement.