Screening for Subsequent Pancreatic Cancer in Childhood Cancer Survivors is Needed. A Case Report

Abstract

Introduction: The survival of children with cancer has improved considerably over the last decades which have led to a growing number of long term survivors. One of the most serious adverse outcomes in this population is subsequent primary neoplasms with the risk as high as six-fold over expected. The relative risk for subsequent pancreatic cancer in childhood cancer survivors is high, especially after subdiafragmatic radiotherapy and/or chemotherapy with alkylating agents. The survival of patient with advanced pancreatic cancer is very low, and early diagnosis is of vital importance. Case report: We present a female patient, treated for Ewing sarcoma of thoracic wall with multimodal treatment at the age of 5. She received chemotherapy containing a high dose of Cyclophosphamide and postoperative radiotherapy to the left hemithorax with the dose of 15 Gy followed by local boost to the tumour bed. She had regular follow-ups at the Late-effect clinic at the Institute of Oncology in Ljubljana. Well differentiated papillary cancer of thyroid with nodal metastases was diagnosed during a regular neck ultrasound 26 years after the completion of cancer treatment. Two years later, at the age of 33, she presented with abdominal distension, inappetence and diffuse liver metastases with ascites were found by abdominal ultrasound. Tumour marker CA 19-9 was high, but pancreas was morphologically normal on the ultrasound and on abdominal helical CT. Cytological test of ascites and hepatic metastases showed poorly differentiated adenocarcinoma. The disease progressed very fast and she died a month after the appearance of the first symptom. The autopsy revealed poorly differentiated adenocarcinoma of the pancreatic head and body with multiple metastases in abdominal organs and lungs. Conclusion: It would be reasonable to introduce the same guidelines for screening of subsequent pancreatic cancer in childhood cancer survivors at high risk for subsequent pancreas cancer as proposed for patients with increased risk for familial pancreatic cancer.