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Pancreatic C ancer Case D iscussion

Pancreatic C ancer Case D iscussion. Burçak Erkol, MD Koç University Medical Faculty / Medical Oncology 8th International Gastrointestinal Cancer Conference 09.12.2018. 62 years old female a dmitted to hospital with mid-abdominal pain which increased for 1 month , no other symptoms

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Pancreatic C ancer Case D iscussion

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  1. PancreaticCancerCase Discussion Burçak Erkol, MD Koç UniversityMedicalFaculty/MedicalOncology 8th International GastrointestinalCancer Conference 09.12.2018

  2. 62 yearsoldfemaleadmittedtohospitalwithmid-abdominalpainwhichincreasedfor1 month, noothersymptoms • Blood biochemistrywas normal • Blood CA19-9 levelwas 917 • Esophagogastroduodenoscopyrevealed a masswhichinvades 2.nd part of duodenum • Abdomen-thoraxCT, MRI and PET CT showedpancreaticmassandperipancreaticlymphnodeswithsuperiormesentericarteryinvasion

  3. ECOG PS: 0 • No physicalexaminationfindings • Hypothyroidism, Hashimotothyroiditis • Exsmoker (20 pack/peryear ) • Levotiron 100mcg

  4. Therewas a 38x30 mm softtissuemass at theuncinateprocess of pancreaswhichinvadesduodenumand SMA morethen 180 degrees, andtouching SMV 180 degrees Itseemsunresectable at this time

  5. CT showesperipancreatic LAP

  6. Endoscopicultrasoundperformed in August 2017 forbiopsytothe 38x30mm mass at uncinateprocess of pancreas • Pathologicaldiagnosiswasadenocarcinoma of pancreas • ClinicalstageT4N+M0 - III pancreascancer • At GI oncology board wedecidedtogive FOLFIRINOX forthediseaseof thepatient

  7. Thetherapywaswelltoleratedexceptgrade I neutropenia, andgrade I peripheralsensoryneuropathy • After 3 months, 6 cycles of FOLFIRINOX therapy, wediscussthepatient at the GI oncology board again • Her CA19-9 was 33

  8. Thediseasewasstable After 6 cycles -3 months-of FOLFIRINOX wedecidedtocontinuechemo. andadd radiotherapy Borderlineresectable?

  9. After 12 cycles of FOLFIRINOX andfivedays of radiotherapy (5x5 Gy)patient has operatedwithWhipple’sprocedure

  10. Pathologicexaminationrevealedthat • Adenocarcinomagrade I, therewasnomacroscopicmassidentified • Thewidth of regressedtumourwasmesured 1.5 cm in thelargestsection. Therewere 3 carcinomatubule, and 2-3 isolatedcancercells • Therewasacellulermusinallovertheduodenalmuscularispropriaandretroperitonealsurgicalborder

  11. Therewasnolymphatic, perineuralorvenousinvasion • Therewere <%1 alivetumourcells • Mandardgrade II (isolatedtumourcells) • CAP classification: Nearcompleteresponse • No surgicalborderinvasion • No lymphnodeinvolvement LN 49/0, yPT1aN0M0

  12. Wedecidedtomakeactivesurvillance • At December 2018, 7 monthsaftersurgeryshe has stillnolocaleormetastaticevidence of thedisease

  13. Thankyouforyourattention

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