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Successful Management of Pancreatic Cancer: A Case Study at Gastrointestinal Cancer Conference

This case study discusses the diagnosis, treatment, and outcome of a 62-year-old female with advanced pancreatic cancer. The patient underwent FOLFIRINOX therapy followed by Whipple’s procedure resulting in near-complete response and excellent prognosis with no evidence of disease after 7 months.

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Successful Management of Pancreatic Cancer: A Case Study at Gastrointestinal Cancer Conference

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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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