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Case #1

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Expand Physical Exam

01/18/XX

54-year-old man with 2 weeks of dark urine was treated for UTI but symptoms persisted. Symptoms progressed over the next 3 months to include epigastric pain, lightening of stool, nausea and vomiting, jaundice and a 15 pound weight loss.

Expand X-Rays & Scans

01/18/XX

Abd CT: 4.2 cm mass in head of pancreas with intra/extrahepatic ductal dilatation. Appears to abut SMV. Markedly dilated gallbladder. IVC negative. Numerous mesenteric/retroperitoneal and para-aortic nodes. Adrenals/bone windows negative. Impression: mass compatible with pancreatic malignancy, nodes suspicious for metastatic disease. Chest X-Ray: Negative.

Expand Scopes

01/20/XX

ERCP: stent placement for common bile duct stricture, biopsy of periampullary duodenum.

Expand Laboratory

01/20/XX

Total bilirubin 11. Elevated ALT 746 AST 268 Alk Phos 245.

Expand Operative Findings

01/30/XX

Diagnostic laparoscopy, partial pancreatico-duodenectomy, insertion of jejunostomy tube: No ascites, peritoneal disease or liver nodules.

Expand Pathological Reports

01/20/XX

Biopsy, periampullary duodenum: adenocarcinoma.

01/30/XX

Pancreas: invasive adenocarcinoma, 4.8 cm diameter, well differentiated, invading into submucosa of adjacent duodenum but not involving margins. Eleven regional lymph nodes negative for malignancy. Gallbladder, bile duct margins and mesenteric fat negative.

Expand Treatment

01/30/XX

Surgery: Pancreatico-duodenectomy

03/02/XX

Chemotherapy: Started Chemo: 5-FU

03/03/XX

Radiation: 4500 cGy IMRT, with boost 540 cGy IMRT in a total of 28 fractions.