DOI: 10.1097/MPA.0b013e3181fe4031
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PMID: 21311315
Issn Print: 0885-3177
Publication Date: 2011/03/01
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Excerpt
Pancreatic cancer is the fifth leading cause of cancer death in Japan. Despite recent advances in cures for cancers, pancreatic cancer is still one of the most intractable carcinomas because of its high-grade malignancy. To decrease the mortality rate by pancreatic cancers, the development of an efficient screening strategy for early pancreatic cancer detection is necesary.1 However, it remains unclear whether the development of such a strategy to decrease the mortality of pancreatic cancer is feasible. Here, we report a case of advanced-stage pancreatic cancer with multiple remote metastases to the liver and bones at the time of initial diagnosis. The cancer was observed over the course of 5 months by multidetector row contrast medium-enhanced computed tomography (MDCT).
A 65-year-old man visited Nagoya University Hospital complaining about pain in the upper abdomen and the left leg for 2 days. He had been visiting the hospital every 6 months for a regular medical checkup for a cyst in the body of the pancreas 1 cm in diameter. The cyst was diagnosed as due to the branched type intraductal papillary mucinous neoplasm. The size of the cyst was mostly unchanged for the last 5 years (Fig. 1A). Five months later, after the regular examination by MDCT, he was admitted to our hospital. On admission, his blood analysis showed elevated serum pancreatic enzymes and a high C-reactive protein level. Abdominal MDCT showed a 2-cm diameter low-density mass in the body of the pancreas (Fig. 1B). The main pancreatic duct was obstructed by the mass, and the tail of the pancreas was swollen because of obstructive acute pancreatitis. Multiple low-density masses were seen in the liver. Positron emission tomography with CT (PET-CT) was performed to find the cause of pain in his left leg. The PET-CT identified the presence of multiple bone metastases including in his left hip bone (Figs. 1C, D). His condition was diagnosed as pancreatic cancer with multiple liver and bone metastases and has been under chemotherapy with gemcitabine thereafter.
Most pancreatic cancers are unresectable at the time of diagnosis. Gemcitabine chemotherapy is administered to patients with pancreatic cancer with the expectation of extending the median survival time and palliation of cancer-related symptoms. Pancreatic cancers cannot be cured by chemotherapy even with a case that responds well to gemcitabine. Much effort has been exerted to establish effective screening methods to find surgically curable tumors in their early stages to improve the prognosis of pancreatic cancer. However, there is currently no screening strategy by which resectable pancreatic cancers can efficiently be found.
Chronic pancreatitis3 or intraductal papillary mucinous neoplasm4 is known to be at increased risk for developing pancreatic cancer. Therefore, regular medical checkups for screening for malignancies are recommended. In this patient, MDCT at 6-month intervals has been continued for the past 5 years as a screening for pancreatic malignancy; however, he developed pancreatic cancer with multiple liver and bone metastases within 5 months after a complete examination by MDCT with negative results. We speculate that complete examinations at 3-month intervals were needed to find the tumors in their early stages in this patient. However, such a screening interval is not practical.
Pancreatic cancer progresses rapidly, and the prognosis of patients is usually poor. Because most pancreatic cancers show rapid progression, an early detection of pancreatic tumors seems to be difficult. A hope for developing an effective screening strategy for the early detection of pancreatic cancer may require reconsideration.
