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Q2. Correct Answer: A
Rationale:
In a patient with chronic pancreatitis and a pancreatic mass, the most likely etiology is adenocarcinoma. This patient has radiologically resectable pancreas cancer. There is no evidence of lymphadenopathy or vascular invasion. Performing an ERCP with stent placement to relieve biliary obstruction has not been shown to be of benefit in patients with a resectable pancreatic mass. In fact, surgical outcomes are worse if a stent is placed in the bile duct. Surgical consultation should be obtained and the patient should undergo pancreaticoduodenectomy. EUS is sometimes done, but most cases of resectable disease should go straight to surgery.
Reference
Ghaneh P, et al. Biology and management of pancreatic cancer. Gut 2007;56(8)1134-52.
ginews@gastro.org
Q2. Correct Answer: A
Rationale:
In a patient with chronic pancreatitis and a pancreatic mass, the most likely etiology is adenocarcinoma. This patient has radiologically resectable pancreas cancer. There is no evidence of lymphadenopathy or vascular invasion. Performing an ERCP with stent placement to relieve biliary obstruction has not been shown to be of benefit in patients with a resectable pancreatic mass. In fact, surgical outcomes are worse if a stent is placed in the bile duct. Surgical consultation should be obtained and the patient should undergo pancreaticoduodenectomy. EUS is sometimes done, but most cases of resectable disease should go straight to surgery.
Reference
Ghaneh P, et al. Biology and management of pancreatic cancer. Gut 2007;56(8)1134-52.
ginews@gastro.org
Q2. Correct Answer: A
Rationale:
In a patient with chronic pancreatitis and a pancreatic mass, the most likely etiology is adenocarcinoma. This patient has radiologically resectable pancreas cancer. There is no evidence of lymphadenopathy or vascular invasion. Performing an ERCP with stent placement to relieve biliary obstruction has not been shown to be of benefit in patients with a resectable pancreatic mass. In fact, surgical outcomes are worse if a stent is placed in the bile duct. Surgical consultation should be obtained and the patient should undergo pancreaticoduodenectomy. EUS is sometimes done, but most cases of resectable disease should go straight to surgery.
Reference
Ghaneh P, et al. Biology and management of pancreatic cancer. Gut 2007;56(8)1134-52.
ginews@gastro.org
Q2. A 56-year-old male with known chronic pancreatitis presents with progressive abdominal pain, weight loss, and obstructive jaundice and a bilirubin of eight. A CT scan with contrast reveals a 4-cm mass in the pancreas head. There is no lymphadenopathy and vascular architecture is maintained.