Signs And Symptoms Of Pancreatic Cancer

Pancreatic cancer is the common and highly fatal with an overall 5-year survival rate of less than 5%. Even with advanced imaging technologies, detecting a pancreatic tumor measuring less than 10 mm is difficult. In some cases, the tumor in the pancreas is inconspicuous and indicated by extensive peri-pancreatic artery invasion.

A 66-year-old man was referred to our hospital for evaluation of an elevated serum carbohydrate antigen 19-9 (CA19-9) level (130.9 U/mL, normal: <37 U/mL). His physical examination showed normal condition, with all other laboratory tests within normal range. Enhanced computed tomography (CT) revealed no abnormalities in the pancreas, but soft-tissue density in the region surrounding the celiac axis and superior mesenteric artery (SMA) was present. On subsequent endoscopic ultrasound (EUS) examination, the softtissue density surrounding the peri-pancreatic arteries was not clearly visualized except for that of the celiac trunks. CT scans performed at 2 months and 5 months revealed no abnormalities in the pancreas and no changes in the soft tissue surrounding the celiac axis and SMA. In addition, the serum CA19-9 level remained stable. Abdominal CT performed at 8 months revealed no marked changes in the soft-tissue density; however, mild dilation of the main pancreatic duct in the tail of the pancreas and a low-density area measuring 10 mm in the body of the pancreas were visualized. EUS also revealed a low-echoic mass measuring 10 mm in the pancreatic body. Subsequent EUS-guided fine needle aspiration (EUS-FNA) was performed for the pancreatic mass, and the histopathological diagnosis was ductal adenocarcinoma. There were no metastasis diseases, however we thought the tumor had directly invaded the celiac axis and SMA. According to the above, we diagnosed it as an unresectable locally advanced pancreatic cancer (T4aN0M0). Then chemotherapy was prescribed, resulting in reduction of the tumor size and shrinkage of the soft-tissue density. In addition, serum CA19-9 levels were followed and have remained relatively stable with time. The patient has survived more than two years.