Devita, Hellman, and Rosenberg's Cancer

LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4

244 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 20.2.3. A 56-year-old African American man with a medical history of hyper-

tension and type II diabetes presented to his primary care physician with

a 1-month history of gradually worsening painless jaundice and a 10-lb

weight loss. Computed tomography (CT) scan of the abdomen and pelvis

revealed a 3.3-cm pancreatic head mass adjacent to the superior mesen-

teric vein with no intervening fat plan and encasing both the superior

mesenteric vein and artery. The common bile duct was dilated, with a

diameter of 1.8 cm, and the pancreatic body and tail were atrophied

with dilatation of the pancreatic duct. Portal lymphadenopathy measuring

2 cm was present. The patient underwent endoscopic retrograde cholan-

giopancreatography ERCP, and a biliary stent was placed. Biopsy of the

mass was consistent with moderately differentiated pancreatic adenocar-

cinoma. What is this patient’s stage?

A. Stage I

B. Stage II

C. Stage III

D. Stage IV

Question 20.2.4. A 67-year-old woman presents to her local emergency department with a

2-month history of right upper quadrant pain, jaundice, and 20-lb weight

loss. She has no fever and chills. Standard CT of the abdomen reveals a

2.5-cm, ill-defined soft tissue density within the head of the pancreas

and mild celiac axis, porta hepatis, and porta caval adenopathy, with the

largest being within the celiac axis region measuring 2.0×1.8 cm. Endo-

scopic retrograde cholangiopancreatography is done, and a biliary stent is

placed. Biopsy of the mass reveals poorly differentiated adenocarcinoma.

CA 19-9 is 798. Which of the following should be done next for staging?

A. Multiphase multidetector helical computerized axial tomography

B. Magnetic resonance imaging

C. Ultrasonography

D. Staging laparoscopy

E. Endoscopic ultrasonography

Question 20.2.5. A 71-year-old Hispanic woman undergoes Whipple resection for a T3,

N1, M0 pancreatic adenocarcinoma. Postoperative recovery was unevent-

ful, and she starts adjuvant therapy 7 weeks later with gemcitabine given

intravenously weekly for 2 weeks, followed by a 1-week break. In a

follow-up visit after her first cycle she reports a 5-lb weight loss, nau-

sea, decreased appetite, occasional abdominal cramping, and diarrhea.

What should be done next?

A. Increase pancreatic enzyme supplementation

B. Admit the patient for small bowel obstruction

C. Hold chemotherapy for 1 week and follow up on symptoms

D. CT scan of the chest, abdomen and pelvis to rule out metastatic

disease