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Pancreatic cancer should be treated as a medical emergency

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5261 (Published 04 September 2014) Cite this as: BMJ 2014;349:g5261
  1. J-Matthias Löhr, professor of gastroenterology and hepatology and senior consultant, Karolinska Institutet and Karolinska University Hospital, Gastrocentrum, Stockholm, Sweden
  1. matthias.lohr{at}ki.se

“The greatest oncological challenge” results partly from delays to diagnosis and treatment, writes J-Matthias Löhr

Outcomes for pancreatic cancer are poor, and the following case shows why. A 63 year old man presented to his general practitioner with abdominal pain and weight loss and eventually had diabetes diagnosed. He subsequently developed obstructive jaundice and was admitted to the emergency department of his local hospital on a Friday afternoon. Endoscopic retrograde cholangiopancreatography (ERCP) at the beginning of the next week helped identify a pancreatic tumour.

It took two more weeks to complete high quality imaging and to send the scans to the regional cancer centre for evaluation. At the multidisciplinary team meeting, the tumour was deemed borderline resectable. Because the patient insisted on surgery, pancreatic resection combined with vascular resection and reconstruction was performed six weeks after the patient’s first visit to a physician. The delay was partly because of the holiday season.

Pathological examination confirmed the diagnosis of ductal adenocarcinoma, with microscopic margin involvement and spreading to multiple lymph nodes. The patient recovered well after surgery and started adjuvant chemotherapy six weeks later. Unfortunately, he tolerated gemcitabine poorly and his condition deteriorated. …

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