# Pancreatic Mass
-- ABCs: assess for life-threatening disease such as PE/DVT or sepsis/cholangitis
-- HPI Intake: smoking, EtoH use, poor appetite, weight loss, RUQ pain, pale stool, dark urine, FHx cancer
-- Admission Orders: CTAP with IV contrast, CBC, BMP, LFTs, lipase, CA 19-9, CEA
-- History: *** smoking, EtoH use, diabetes, chronic pancreatitis
-- Clinical: *** poor appetite, weight loss, RUQ/epigastric pain, pale stool, dark urine
-- Exam: *** jaundice, cachexia, ascites, distention, LE edema, Courvoisier Sign, Trousseau Syndrome
-- Data: *** LFTs, lipase, CA 19-9, CEA, CTAP
-- Etiology/DDx: *** adenocarcinoma, neuroendocrine tumor, IPMN, pseudocyst, metastasis
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- f/u CBC, BMP, LFTs, lipase, CA 19-9, CEA
-- Imaging: *** CTAP with IV contrast vs RUQUS → MRI/MRCP to further characterize; CT chest to stage if ultimately cancer
-- Biopsy: *** GI vs IR for EUS, ERCP, or biopsy of metastasis
-- Pancreatic Adenocarcinoma: in outpatient setting - Resectable - surgery (Whipple) and systemic therapy with FOLFIRINOX; Locally Advanced - FOLFIRINOX or SBRT; Metastatic - FOLFIRINOX; olaparib for BRCA; MSI-H - pembrolizumab
-- Palliative: *** (pain, N/V, mood, etc)
-- Stenting with GI via ERCP for malignat obstruction
-- Consult Oncology to assist with guidance and arranging follow up
-- Consider an early palliative consult
-- Consider nutrition consult for counseling and supplementation
PDF coming soon!
When patients present with a new pancreatic mass, it is most often a pancreatic adenocarcinoma. More than half of of patients present with metastatic disease. You need to get tissue and stage the tumor before arranging for follow up in the outpatient setting. These patients are at increased risk of biliary obstruction (and thus cholangitis), and clotting.