Chapter 10: Once a surgeon, always a surgeon

A retired consultant general surgeon presented with back pain, weight loss and fatigue. He found his old houseman at the hospital who was now a consultant anaesthetist and persuaded him to arrange an abdominal CT scan for him.

• 1. What does the CT scan show?

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  Correct answer:
  The CT scan revealed a pancreatic tail cancer with multiple liver metastases.
  

He had a CT-guided liver biopsy that confirmed the diagnosis of metastatic adenocarcinoma compatible with a pancreatic primary.

• 2. How do exocrine cancers of the pancreas commonly present?

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  Correct answer:
  

  • Pain (epigastric or back)
  • Weight loss
  • Anorexia
  • Fatigue
  • Obstructive jaundice (tumours of the head of the pancreas)
  • Superficial venous thrombosis (Trousseau’s sign)

Like many surgeons, he thought that the only way to treat cancer was with a scalpel and politely declined the palliative gemcitabine and capecitabine chemotherapy that an oncologist offered him.

• 3. What are the pros and cons of palliative chemotherapy?

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  Correct answer:
  

  • Effect on quality of life
  • Effect on progression-free and overall survival duration
  • Toxicity of chemotherapy
  • Time spent at hospital to receive chemotherapy
  • Cost of chemotherapy