4th Edition

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?

    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?

    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?

    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

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