(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient is an elderly male who was treated at an outside hospital for abdominal pain and other uncomfortable symptoms, but with average efficacy, so he came to our hospital and was diagnosed with pancreatic cancer after completing relevant examinations.
Basic information】Male, 63 years old
Disease Type】Pancreatic cancer
Hospital】The First Hospital of China Medical University
Date of consultation】January 2022
Treatment plan】Injectable drugs (injectable gemcitabine hydrochloride, paclitaxel injection) + oral drugs (omeprazole magnesium enteric tablets) + topical drugs (granisetron transdermal patch)
Treatment period】Continuous intermittent treatment
Treatment effect] The disease was initially controlled.
I. Initial consultation
The patient is male, 63 years old. He complained of intermittent epigastric pain for more than 2 months, accompanied by acid reflux, heartburn, and mild abdominal distension, and had undergone gastroscopy in a foreign hospital, which indicated ulcer in the duodenal bulb and chronic gastritis with erosion. The physical examination showed that there was pressure pain in the abdomen without rebound pain, and the five tests of alpha-fetoprotein, carcinoembryonic antigen and coagulation routine, as well as the CT scan of the lower abdomen were normal.
II. Treatment history
After the patient was admitted to the hospital, the gastroscopy suggested the presence of chronic non-atrophic gastric sinusitis with erosion, and the patient was treated with omeprazole magnesium enteric solution tablets. The imaging findings suggested pancreatic changes and retroperitoneal lamellar hyperdensity with possible regional portal hypertension, so an enhanced 3D dynamic CT thin-section scan of the liver, gallbladder, pancreas and spleen was performed, suggesting pancreatic and retroperitoneal lesions with lesions encircling the abdominal trunk, splenic artery and splenic vein, and considering pancreatic cancer invading the peripheral vessels. After explaining the patient’s condition to the patient and his family, it was decided to first perform a pancreatic mass puncture biopsy, and the biopsy results suggested pancreatic cancer. According to the patient’s condition and the family’s wish, we decided to give conservative treatment by placing a PICC in the left arm and then administering chemotherapy with injectable gemcitabine hydrochloride and paclitaxel injection to inhibit the growth of tumor cells and shrink the lesion site.
III. Treatment effect
After drug treatment, the patient’s symptoms such as acid reflux, heartburn and mild abdominal distension have improved, and the ulcer surface was reduced on review of gastroscopy; and after 3 months of chemotherapy, the symptoms of abdominal pain, acid reflux and heartburn have improved, and no serious chemotherapy side effects have occurred because the patient used granisetron transdermal patch for antiemetic during chemotherapy. The patient reported that he had no abnormal symptoms and felt good mental status, and at present, chemotherapy is continuing and no deterioration has occurred.
IV. Precautions
After one phase of chemotherapy, the patient’s condition was controlled and her mental outlook improved. At the same time, I reminded the patient that he should keep his left arm clean during the interval of chemotherapy, avoid getting wet dressing when washing face and hair, and do not lift heavy objects with his left arm; in addition, during the home period, the patient can appropriately supplement nutrition, while the patient is older, he can choose some meat with lower fat content, such as fish and chicken breast, and limit the intake of fatty meat and animal offal; in addition, he can eat more fresh vegetables and fruits, which also has a positive effect on the recovery of the disease.
V. Personal insight
When pancreatic cancer starts, there are no special clinical signs, but often symptoms such as upper abdominal discomfort and indigestion, especially in older patients as in this case, they do not have a proper understanding of these discomfort symptoms and do not come to the hospital until the abdominal pain and other discomfort symptoms worsen. Therefore, when abnormal symptoms appear in the abdomen and digestive tract, timely consultation should be made and targeted treatment measures should be taken to control the development of the disease.