Pancreatic Tail Cancer with Sole Manifestation of Left Flank Pain: A Very Rare Presentation

Abstract

Pancreatic cancer is sometimes called a "silent disease" because it often causes no symptoms in the early stage. The symptoms can be quite vague and various depending on the location of cancer in the pancreas. The anatomic site distribution is 78% in the head of the pancreas, 11% in the body, and 11% in the tail. Pancreatic cancer is rarely detected in the early stage, and it is very uncommon to diagnose pancreatic tail cancer during an emergency department visit. The manifestation of pancreatic tail cancer as left flank pain is very rare and has seldom been identified in the literature. We present a case of pancreatic tail cancer with the sole manifestation of dull left flank pain. Having negative findings on an ultrasound study initially, this female patient was misdiagnosed as having possible acute gastritis, urolithiasis or muscle strain after she received gastroendoscopy and colonofiberscopy. Her symptoms persisted for several months and she visited our emergency department due to an acute exacerbation of a persistent dull pain in the left flank area. Radiographic evaluation with computed tomography was performed, and pancreatic tail tumor with multiple metastases was found unexpectedly. We review the literature and discuss this rare presentation of pancreatic tail cancer.

Management of primary squamous cell carcinoma of the pancreas with a nanosomal paclitaxel lipid suspension-based regimen: A case report

“…The symptoms can vary depending upon the anatomic location of the tumor. The head of the pancreas (78%) is most commonly affected, followed by the body (11%) and tail (11%) (3). Cancers of the pancreatic head are located near the common bile duct, may cause jaundice even if they are small, and can be diagnosed at an early stage.…”

“…Pancreatic cancer is a highly lethal malignancy with short-term survival rates (1) and is associated with a high mortality rate that closely parallels its incidence (2). It is generally considered as a ‘silent disease’ (3) as there are no signs and symptoms in its early stages, and is generally diagnosed at an advanced stage (2,3). The number of new cases of pancreatic cancer were 12.6 per 100,000 men and women per year according to the National Cancer Institute Surveillance, Epidemiology, and End Results Program (NCI SEER) data from 2011–2015 (4).…”

The seemingly innocuous presentation of metastatic pancreatic tail cancer: a case report

“…In contrast, pancreatic carcinomas arising from the tail are less common and present later, usually with abdominal pain, back pain, and weight loss. Pancreatic cancer of the tail is often undiagnosed or misdiagnosed and thus is associated with a higher mortality rate due to its frequent late presentation [3, 4, 7, 8]. An earlier diagnosis depends on a better understanding of the clinical course of the disease; however, much of the current literature focuses on pancreatic head adenocarcinomas due to their higher incidence.…”

“…Pancreatic cancer is sometimes referred to as the “silent” disease because it is often asymptomatic at early stages. When symptoms do occur, they are often vague, and they vary depending on the location of the tumor [3].…”

“…Tumors arising in the body and tail tend to present later, often with infiltration of adjacent organs or metastatic disease on presentation, and thus are associated with poorer survival rates than head lesions [6–8]. In the earlier stages, pancreatic tail cancer is often undiagnosed or misdiagnosed during emergency department visits due to its vague symptoms [3]. In this case report, we describe a patient with pancreatic tail adenocarcinoma who presented with mild clinical symptoms, despite imaging revealing advanced metastatic disease.…”