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

Abstract

Background Pancreatic cancers of the tail have an especially poor prognosis due to their late detection. 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 owing to their higher incidence. Thus, we add our case report to the current literature of pancreatic tail cancers in the hope of aiding earlier detection. We present an interesting case of a patient who initially presented with innocuous abdominal pain and a single episode of vomiting who was subsequently diagnosed with metastatic pancreatic tail cancer. Case presentation A 56-year-old Hispanic man with a past medical history of alcohol and cocaine abuse was initially evaluated in our clinic after presenting to the emergency department with sudden onset of abdominal pain and one episode of emesis. On further questioning, he stated that he had been experiencing dull, intermittent left back pain for the past 2–3 years. Laboratory tests were performed, which showed that the patient had new-onset diabetes, and imaging revealed a pancreatic tail mass with metastases to the liver. Biopsy confirmed the diagnosis of stage IV metastatic pancreatic tail adenocarcinoma. During follow-up 1 month later, the patient reported that he had been largely asymptomatic since his hospital admission; however, his left back pain had increased in severity. He was then started on a FOLFIRINOX chemotherapy regimen (5-fluorouracil/leucovorin, irinotecan, and oxaliplatin). Conclusions There are many pitfalls in the diagnosis of pancreatic cancer, especially pancreatic tail cancer due to its vague symptoms. Thus, pancreatic cancer of the tail often presents late with a very poor prognosis. Because there is currently no widespread screening for pancreatic cancer, it is often difficult for practitioners to identify pancreatic tail cancers. Current research suggests that there is a strong association between new-onset diabetes after the age of 50 and pancreatic cancer, and tumors detected at the onset of diabetes are favorable to resection. Pancreatic cancer has also been shown to be associated with certain risk factors, such as smoking, high body mass index, chronic pancreatitis, and a family history of pancreatic cancer. Thus, when patients with presentations similar to our patient’s with new-onset diabetes after the age of 50, along with vague symptoms such as back or abdominal pain as well as the presence of risk factors, we suggest that it is beneficial for practitioners to maintain a high index of suspicion for pancreatic cancer.

Carcinoma of Tail of Pancreas: A Case Report

“…Pancreatic carcinomas originating from the tail, on the other hand, are less prevalent and generally appear later, with stomach discomfort, back discomfort, and physically thinner. Pancreatic carcinoma of the tail is frequently undetected or incorrect diagnosis, and as a result has a greater death risk due to its late appearance [2,3].…”

“…Because it is often asymptomatic in the early stages, pancreatic cancer is known as the "silent" ailment. When symptoms do arise, they are often vague and vary depending on the tumor location [2]. Around 75% of all pancreatic carcinomas are found in the head, 15%-20% in the body, and 5%-10% in the tail [3].…”

A Diagnostic Dilemma of Pancreatic Adenocarcinoma: The Duct Cut-off Sign

“…Pancreatic cancer has a mortality rate as high as 98% [1][2][3]. 75% of pancreatic adenocarcinomas occur at the head and neck, 15-20% occur in the body of the pancreas, and 5-10% arise in the tail [4,5].…”

Initial Cutaneous Metastases of Pancreatic Cancer without Evidence of Pancreatic Mass

“…Pancreatic cancer mainly affects individuals residing in the Western/industrialized parts of the world; the highest incidence is reported in high-income North America, Asia Pacific, and Western and Central Europe, while people living in South Asia and eastern and central Sub-Saharan Africa have the lowest reported incidence [1]. Major risk factors for pancreatic cancer are new-onset diabetes after 50, smoking, high body mass index, chronic pancreatitis, and a family history of pancreatic cancer [2].…”