A 76-year-old woman with no history other than hypertension consults for painless jaundice and pruritus with anorexia. Laboratory tests show bilirubin of 12 mg/dl (9.5 direct). Ultrasound shows intrahepatic and extrahepatic biliary dilatation together with a single hepatic nodule smaller than 2 cm located peripherally on the anterior aspect of the left lobe. The CT scan confirms these findings also demonstrating the presence of a pancreatic mass of 3.5 cm. In the pancreatic head. The aspiration puncture of the hepatic nodule is conclusive for adenocarcinoma. Indicate the best therapeutic option:
This case does not seem so easy to me. It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5. In principle she is a patient in moderately good general condition, so the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 being the one I consider most correct.
Neoadjuvant chemo/radiotherapy, conditioning the option of radical surgery on initial response.
Percutaneous external biliary drainage with palliative character with eventual reconversion to internal drainage in case of intolerance or complications.
Palliative surgical biliary bypass with or without prophylactic gastrojejunostomy depending on intraoperative findings.
Metallic biliary prosthesis by endoscopic retrograde cholangiopancreatography with the option of palliative chemotherapy.
Cephalic duodenopancreatectomy, with percutaneous ablation by radiofrequency or alcoholization of the hepatic lesion.
It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5.
In principle she is a patient in moderately good general condition, so the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 being the one I consider most correct.
It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5.