Pancreatic Cancer Tumor Board Janet Ely, MSN, FNP, AOCNP, APCHN - - PDF document

3/19/2018 1

Pancreatic Cancer Tumor Board

Janet Ely, MSN, FNP, AOCNP, APCHN Diane Koeller, MS, MPH, LCG Jennifer May, RD, CD Nicole Messier, BSN, RN, OCN, ONN‐CG

• Fred (74); presented to PCP with jaundice, bilirubin 8.6
• 4/20/16‐CT abdomen; 3.6 cm pancreatic head mass with biliary

ductal dilatation

• 4/22/16‐EUS/ERCP; pancreatic head mass abutting portal vein but no
• bvious vascular invasion, stent placed. Biopsy confirms pancreatic

ductal adeno ca

• Referral to UGI MDC
• Chest CT; no metastatic disease
• 4/25/16‐case reviewed at UGI tumor board w/recommendation for

neoadjuvant chemotherapy x 4 cycles, oncology consult 4/28

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• 5/9/18 FOLFIRINOX initiated
• C1 & 2‐nausea, abdominal pain, diarrhea, anorexia and fatigue
• Referral to dietician
• Palliative care referral
• C3 & C4‐tx changed to FOLFOX
• 7/8/16‐CT c/a‐decrease in size of pancreatic head mass to 2.4 cm, no
• bvious vascular involvement or metastatic disease
• 7/25/16‐surgical consult; plan for Whipple after cycle 6
• 8/30/16‐Whipple; ypT2ypN1 (1/17 LNs, margins negative)
• Review at UGI tumor board; 2 additional cycles FOLFOX to complete total
• f 4 months of systemic therapy
• Completes chemotherapy on 11/3/17
• 2/16/17‐CT c/a; no evidence of recurrence
• Oncology f/u; feeling well, no issues
• Ca 19‐9 522 (147 on 12/15, 61 on 10/18)
• 4/20/17‐Ca 19‐9 928
• 5/1/17 CT c/a‐2 new liver lesions c/w metastatic disease
• Oncology f/u‐chemotherapy recommended
• 5/11/17‐Gemzar initiated
• 6/1/17‐Ca 19‐9 675, tolerating chemo well w/o toxicity

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• 8/3/17‐Ca 19‐9 997, bilirubin 1.4
• 8/8/17‐CT c/a‐liver lesions stable, new soft tissue mass at surgical site

resulting in biliary ductal dilatation suspicious for local recurrence

• 8/18/17‐PTC placement, CBD brushings highly suspicious for malignant

cells

• 9/7/17‐oncology f/u; feeling better, jaundice resolved. Gemzar re‐started
• Reviewed at UGI tumor board; recommendation for consideration of

palliative radiation to help reduce risk of local recurrence causing future

• bstruction
• 9/29/17‐radiation oncology consult; palliative radiation offered, pt declined
• Systemic treatment continued
• 11/9/17‐Gemzar given; pt feeling well, active
• 12/23/17‐to ED w/fever, blood cultures + for Klebsiella pneumonia,

admitted

• CT a/p‐cholangitis, progression of local recurrence and metastatic

disease in liver

• Pt chose to d/c home for holiday; decision made to transition to

hospice

• Passed away 2/9/18 at Vermont Respite House