Connecting the Patient to Specialists

ICAN Program Services are customized for each cancer patient. Here, ICAN has arranged an appointment between the patient's surgeon and another pancreas surgeon to discuss the case and the proposed surgery. ICAN staff prepared this fax to brief the surgeon on the case. The reason for the phone call between surgeons is to give the patient a higher comfort level about the prospect of facing one of the most major surgeries one can have – "the Whipple" – a pancreaticoduodenectomy, a life-extending and potentially life-saving surgery in the battle against pancreatic cancer.

For Dr. ________________________

Telephone Appointment with Dr. __________________________ of ____________________________

Thursday, _________, perhaps between 4:30 and 5:00 pm ________________ (specific time will be confirmed

with _____________on Thursday morning)

_____________________________________, Summary of Case

Patient is a 49-year old female, with no known risk factors for pancreatic carcinoma. Lab studies confirmed 5 episodes of pancreatitis which occurred 6 months after patient's cholecystectomy. An ERCP removed a CBD stone after sphincterotomy. Patient has experienced abdominal pain during these 5 episodes of pancreatitis; weight loss over the last two months of 15 pounds; malabsorption of fat and anorexia (and aversion to eating fat because of worry of consequent pain); no jaundice or pruritus. Patient has been pain-free for the last two weeks although continues to experience persistent abdominal tenderness as well as a persistent gnawing/radiating sensation. 

  • Patient's second ERCP found:
    • 1.3 cm very tight pancreatic duct stricture in the head of the pancreas with upstream dilation proximal to the stricture. The pancreatic duct was brushed.
    • The main pancreatic duct is dilated at 7 mm and the MPD is dilated from the stricture all the way out to the head of the tail.
    • The post-cholecystectomy CBD is 9 mm. Brushings of distal CBD taken as well. Intrahepatic dilation noted. No evidence of filling defects.
  • Biopsies during ERCP taken of ampulla status post-sphincterotomy.
  • Pathology report on ERCP biopsies: are attached.
  • CT scan showed pancreatic atrophy in body and tail; dilated main pancreatic duct; no mass observed, no enlarged head.
  • Pre-operative Labs are normal, except ALP is 170. CA 19-9 was 39.
  • Patient is scheduled on __________________________ for a transduodenal ampullectomy followed by a Whipple depending upon results of intraoperative frozen sections.

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