P-0110 - Profile of Carcinoma head of pancreas presenting with extrahepatic biliary obstruction in Indian population

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Pancreatic Cancer
Pathology/Molecular Biology
Presenter Richa Sharma
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors R. Sharma1, V. sharma2, M. Goyal2
  • 1National Cancer Control Programme, Jaipur/IN
  • 2Soni Manipal Hospital, Manipal Group of Hospitals, Jaipur/IN

Abstract

Introduction

Carcinoma head of Pancreas (CAHOP) presenting with extrahepatic biliary obstruction (EHBO) is a common condition presenting to oncologist. There is scant data of profile of theses patients from Indian population.

Methods

Retrospectively our data was collected and analyzed, from January of 2009 to 2013 end. Patients presenting with jaundice and suggestion of carcinoma head of pancreas were investigated. Diagnosis was based on imaging with cytological confirmation. Demographic, clinical, imaging, laboratory details were analyzed.

Results

Total number of patients was n = 190. Median age of patients was 60 (range 25-86 years), 45 (24%) of the patients were female and 144 (76%) were male. Among these 78 (41%) were nonvegetarians, 103 (54%) were smokers, 34 (18%) were alcoholics, 6 patients (3%) HBsAg positive. We found associated problems like diabetes in 47 (25%), gall stones in 32 (17%), chronic pancreatitis in 12 (6%) and post cholecystectomy status in 19 (10%) of patients. Presenting symptoms were cholestatic jaundice in 182 (96%) patients, median duration of Jaundice was 30 days (range 7 -270), Pain right hypochondrium in 117 (62%) patients for median duration of 28 days (range 6-270), pruritus in 146 patients (76%) for median duration of 33 days (range 7-270) and fever in 78 (41%). Other complaints were anorexia 146 (77%) patients, weight loss in 152 (80%), lump abdomen in 5 (2.5%), history suggestive of gastric outlet obstruction was present in 17 (9%) and gastrointestinal bleed in 15 (8%) of patients. On examination icterus was present in 182 (95%), hepatomegaly in 146 (77%), palpable gallbladder in 95 (50%), lump abdomen in 36 (19%), ascites in 19 (10%), succusion splash 5 (3%), supraclavicular lymph node in 3 (1.5%) of patients. Median serum bilirubin was 8.5 (range 1.9-38 mg/dl), alkaline phosphatase 678 (66-3244 iu/l), raised SGPT (more than 2 times) in 95 (56%) (median 88, range 10-657 iu/ml), Albumin 3.1 (range 1.2-4.6 gm/dl). Renal failure was present in 23 (12%) patients with median creatinine 0.9 (range 0.5-8,8 mg/dl). Coagulopathy (INR >1.2) in 20 (10%), type 1 biliary block in 168 (90%), type 2 in 17 (6%), type 3 & 4 block in 5 (4%) patients. Liver infiltration noted in 9 (4%), distant metastasis in 43 (23%) and ascites in 20 (11%) patients. Lymphadenopathy notes in 79 (41%), stage N1 30 (16% of total, 38% of nodal metastasis), N2 49 (26% total, 62% of nodal mets), duodenal infiltration 55 (29%) and major vessel invasion noted in 30 (16%) of patients. American joint committee for cancer stage 1 in 15 ((%), stage 2 in 49 (26%), stage 3 in 45 (24%) and AJCC stage 4 in 80 (42%) of patients. Only 62 (33%) of patients referred for surgery, rest of the patients underwent palliative biliary / duodenal stenting or declined any treatment.

Conclusion

CAHOP in increasing in Indian population mostly related to changing life style and smoking. Most patients present in advanced stage with nodal metastasis, liver metastasis and duodenal infiltration, most likely due to illiteracy, delayed seeking of medical care, traditional medicine for jaundice etc.