A 78-year-old man is evaluated because of shortness of breath of acute onset. The patient reports a 13.6-kg (30-Ib) weight loss, vague upper abdominal discomfort, nausea, loss of appetite, and fatigue. He has hypertension and symptomatic atherosclerotic coronary artery disease despite optimal medical management. Even before the recent episode of dyspnea, his physical activity has been limited; he spends most of the day resting either in bed or in a chair.Laboratory studies: Hemoglobin 10.5 g/dL Serum albumin 2.6 g/dLSerum alanine aminotransferase 65 U/LSerum aspartate aminotransferase 78 U/L CA 19-94500 U/LArterial oxygen saturation 85% by pulse oximetrySpiral CT scan of the chest shows a pulmonary embolism.The patient is hospitalized for anticoagulation and oxygen therapy and gradually improves. Subsequent CT of the abdomen shows a 4-cm mass in the tail of the pancreas and numerous low-attenuation lesions in the liver. CT-guided biopsy of the hepatic lesions and the pancreatic m

Question

A 78-year-old man is evaluated because of shortness of breath of acute onset. The patient reports a 13.6-kg (30-Ib) weight loss, vague upper abdominal discomfort, nausea, loss of appetite, and fatigue. He has hypertension and symptomatic atherosclerotic coronary artery disease despite optimal medical management. Even before the recent episode of dyspnea, his physical activity has been limited; he spends most of the day resting either in bed or in a chair.Laboratory studies: Hemoglobin 10.5 g/dL Serum albumin 2.6 g/dLSerum alanine aminotransferase 65 U/LSerum aspartate aminotransferase 78 U/L CA 19-94500 U/LArterial oxygen saturation 85% by pulse oximetrySpiral CT scan of the chest shows a pulmonary embolism.The patient is hospitalized for anticoagulation and oxygen therapy and gradually improves. Subsequent CT of the abdomen shows a 4-cm mass in the tail of the pancreas and numerous low-attenuation lesions in the liver. CT-guided biopsy of the hepatic lesions and the pancreatic m

Quizplus · Accepted Answer

The patient's presentation with significant weight loss, anorexia, fatigue, and a markedly elevated CA 19-9 level, along with imaging showing a pancreatic mass and liver lesions, is highly suggestive of advanced pancreatic cancer. Given his age, comorbidities, and the advanced stage of the disease, best supportive care and referral to hospice are the most appropriate management options to focus on quality of life.

A 78-Year-Old Man Is Evaluated Because of Shortness of Breath