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Patient Details

Clinic letter (25 weeks ago 16:12)

Clinic letter Mon 13 October 2025 16:12

Last Modified: 25 weeks ago

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Content:

Diagnosis:
Pancreatic cancer (head of pancreas)

Other Medical Diagnoses
• Diabetes mellitus
• Previous pancreatitis (10 years ago)
• Previous cholecystectomy
• Previous pancreatic pseudocyst

Medications:
• Lansoprazole
• **Creon (pancreatic enzyme replacement therapy) - newly prescribed**
• **Ensure nutritional supplements - increased as tolerated**

Investigations:
• CT abdomen and pelvis October 2025: 3-4cm mass in head of pancreas with involvement of superior mesenteric artery and superior mesenteric vein, causing bile duct obstruction. No metastatic spread identified.
• Blood tests: Raised inflammatory markers and mildly elevated bilirubin
• Chest CT: Pending

Plan:
1. CT thorax to exclude pulmonary metastases
2. UGI MDT referral [/]
3. Creon pancreatic enzymes with meals
4. Increase Ensure nutritional supplements as tolerated
5. Analgesia as required
6. Antiemetics as required
7. Family update tomorrow following MDT meeting

Dear GP,

I reviewed Mr Peter Kearney today regarding his recent presentation with weight loss (15-17kg over couple of months), bloating, and post-prandial abdominal pain. He is a retired gentleman who has been previously well apart from pancreatitis and cholecystectomy 10 years ago.

He is fit and active, walking 5 miles without having to stop, taking regular exercise and gardening. He is a retired electrical businessman.

Unfortunately, CT imaging has revealed a 3-4cm mass in the head of pancreas with appearances consistent with pancreatic adenocarcinoma. The mass is causing bile duct obstruction (explaining his mildly elevated bilirubin) and appears to involve the superior mesenteric vessels. There is no evidence of metastatic disease on abdominal imaging.

I have discussed the diagnosis with Mr Kearney, explaining that whilst the appearances are highly suggestive of cancer, tissue confirmation is still required. His case will be discussed at our specialist MDT meeting tomorrow to determine the optimal management approach, including assessment of surgical resectability.

I have commenced him on Creon pancreatic enzyme replacement therapy to address his malabsorption and weight loss, alongside increased nutritional supplementation. We plan CT thorax to complete staging and upper GI endoscopy with tissue sampling.

I will update his family tomorrow following the MDT discussion and provide further information regarding treatment options and prognosis.

Yours sincerely,
Gastroenterology Registrar

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Clinic letter Mon 13 October 2025 16:12

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