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Background This study was undertaken to delineate the most predictive pattern at presentation for patients with non-metastatic pancreatic cancer compared to patients with metastatic pancreatic cancer who present to a medium sized hospital. Methods Data were collected at a medium sized hospital from 2009-2014 for patients with newly diagnosed pancreatic adenocarcinoma. Laboratory values, CT scans, pathology reports and ERCP results were obtained. Data are presented as mean (median +/- standard deviation). Results Fifty-two patients met the criteria for inclusion and were clinically diagnosed with pancreatic cancer. The median age was 71 years old. CEA levels for metastatic pancreatic cancer were 107.9 (20.6 +/- 166.7) ng/dl and 9 (6 +/- 11.6) ng/dl for non-metastatic cancer (P-value<0.05). Bilirubin levels for metastatic pancreatic cancer were 4.1 (0.7 +/- 6.6) mg/dl and 10.3 (10.4 +/- 8.1) mg/dl for non-metastatic cancer (p=0.009). CA19-9 levels for metastatic pancreatic cancer were 37,529 (644 +/- 88,352) U/ml and 5,150 (668 +/- 16,985) U/ml for non-metastatic cancer. Conclusion Elevated total bilirubin alongside low CEA appears to be a stronger predictor of non-metastatic disease at presentation compared to CA 19-9 alone.
Pancreatic adenocarcinoma is one of the leading causes of cancer-related death in the United States. Rarely, a tumor at the head of the pancreas can invade adjacent structures to cause a gastrointestinal bleed (GIB). We present a 78-year-old female whose massive upper GIB was the initial presentation of metastatic pancreatic adenocarcinoma. Prior reports have documented GIB in patients with known pancreatic cancer, but in our case, the diagnosis was made after the bleed was controlled, making this presentation rare and associated with a poor prognosis.