Management options and prognosis of pancreatic adenocarcinoma at 16 weeks' gestation: a case report.

BACKGROUND: Antepartum diagnosis of pancreatic adenocarcinoma is extremely rare, with only 9 cases previously reported in the literature. We report on such a case and review the literature for management options and prognosis of this unfortunate condition. CASE: A 33-year-old woman, gravida 1, para 0, was referred at 16 weeks' gestation due to weakness, weight loss and anemia. Comprehensive investigation followed and a final diagnosis of pancreatic adenocarcinoma was made after pancreatic fine needle aspiration biopsy during endoscopic ultrasound of the upper abdomen. At 19 weeks' gestation fetal demise occurred. CONCLUSION: While early diagnosis may not alter long-term outcome, it may provide the patient with an earlier opportunity to evaluate decisions related to pregnancy. The two most important factors determining management options for pancreatic cancer during pregnancy are disease stage and gestational age. Prognosis is extremely poor, with 5-year survival after surgery being 20% versus 3-5% in unresectable disease. Prognosis depends on disease stage and on the interval between diagnosis and surgery. Delay for even one month may render the disease metastatic. Participation of a multidisciplinary team is critical in the management of such cases since, due to the rarity of the disease during pregnancy, there are no evidence-based data to guide decisionmaking.