scholarly journals Recurrent Strokes as the First Presentation of Occult Pancreatic Cancer; Trousseau Syndrome: A Case Report

2021 ◽  
pp. 1741-1747
Author(s):  
Firas Al Nidawi ◽  
Mohamed Wael Mohamed ◽  
Fatima Taha ◽  
Daher Alarab ◽  
Amr Elsayed M. Hussein
Keyword(s):  
Pancreatic Cancer ◽  
Ischemic Stroke ◽  
Cancer Patients ◽  
Cerebrovascular Disorders ◽  
Whole Body ◽  
Vessel Occlusion ◽  
Positron Emission ◽  
Cardiac Assessment ◽  
Nonbacterial Thrombotic Endocarditis ◽  
Recurrent Strokes

Cerebrovascular disorders (CVDs) are widespread in cancer patients, exacerbating their condition and lowering their prognosis. Approximately 15% of cancer patients have a coexisting CVD. Stroke may occur after the initial cancer diagnosis or before the diagnosis of malignant disease. The underlying causes of stroke in cancer patients are distinct from those in noncancer patients and are related to both cancer itself and the type of treatment. Cardio-embolism, large vessel atherosclerosis, and small vessel occlusion have all been identified as important causes of ischemic stroke, but nonbacterial thrombotic endocarditis has been documented only infrequently. We present a case of a 64-year-old female with recurrent ischemic stroke of unknown cause and involving different arterial territories, who was discovered to have metastatic pancreatic cancer. The initial workup with brain imaging revealed multiple acute/subacute ischemic strokes and a negative cardiac assessment. Accordingly, she underwent a whole-body positron emission tomography-computed tomography which revealed a hypermetabolic mass lesion in the pancreaticoduodenal area. Our case indicates that cancer-associated stroke should be seriously evaluated. It demonstrates the critical nature of contemplating hidden cancer in survivors of ischemic stroke and identifies factors that may necessitate further investigation as part of a comprehensive approach to ischemic stroke, especially embolic stroke of unknown sources.

scholarly journals NCMP-20. A RETROSPECTIVE SINGLE-CENTER EXPERIENCE WITH NONBACTERIAL THROMBOTIC ENDOCARDITIS AND STROKE - OUTCOMES, ANTICOAGULATION STRATEGIES, AND INCORPORATION OF NEXT-GENERATION SEQUENCING DAT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii127-ii127
Author(s):  
Ashley Aaroe ◽  
Kristin Alfaro-Munoz ◽  
Charles Bornstein ◽  
Trey Kell ◽  
Samuel Camp ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Next Generation Sequencing ◽  
Next Generation ◽  
Processing Application ◽  
Medical Diagnoses ◽  
Increased Risk ◽  
Nonbacterial Thrombotic Endocarditis ◽  
Recurrent Strokes ◽  
Stroke Mechanism ◽  
Generation Sequencing

Abstract BACKGROUND Acute ischemic stroke is a common neurologic complication of cancer and contributes to worse prognosis. Hypercoagulable state is an important stroke mechanism in cancer. Nonbacterial thrombotic endocarditis (NBTE) represents an extreme manifestation of such hypercoagulability. Evidence comparing LMHW to unfractionated heparin or direct oral anticoagulants (DOACs) for secondary stroke prevention is lacking in cancer patients. It is also unknown whether certain tumor mutations are associated with increased risk of NBTE. METHODS We reviewed clinical documents at MD Anderson Cancer Center using a RichSearch Natural Language Processing application to search for terms related to marantic endocarditis. Each patient was assessed for documentation of both valvular thickening or vegetations on echocardiogram, and negative blood cultures. Targeted next generation sequencing (NGS) information was interrogated using the PROACTIVE database. RESULTS 100 patient records were reviewed and of these 41 patients were determined to have likely NBTE based on the above criteria. 12 patients had recurrent strokes despite anticoagulation, two of whom had two recurrent strokes despite different anticoagulation strategies (4 strokes through therapeutic dose LMWH, 4 through rivaroxaban, 3 through apixaban, 1 through fondaparinux). The most common primary malignancies were non-small cell lung cancer (n=14) and pancreatic cancer (n=11). NGS data was available for 13 patients, and the most common mutations were KRAS (n=8), TP53 (n=7), EGFR (n=4), and BRAF (n=2) CONCLUSIONS NBTE is an important stroke mechanism in cancer, and the optimal secondary prevention strategy is unknown. These results confirm that NBTE is common in NSCLC and pancreatic cancer. These cancer types commonly harbor mutations such as KRAS, TP53 and EGFR, and work is ongoing to clarify how such mutations might contribute to hypercoagulability. Recurrent stroke is possible with all anticoagulation strategies. Further analysis of outcomes, serum biomarkers (ex. D-dimer), and comorbid medical diagnoses known to confer increased cardiovascular risk is underway.

scholarly journals Effects of oral meal feeding on whole body protein breakdown and protein synthesis in cachectic pancreatic cancer patients

2015 ◽  
Vol 6 (3) ◽  
pp. 212-221 ◽  
Author(s):  
David P.J. van Dijk ◽  
Marcel C.G. van de Poll ◽  
Alastair G.W. Moses ◽  
Thomas Preston ◽  
Steven W.M. Olde Damink ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Protein Synthesis ◽  
Cancer Patients ◽  
Whole Body ◽  
Protein Breakdown ◽  
Body Protein ◽  
Meal Feeding

Fluorodeoxyglucose whole-body positron emission tomography in colorectal cancer patients studied in routine daily practice

1997 ◽  
Vol 40 (10) ◽  
pp. 1195-1204 ◽  
Author(s):  
Juergen Ruhlmann ◽  
Axel Schomburg ◽  
Hans Bender ◽  
Peter Oehr ◽  
Gerda-Marie Robertz-Vaupel ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Positron Emission Tomography ◽  
Cancer Patients ◽  
Daily Practice ◽  
Emission Tomography ◽  
Whole Body ◽  
Positron Emission ◽  
Colorectal Cancer Patients

Impact of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography on Patient Management: First Year’s Experience in a Clinical Center

2001 ◽  
Vol 19 (9) ◽  
pp. 2504-2508 ◽  
Author(s):  
Robert Tucker ◽  
Marc Coel ◽  
Jehoon Ko ◽  
Paul Morris ◽  
George Druger ◽  
...  
Keyword(s):  
Decision Making ◽  
Positron Emission Tomography ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Patient Management ◽  
Emission Tomography ◽  
Whole Body ◽  
First Year ◽  
Positron Emission

PURPOSE: To measure the impact of whole-body fluorodeoxyglucose (FDG) positron emission tomography (PET) on patient management during its first year of use in a community hospital. MATERIALS AND METHODS: First-year FDG-PET impact was determined from 463 referring physicians’ evaluations of their patients’ PET imaging results using two surveys. Survey 1 was given to all physicians referring patients to PET to discover whether PET changed patient management or had decision-making value in the patient’s clinical algorithm. Survey 2 was given to one surgeon and one pulmonologist after therapy to determine how PET affected the surgical, chemotherapeutic, and/or radiotherapeutic treatment for the 53 cancer patients they referred. RESULTS: The 463 responses to survey 1 described 23 different PET indications. Lung (40%), head and neck (18%), and colorectal cancers (11%) were the three leading causes of referral. PET changed patient management/therapy in 45% of all patients referred and had inferential/decision-making value in another 44%. Overall, PET had some type of positive influence in 412 (89%) of the patients. Survey 2 provided a more detailed assessment of 53 referrals from two specialists. PET positively affected surgery in 31 patients (58%), prompted the addition of chemotherapy or radiation therapy in nine patients (17%), and eliminated chemotherapy or radiation therapy in four cases (8%). Overall, PET affected patient management/therapy in 70% of the cases and had some decision-making value in another 26%, for a combined PET impact on patient management of 96%. CONCLUSION: FDG-PET can be valuable for physicians in clinical practice. Its sensitivity and specificity in metabolic imaging, when combined with complementary anatomic imaging techniques, contribute significantly to the clinical treatment of cancer patients. In addition, the high accuracy of FDG-PET makes it a cost-effective radiologic procedure in the work-up of all suspected and/or recurrent cancer patients. Further research is needed to link this demonstrated impact on patient management to cost-effectiveness.

scholarly journals PET imaging in differentiated thyroid cancer: where does it fit and how do we use it?

2007 ◽  
Vol 51 (5) ◽  
pp. 793-805 ◽  
Author(s):  
Nathan C. Hall ◽  
Richard T. Kloos
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Differentiated Thyroid Cancer ◽  
Imaging Modality ◽  
Treatment Plan ◽  
Whole Body ◽  
Case Examples ◽  
Positron Emission

Positron emission tomography (PET) is a rapidly evolving imaging modality that has gained widespread acceptance in oncology, with several radionuclides applicable to thyroid cancer. Thyroid cancer patients have been studied most commonly using 18F-Fluorodeoxyglucose (FDG)-PET, with perhaps the greatest utility being the potential localization of tumor in differentiated thyroid cancer (DTC) patients who are radioiodine whole body scan (WBS) negative and thyroglobulin (Tg) positive. Also of value is the identification of patients unlikely to benefit from additional 131I therapy and identification of patients at highest risk of disease-specific mortality, which may prompt more aggressive therapy or enrollment in clinical trials. Emerging data suggest that PET/CT fusion studies provide increased accuracy and modify the treatment plan in a significant number of DTC cases when compared to PET images alone. However, studies documenting improvements in survival and tumor recurrence attributable to FDG-PET imaging in thyroid cancer patients are lacking. Specific case examples of thyroid cancer patients who appear to have benefited from FDG-PET imaging do exist, while less data are available in the setting of anaplastic or medullary thyroid carcinoma. This article reviews the utility and limitations of FDG-PET in DTC management, and offers practical recommendations.

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