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Pancreatic cancer with cholangitis — ESEGH MCQ

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HardGI CancerPancreatic cancer with cholangitisESEGH

A 58-year-old man presents with painless jaundice, weight loss and new diabetes. CT shows a 3 cm pancreatic head mass abutting less than 180 degrees of the superior mesenteric vein, with no metastases. Bilirubin is 210 micromol/L and he has fever and rigors. What is the most important next step?

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Reveal the answer and explanation

Correct answer: B — Urgent biliary drainage and antibiotics for cholangitis before oncological planning

Pancreatic cancer is likely, but fever, rigors and severe obstructive jaundice indicate cholangitis requiring antibiotics and urgent biliary drainage before definitive cancer treatment. Starting chemotherapy during uncontrolled sepsis is unsafe. Repeating CT in 6 months would delay potentially curative management. The pearl is that cancer staging and sepsis control often run in parallel.

Reference: NICE Pancreatic Cancer Guideline NG85; BSG ERCP Guidance