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Q. A patient with stomach pain was diagnosed with cancer in FNAC. Does she need a PET scan?

Answered by
Dr. Pawar Satyajit Jalinder
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 19, 2021

Hi doctor,

A patient has abdomen pain and vomiting with fever one month back. She was admitted to the hospital and came back home. Again last week, she had pain, and a lot of tests were performed. In which her FNAC reports showed cancer. Based on these reports, we require what should be the following protocol to move further. I am attaching her reports.

1) Whether she requires a small surgery to take out the mass and should be given for final biopsy and IHC?

2) Require a PET scan or direct surgery?

3) Does she require chemotherapy?

Kindly give your opinion.

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Hello,

Welcome to icliniq.com.

I have gone through your query and reports provided (attachments are removed to protect the patient's report).

Based on this, my final analysis is periampullary carcinoma, biopsy papillary tubular neoplasm, and MRCP CT (magnetic resonance cholangiopancreatography) is a localized disease that appears resectable.

The best treatment for periampullary carcinomas is surgery followed by chemotherapy. As she had undergone a biopsy and FNAC (fine needle aspiration cytology) additional small operation is not required. Direct chemotherapy is not needed unless the surgeon feels that the tumor is not resectable and needs to be downsized (which does not appear to be the case as per the report).

A PET (positron emission tomography) scan can be done before to check whether the tumor has spread to anywhere else like lungs or bones as these organs are not covered in CT 9computed tomography) well.

Also would like to see her bilirubin levels to see if she needs stenting before surgery to reduce jaundice (if present).

The best case for her would be a PET scan followed by direct surgery.

If you have any more questions, you can always revert back here. I hope this was helpful.


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