Lessons to be learned: a case study approach: Ascites and elevated serum CA 125 due to a pancreatic carcinoma. A diagnostic dilemma

A 72 year-old lady with unrecognised cancer of the body of the pancreas pre sented with a 4-month history of progressive loss of weight and ascites. Th e results of laboratory investigations were either negative or within norma l limits - apart From a raised serum CA 125 level; no tumour mass was detec ted on diagnostic imaging. She underwent exploratory laparotomy for a suspe cted ovarian tumour, but this proved not to be the correct diagnosis. A ser um CA 19-9 level was subsequently requested and found to be significantly r aised; a second contrast CT scan then showed the presence of ill-defined pe ri-aortic tissue. A further exploratory laparotomy was carried out in order to establish the true nature of the problem; a large pancreatic carcinoma was revealed.