Please give a significant medical suggestion for endhancing life expectancy and proper treatment plan for a patient clinically diagnosed with periampullary masses, bile duct obstruction and possible liver metastasis.
History: No drug, smoking and drinking habit
Medical history: Long term gastric issues, upper abdominal plane (sometimes), weight loss, slight yellowish eye etc.
This patient probably have adenocarcinoms of the periampullary region. With multiple liver mets, making the disease stage 4, the patient seems to have potentially incurable disease. However at this stage , the appropriate treatment will provide survival improvement with acceptable quality of life.
specifically for this patient I would recommend, biliary stenting, biopsy from the liver and pathological examination with biomarker testing such as MSI, HER-2, NTRK, BRCA, pdl-1, Ret gene alterations, -ras and braf testing minimally, a comprehensive tumor profiling including these tests of course more than welcome, if affordable by the patient. Meanwhile a chemotherapy regimen such as FOLFIRINOX can be started.
Metal stent to drain the jaundice. If bilirubin comes down, then FOLFIRINOX chemo if fit, GemCap if not fit
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