A 72 year-old lady with unrecognised cancer of the body of the pancreas presented with a 4-month history of progressive loss of weight and ascites. The results of laboratory investigations were either negative or within normal limits - apart from a raised serum CA 125 level; no tumour mass was detected on diagnostic imaging. She underwent exploratory laparotomy for a suspected ovarian tumour, but this proved not to be the correct diagnosis. A serum CA 19-9 level was subsequently requested and found to be significantly raised; a second contrast CT scan then showed the presence of ill-defined peri-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.
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