Pancreatic Adenocarcinoma Associated with Vocal Cord Paralysis

A 30-year-old male patient presented with a mixed complaint. He initially had developed complaints of backache two months ago. This pain was accompanied by the formation of two lumps in the back in the upper and lower regions. However, this was not the reason behind him presenting to the hospital. He complained of hoarseness of the voice, which seemed to have no background.
The man is neither an alcoholic nor a smoker. He has no significant medical or surgical history. His work history also remains unrelated to the hoarseness of his voice, as he is not required to speak loudly, which is typically linked to over exertion of the vocal cords.
Upon examination, it was learned that the two lumps that the patient had initially observed had grown in number. Now, there were several lumps on his back and shoulder regions.
When this particular observation, coupled with the hoarseness of voice, was investigated via diagnostic imaging techniques such as X-ray, CT, and MRI, it was discovered that the patient was suffering from Grade IV Pancreatic Adenocarcinoma. The cancer had progressed significantly as there was numerous organ involvement observed. The liver, adrenal glands, lungs, subcutaneous tissues, and muscles were all seen to be involved. Along with this, he had also developed bilateral deep vein thrombosis on both his lower limbs.
Although the patient had no significant symptoms that could have forced an earlier diagnosis, it was evident that the carcinoma was pancreato-biliary in origin.
The patient is now undergoing his chemotherapy, and so far, he has shown a remarkable ‘partial’ response to his treatment cycles. Therefore, a good prognosis is hoped if the progress remains the same over time.
This case study aims to reflect on all the possible angles of this patient’s presentation. It is also the utmost priority to correlate and investigate the link of his hoarseness with his actual cancer. This case study will guide future physicians and clinicians who will come across confusing cases such as these to reach a conclusive diagnosis.
Had it not been for the advanced diagnostic imaging technologies available within reach of both the hospital and the patient, the patient undoubtedly would have only been treated for his hoarseness, leaving the actual disease unchecked, undiagnosed, and untreated.