Need a second opinion as soon as possible

3 years ago I had an appendectomy and they saw a mass in my small intestine (Terminal Iluem) through a Cat Scan. They did a colonoscopy but couldn't get to it. We watched it for 1 year and it didn't grow. Three months ago I started having stomach pains. I had H.Pylori. After the antibiotics I began having stomach pains again. Friday they did a Cat Scan and saw this mass has grown from 3.8 to 4.5 since 2005 and a couple of lymph nodes are slightly enlarged nearby. The surgeon now wants me to have surgery to find out what this mass is. Is this really necessary? He thinks it could be benign, Crohns, lymphoma. We just don't know. Does it have to be cancer since it's grown and affected the lymph nodes? Can I wait or should I go in as soon as possible to get this surgery? I'm only 42. Could I be having the stomach pains because of this mass or could it be the H.Pylori returned? What do you think?

[Kevin Pho, MD]

It is difficult to give a concrete diagnosis without examination.

Cancer or carcinoid tumors certainly needs to be ruled out.  

Further imaging with an MRI can be considered.  To visualize the small bowel, an upper GI series with small bowel follow-through can be done.  Capsule endoscopy can also be considered.  The problem is that even if a mass is visualized, it cannot be biopsied.

Surgery is a feasible option.  With this route, the mass can be biopsied or removed - giving a more certain diagnosis.

These options should be discussed with your personal physician, or in conjunction with another opinion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[April2]

Sorry, I forgot to mention that I've been on a liqued diet for the last two days and it really seems to have helped with the stomach pain. Is this significant? I'm not blocked. The dye from the Cat Scan went through fine. Can you give me your honest opinion? The fact that the mass increased from 3.8 to 4.5 cm and affected a couple of lymph nodes, does this mean cancer? This is major surgery so I'm dreading it. I just want to do the right thing. Thank you.

[April2]

I appreciate your answer and I will consider what you said. However, you didn't answer all my questions. Could this mass be benign and still grow and affect the lymph nodes? Also, do you think this stomach pain could be associated with this mass? The surgeon saId he would have thought that I would have had different symptoms. Could it still be cancer even though it didn't grow that first year we watched it? You said even if the mass is visualized it can't be biopsied. So what would doing this upper GI and endoscopy do? Just to maybe prove it's really there or to get a better look at it? My surgeon wants me to get this done Aug 7th because that's the best date for him and the hospital so I'm running out of time. If this were you or your loved one, would you choose the surgery? I'd really like to know. Thanks so much!

[Jaybay]

The docs don't come back for follow-up answers on this forum, but if it were me or a loved one, I'd do the surgery.  They HAVE to get to the mass to biopsy it and determine if it's cancerous or benign.  I just don't see any way around it - you need the surgery, the sooner the better.  Have you ever had surgery before?  Are you more afraid of the procedure itself or what you might learn?  Is your surgeon planning on trying this via laparoscopy or open laparotomy?  Those are a couple questions you might ask before having it done - but DO IT!  :-)

[April2]

Thanks for your comments. I think I'm just not that crazy about the idea of surgery. It is major surgery after all. They'd have to cut out the mass and reattach the small intestine back to the large intestine. Of course there are risks involved. The biggest one being that there could be leakage if it's not reattached back just right. I'm only 42 years old too. I have three children with the youngest being three years old. My grandmother had colon cancer so I'm very aware of it, but she was in her sixties or seventies when she started getting it. I just wish I could know for sure if it was cancer first. I'd hate to go through all of that if it really is nothing.
My surgeon is going to do this laparoscopy I guess. He said they'd have to make a big enough incision to stick his hand through and two more small incisions (I think he said) for the laparoscope.
You sound familiar with all of this. Have you had something simular? Thanks again for responding! I think I knew I'd have to do this, I'm just kinda dreading it. Still, I have a lot of people praying for me and I know I'm in God's hands. I'm not really afraid. I'm just trusting God to take care of me.

[April2]

I had the surgery and just thought I'd let everyone know they biopsied the mass and said it was fibrous scar tissue with ulceration nearby that looked to be a classic case of Crohn's Disease. My surgeon was surprised. He didn't think I showed enough symptoms for Crohns. The next step is to see a Gastroenterologist and see where we go from here. I don't know that much about Crohn's yet but I've been trying to learn. Hopefully, it's just a mild case since they only saw one ulcer. I did think it strange that I had the H.Pylori first a couple of months ago and asked if there could be any connection. The doctor didn't think so since the stomach and the small intestine are not related. But I feel it's all part of the digestive system. It just seemed strange to me that I got a bacteria that can lead to ulcers in the stomach and then the see an ulcer in my small intestine. I'm trying to now look into diet and health and what I can do to improve my symptoms and overall health. Thanks everyone for you help!