Pancreatic cancer? Gall stone? Kidney Stone?

Hello. I am a 42 year old caucasian woman with no history of illness. There is no history of illness with my parents either. My weight is what it has always been 130-135 depending on time of month. My menstruation is like clockwork and always has been. I smoke. Last April I experienced a urinary track infection -- the first time I had ever had anything warranting a visit to the doc since bearing children. I was prescribed anti-biotic and it cleared up fine. The symptoms were unusual smelling urine and mild flank pain. Tests concluded UTI. However two months later, beginning in June-July, I would notice that flank pain(discomfort) again,middle upper right back region intermittent at most. It started to increase and I also noticed a dull pain(again, discomfort) below my right rib. About a month ago, I started experiencing pain to the right shoulder. This is real pain.  It now comes and goes and I can discern no pattern between what I eat and when the discomfort occurs, however I almost always notice the flank pain first thing in the morning. I never have pain at night or during sleep hours. My diet is not what it should be. I usually drink coffee every morning and my job is physically laborous, I clean homes and use every muscle in my body lifting furniture and vacuums etc.. I tend to eat once a day- dinner,  and admittedly don't drink nearly enough water. My urine is darker, but not so dark that I am concerned, just not what it is when I force myself to drink lots of water.I have no fever or nasusea, no yellow eyes or stool, stool is quite normal and regular. I don't feel as strong as I used to be, but then I'm not 30 either. I eat pretty well, although probably not enough fruits and veggies. I eat no fast food.I thought at first kideny stone, but sort of changed my mind on that because I have no accute pain. Then I considered possibly gallstones because there will be a week or two when I have no pain at all. I am now worried that it may be pancreatic in nature,I don't know. Besides this discomfort which deoes not keep me down in any way, I feel fine, although completed depressed out over the election results, but that's another matter. I have no health insurance and pay by cash when I need to go tot he doctor, which so far has been the one time described above for the UTI. I guess my question is could it be that I have pancreatic cancer or some such thing?I mean, how likely is that disease given my predisposition because I smoke? Or could this be common symptoms of gall stones? I know you will say go see a doctor, but without medical insurance, well, you know. The ER is the only option I have and I would probably want to help them pinpoint the problem as much as I can. I have three children to raise on my own -- I definitely need to be well here. Any light you can shed would be most appreciated, please and thank you.

[Kevin Pho, MD]

Tough to say without examining you.  Smoking certainly increases the risk of pancretic cancer, but there are more likely possibilities.  Yes, gallstones and kidney stones are also possible.  

Given your description, I would suggest a right upper quadrant ultrasound to start, along with liver function tests.  This is a pretty good workup for most gallbladder and liver diseases.  

If negative, a spiral CT scan without contrast can be considered to evaluate for kidney disease.  A urinalysis can be obtained to evaluate for blood in the urine, suggestive of a kidney stone.

If there is concern about pancreatic cancer, the abdominal CT scan can be done for further evaluation.

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.
Medical Weblog:
kevinmd_b

[donailin]

I forgot to mention, no blood in urine or stool either. Thanks

[donailin]

ah shoot, I also forgot to mention the gout. I have gout for about three years now, my big toe hurts maybe once or twice a year and I also have arthitis in my hands -- big knucles and all that. I guess I don't consider these things as illness, just stuff that comes along with old age. I will usually take a motrin when necessary. Also,I do not drink at all. Dang I hope that covers everything. Sorry.

[CoghanB]

What you describe sounds more like gallbladder than anything else.  If you had pancreatic cancer, you would be pretty sick. I've known two people who died from it, and one currently battling, and the symptoms become pretty bad quickly.  Also, sometimes a urinary tract infection can linger on for awhile and make it's way to the kidneys where it can hang on as a low grade infection for quite some time.  I would relax on it being something life threatening and look to more likely causes like gallstones or perhaps a kidney infection.  It isn't even impossible that the pain is an ovarian cyst.  My wife had one and it went undiagnosed for several weeks because the pain was higher up on her side.

[anointed97701]

A related discussion, All tests are negative-what now? was started.