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Pancreatic cancer?
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Pancreatic cancer?

I'm a 35 year old male in reasonably good health. I have been diagnosed with IBS after complaining about lower abdominal pain 1 year ago. A colonoscopy revealed nothing.

Over the past few years, my left side at lower rib level, has always been slightly achy and uncomfortable to sleep on. Four weeks ago, the pain in my side increased fivefold. It is constant and often very distracting. Ibuprofen does nothing for this.  The gnawing pain ranges from my left side at rib level to mid chest just below "rib" level.  Sometimes it feels a bit like something has been shoved under my ribs.  I'm not certain if there is any correlation between the discomfort and eating.

I went to the doctor twice. The first time she thought nothing of it. Then I had a serious bout of constipation for 2 days in which the stools were grayish and full of undigested food.  The following week I had 2 days of notable diarrhea.  And the gnawing in my abdomen continued.  My second visit left her scratching her head.  She gave me a month of Protonix.  After 2 weeks, this hasn't helped.

Now, incidentally?, I have pain in my back.  It is on my left side between my spine and a bit below my shoulder blade.  I haven't engaged in any activity that would cause any strain as far as I know.  It doesn't really get worse when in bed, though the combination of my side and back have kept me up nights.

I'm also a bit nauseated off and on for the past few weeks.  Not much.  And I really cannot determine at times if it is upper bowel issues, which to me seems like a touch of nausea.

My appetite seems slightly down as well, but this could be due to my diet and exercise routine.

I'm not notably overweight (165 lbs and 5'8") but I'm running a bit high on body fat (22.5%).  Six months ago I started a regimen to lower my weight (I was 192 lbs).

So, I've got a history of being a bit on the hypochondriac edge. I don't know how to gauge my feelings on my health. And I have no doubt this likely enters into my doctor's mind. But, this is really starting to bother me and I'm getting a touch freaked out.  I realize that pancreatic cancer is quite unlikely.  

What could this be? Is there any chance this is pancreatic cancer? If so, isn't doing something sooner MUCH better than waiting for more symptoms, like jaundice? What, if anything, should I ask my doctor to do without seeming like a nut? Or, are all of these just signs of getting older?

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I would agree with surgeon's suggestion of a CT scan being a reasonable next step.  The "gnawing" pain may also be indicative of dyspepsia - i.e. upper GI discomfort caused by GERD, an ulcer, or inflammation of the esophagus or stomach.  

Pancreatic cancer would be unlikely, however the CT scan can evaluate this.  

I would suggest an upper GI workup, including upper GI series and/or upper endoscopy.  The upper endoscopy would comprehensively evaluate for any inflammation or ulcers that may be causing your symptoms.

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.

Thanks,
Kevin, M.D.
7 Comments
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Avatar_n_tn
Other thoughts:

Doc said it wasn't H. pylori.

And I've been saddled with some gas and an uncommon amount of belching recently.
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One more thought:

I did have a sonogram on my abdomen a year an a half ago as my first IBS test.  Nothing came up except for a slightly enlarged spleen.
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I would consider further evaluation, and I'd think a good place to start would be CT scan of the abdomen. If nothing shows there, then, because of the change in bowel habits, I'd suggest colonoscopy. The list of possibilities is long at this point, and would indeed include pancreatic cancer although it's more likely to be something less serious. Nevertheless, it seems it's time to investigate further, rather than to continue to treat symptoms only.
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Avatar_n_tn
You think I should have another colonoscopy within about a year of the first one?

Do you have any thoughts as to what the upper back pain is?  It is getting bad today....
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If you could posit some other less severe possibilites, I'd certainly appreciate it.  It'd certainly make me feel better.
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Avatar_n_tn
You're right: I overlooked the colonoscopy a year ago, so it's not a priority. But as stated, CT scan would be a good first step in the further evaluation. Most back pain is musculo-skeletal in origin, meaning muscle strain, pinched nerve, etc. So it well could be unrelated to the other issues.
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I've had an ultrasound and I'm waiting on results.  Can anyone tell me how reliable ultrasounds are versus CT Scans in pancreas diagnosis?
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