Pancreatic Pseudocyst or Cancer?

I am a 45 year old male in otherwise good health, but have engaged in occasional (once a month or less often) bouts of heavy drinking (5-7 glasses of wine) over the last 6-7 years. Over the last year, I noticed that I was experiencing pain in the back after drinking, but the pain would resolve on its own by the next day. A few months ago, I started experiencing a burning feeling in my stomach accompanied by burping. Having been diagnosed positive for H Pylori a few years ago (treated by Prevpak), I went to the doctor and he found that there was a recurrence of H Pylorri. He prescribed another course of the Prevpak. However, the symptoms did not resolve after the course. The burning feeling continued and after a month, I went back to the doctor, who ordered an endoscopy. The endoscopy came out normal. Meanwhile, the pain continued along with discomfort in the back. The doctor suspected something wrong with the pancreas and ordered a LFT and pancreatic enzyme test. The liver function test was normal. However, serum lipase was 1200. The doctor asked me to get a CT scan of the abdomen, which I got done a few days ago. The radiologist reported a 1.8 x 2 cm hypodense pancreatic pseudocyst consistent with acute pancreatitis, but also recommended further imaging to rule out the "much less likely possibility of cystic neoplasm." In addition, the report also mentioned a 10 mm retroperitoneal lymph node.
I have been reading up a lot and am getting extremely worried. On one hand, if I am right, the report of a cyst-like structure seems a little better than a solid mass that might be characteristic of a carcinoma. On the other, the fact that the retroperitoneal lymph node is at the upper limit of normal seems suspicious.
Could you shed some light for me? I have not been able to get an appointment with a GI specialist till next month and am going crazy with worry.

[Kevin Pho, MD]

I can't give a definitive answer without examination, but you're right, cancer needs to be excluded.

The tests that the GI will likely consider is an MRI, MRCP, ERCP, or an endoscopic ultrasound.

These imaging tests can exclude cancer, as well as confirm the presence of a possible pseudocyst.

If the diagnosis remains non-revealing, another opinion can be sought, preferably at a major academic medical center.

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 Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[k2626]

I am in a similiar boat. I am 34 upper left sided pain for over a month w some burning in the middle. Its important to note my dad died of PC this summer. My lipase was slightly elevated and remains (though last week it was going down-86 when 60 is normal), my dr ran a ca 19 test and it was double normal at 66. He told me this can rise with pancreatitis.

I had an ab US, CT w dye and an EUS without a biopsy all clear. How do I know somethign is not being missed? I am in pain, my labs draw a pic that somethign is off with my pancreas yet my imaging is good.