Pancreatic Cancer

[bjg05044]

Dear Doc,

My problem started out with abdominal discomfort in March that did not improve with PPI's so I had an upper endoscopy in late April.  The findings were normal with a little irritation in the lower part of the stomach. The indigestion improved a bit but I continued to have a burning pain on my left side around the area of the spleen that roams from front left part of the rib cage to the left side.  My doctor then order an Ultrasound and it came back normal for all organ with the exception of a mildly enlarged spleen (13.3). He did some extensive blood work (CBC, Differential, Metabolic Panel, Amylase, Lypase etc...) and it all came back normal.  In late May He then sent me to have a Ct scan of the thoracic, abdominal, and pelvic area with contrast.  It read helical axial images 5mm scanner and the all areas came back unremarkable with the exception of the mildly enlarged spleen. I have improve quite a bit and there are days that I don't experience the pain at all and then there are days that it comes back with a vengence.  He order another CT scan with contrast to put my mind at ease back in mid august and it came back normal with the exception of a mildly enlarged spleen and all bloodwork was normal once again.  

Questions:

I'm a 39 year old male that has been in good health with no history of cancer.  The only medication I'm taking now is .5 mill of xanax twice a day.

Can a mildly enlarged spleen cause me this much pain in the left side of my rib cage?

Can pancreatic cancer be ruled out for now after two CT scans with contrast?

Should I be concerned about my pancrease after all of this testing or move on?

Is there any other tests you would order?

My doctor is tellin me that we will re-evaluate this in 6 months.

[Kevin Pho, MD]

To answer your questions:
1) It is possible for an enlarged spleen to cause some of the symptoms you describe.

2) Pancreatic cancer can be difficult to diagnose.  A negative CT scan would make it less likely.  Further testing can be done with an MRI or endoscopic ultrasound.

3) Cannot answer that without evaluation.  Further imaging of the pancreas can be done with the aforementioned studies.  If negative, pancreatic disease is extremely unlikely.

4) Further testing can be done with a 24-hr pH study or gastric emptying scan.  These tests can evaluate for GERD or gastroparesis respectively.  

These questions can be discussed with your personal physician.

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_

[Nursgirlie23]

I have had the pain you are referring to for the past 2.5 years.  It started for me, with a really bad case of acute pancreatitis.  (the worst case my hospital had seen in over 20 years).  Anyways, last August I had more than the normal pain, and they did a CT scan and my Spleen was enlarged.  I went back to my surgeon and he did an ultrasound of the spleen.  They found that there was a thrombus in one of the vessels that was causing a back up of blood in the spleen and in the vessels surrounding my stomach, which caused varices there.  They then removed my spleen and things got much better after that.  I have since had more of the increased pain, but that is due to progressing to chronic pancreatitis.  I got the pancreatitis from high levels of blood triglycerides.  Not a fun thing to have, but when you get the first acute cases of pancreatitis your amylase and lipase levels would be very high.  Now that I have the chronic version, the levels no longer raise.  Just thought I would put my two cents in!!

[bjg05044]

How painful was the spleen surgery?

[Nursgirlie23]

For the spleen surgery, you first have to have a bunch of immunizations, since when you don't have a spleen anymore, you will be immunocompromised.  Especially the Menningococcal and pnuemonia (pneumonia) vaccines.  Those aren't that bad.  The spleen surgery for me was rough as far as blood loss goes, I  had to recieve several units of PRBC's afterwards.  I also had a ventral hernia repair with mesh placement when they did the spleen removal.  So, the mesh placement was VERY painful.  I don't think it would have been half as bad if the spleen was the only thing they had worked on.  
They diagnosed the spleen thrombus via slenic ultrasound, and the varices via upper endoscopy.  Maybe ask for those tests and you can find out more.  
Hope that helps some.

[cuddles1]

A related discussion, gastric problems was started.