Terrified of pancreatic cancer

[suzanne L.]

I am a 39 female healthy all my life, with no family history of gastrointestinal cancers.

Last July, I began having chronic diahrrea whcih I consulted my gastro about. Several tests revealed parasites and microscopic colitis for which I took Flagyl to help resolve. Over the course of the Fall, I developed back pain (mostly upper across both sides) and mild epigastric discomfort - more recently add to that some nausea and seeming appetite loss (more like nothing looks good enough to eat anymore). I have lost about 6 lbs since last July. Of course, I freaked after looking these symptoms up on the internet and I demanded an ultrasound and complete blood work up from my gastro. We just completed those and both came back simply "normal". Good news, but then I read that abdominal ultrasounds may not always find tumours, etc.... but I would think a pancreatic  tumour large enough to be causing pain in both the back and abdomen would be visible on standard abdominal ultrasound?

[Kevin Pho, MD]

A CT scan has better sensitivity than an ultrasound for the diagnosis of pancreatic cancer (85-90 percent vs 75-80 percent).  Most patients with pancreatic cancer experience pain, weight loss, or jaundice.

Pain is present in 80 to 85 percent of patients with locally advanced or advanced disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating.

Weight loss can be profound; it may be associated with anorexia, early satiety, diarrhea, or steatorrhea.

Jaundice is commonly accompanied by pruritus, acholic stools, and dark urine.  Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion.

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.

Bibliography:
Steer.  Clinical manifestations, diagnosis, and surgical staging of exocrine pancreatic cancer.  UptoDate, 2004.

[surgeon]

Probably, although CT scan is generally a better way to look for pancreatic cancer.

[suzanne L.]

thanks, Surgeon...I am new here...are you a physician as well? I asked my gastro about clarification this very monring and he said there was nothing on the ultrasound suggestive of any abdominal masses or anything along those lines. Next step is an endoscopy he says, and I guess I could push him for a CT scan after...but he is sort of saying right now that the abdominal ultrasound has no abnormalities at all, which is not suggesting to him that we would need an additional view at this time.  Is that common in looking for pancreatic cancer? it would seem to me to be unusual to be totally normal yet still have something large enough to cause pain (EVERYTHING I read is that by the time there are symptoms with this type of cancer , the tumour is large and it has spread...so you would at least see "something", on ultrasound, no?)

thanks!!!!

[surgeon]

I am a general surgeon, semi-retired, with years of experience, who posts here "un-officially" (meaning I'm not on the staff of the website, nor do I get paid, I just do it to help when I think I can.) I've operated on many pancreatic cancers over the years. I'd say (depending a bit on whether the super-latest equipment is used) that CT is more reliable for pancreatic cancer; however it's true that when it presents with pain rather than jaundice, they tend to be big and already inoperable. But before you get too worried, it's quite uncommon at your age and would be far down the list of likely explanations. Doctors typically work through possibilities based on lots of criteria, so starting as yours did makes sense. I was specifically answering your question as to whether pancreatic tumors would be visible on ultrasound. I did not mean to imply that your doc was on the wrong track. As we say, "rare things are rare, and common things are common."  So beginning with general screening often makes more sense than going right to more complex tests.

[suzanne L.]

thanks so much Surgeon! I think you know how helpful it is to have someone with your knowledge helping out. I was actually in the em- ergency room last friday due to the pain and they ran comprehensive bloodwork in addition to the ultrasound and no evidence of reduced liver function or jaundice (bilirubin was .6 with a normal range of .4 - 2.0). I have read  much as you suggest, that smaller tumours of the pancreas that are in the head and cause obstructive jaundice as the only symptom may be too small to see readily on standard abdominal ultrasound. But my presentation is abdominal pain and back (however the pain is not coordinated if you will - they happen separately from each other, no "radiation" from abdominal to the back and visa versa) and they saw nothing at all - no enlarged pancreas, spleen, enlarged gallbladder, liver issues, fluid, etc..... just normal. So I am cautiously optimistic especially, as you suggest, it is quite rare under the age of 45.

thanks again!

[suzanne L.]

To Kevin MD - thank you! I guess the point I am making is I understand and have heard that ultrasounds find about 7-8 out of 10 tumours of the pancreas...but the other 2 "not found", are their ultrasounds totally normal and they are sent home...or don't they show some anomalies such as organ inflammations, fluid in the abdomen, etc...  Just from everything I have read - LOTS I might add - abdominal cancaers that present with pain are usually so far advanced - large, have spread, affected other organs, etc... -  i can't imagine an ultrasound would be "grossly normal". Comments??? please

[mrsp22]

A related discussion, Alot of radiation was started.

[JoeMcDt]

A related discussion, Should I get a second opinion was started.