cancer? colon, stomach, lymphoma?

[kenny p]

Hello! I am a 49-year-old male. Five years ago, I had a change in bowel habits that seemed unremarkable to me at the time, although I should have guessed otherwise. For about a month, my stools were slightly greenish and covered in clear mucus. Then one day I noticed blood in my urine. I went to the emergency room and was treated with antibiotics for a urinary tract infection. It cleared up, but in the immediate aftermath, I felt great fatigue and a feeling of "presence" in my upper left abdomen. That feeling is here to this day. I went to the doctor quite a few times during this period. That was about 4 3/4 years ago. A variety of tests and examinations showed no palpable mass, normal CBC, low SED rate, and slightly elevated serum ferritin levels. I went to the doctor so much that I got to the point where I couldn't bear going any more. So, for years I just continued to live with symptoms that have included partially digested food in my stools, loose stools, stools that appeared to have stringy stuff hanging off of them, upper abdominal discomfort, and fatigue. There have also been times where my lymph nodes - especially on the back of the neck, under the jaw, and in my right armpit seem to have some kind of involvement. However, they never stick out or feel enlarged, neither to me or my doctor. At one time, I felt a real burning just to the right of the sternum at what I assume is the site of a lymph node for about a day and then it was almost like a mini-explosion, and within a day my lymph nodes in my neck had a great feeling of "presence" or "involvement" although they were not enlarged. The abdominal discomfort has continued and has progressed to where I have generalized pain throughout the thoracic region. Recently, I have been going back to the doctor. They've run CBC - normal, chest x-ray - normal, liver function - normal, EKG - normal, upper abdominal ultrasound - normal with the exception of an enlarged spleen. However, as I said, the pain and discomfort have progressed. I am only really comfortable now when I am laying down. Within a half hour of getting up in the morning, I am feeling the upper abdominal discomfort again. I sometimes have a stiff neck, and I've also been having some lower back pain. I realize I should have persisted much more during the early stages of this, but I didn't. Now, I'm pretty sure that I am in the later stages of some type of cancer. I'd kind of like to be able to go in to the doctor and point him into a specific direction so that I can get my affairs in order, get pain meds, etc. without having to jump through too many more hoops. Also, I should note that while I have never seen any evidence of blood in my stools, I have never checked for occult blood. What are the most likely possibilities? Colon cancer? Stomach cancer? Lymphoma? (MALT or other), Pancreas cancer? The enlarged spleen and the feeling of involvement in the lymph nodes has me thinking some gastric lymphoma could be the cause, but who knows?

[Kevin Pho, MD]

All of the scenarios that you presented are possible - although with the many tests that you have done, something would have shown up.  

A CT scan would be helpful in this case.  It can evaluate for any masses as well as look for possible enlarged lymph nodes that may be suggestive of cancer.  The CT can also look at the pancreas for any anatomical abnormalities.

An upper endoscopy can be considered to look at the upper GI tract for any possible masses (i.e. in the stomach).  

Non-cancerous possibilities can include GERD, inflammation of the upper digestive tract, or malabsorption.  You can send the stool tests off to look for evidence of fat malabsorption, or can repeat the celiac antibodies to rule in or out celiac disease.

These options 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.
http://www.straightfromthedoc.com

[tivodad]

Guy74,
I know you've been through the ringer for the past few years. You've gotten some good test results though! Normal liver function, chest x-ray, ultra-sound, EKG, etc. How's your appetite? I don't want to minimize your symptoms, but just from what you've written, the fatigue and back and neck pain are likely due to stress. That's ok. After 5 years of symptoms you're entitled to worry. I'm surprised you haven't had an abdominal CT scan or lower GI series. A CT scan is very sensitive and certainly after 5 years of problems it would give indications of what is wrong. I know it's worrisome to have diagnostics, but if you have your doctor run a couple of tests I believe you'd feel better about all of this. I'm betting he won't find anything serious and once you know that for certain, it should definitely put your mind at ease. You mentioned occult blood. Are your stools black and tarry? There are over the counter tests for fecal occult blood. If you're concerned about that you should buy the test and use it at home.

[lizziecee]

Hi - I have had Crohn's (IBD) for some 35 yrs and am this week having an endoscopy of the small bowel (where it all started, although pan Crohn's colitis now) but was amazed last week when my gastro said he would schedule a calproctin test of my stool - taking the sample in before I have the endoscopy and small bowel follow through. He has just my hospital lab to do this test, although I read about it some 2-3 yrs ago, developed by a gastro at Portsmouth or Southampton hospital in England. If you google calprotectin test you will get some very interesting data. This could show if you have IBD and it rules out IBS. Good luck. Liz.

[scaredstraight68]

Hey doc, question: I'm kinda in the same boat.  I noticed that my stool is all over the place.  Ribbons, thin to normal.  If colon cancer was an issue would the stool change or be consistant.

[tryork]

Hello I am 29 yr old tall very slim male. I have eating fast food for over 6 yrs straight. Now my lower left part of my side hurts from time to time. ALl I feel is pressure. My stool is very dark. Not black but something like very very dark green. I have went to the doctor and got test done not specificall y for my bowel but numerous general blood test done. Everything came back fine but I am so worried that it is cancer! I mean My mucsles are always twitching now and now this pain in my side that moves from one side to the other and some times in my chest.I am so afrai of going to the doctor. I just never feel good anymore. I hate feeling this way.I mean it feels like I can feel my self bleeding. Al though I never saw blood in my urine or stool but my urine is some times faint light green.