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    Are abdominal pain, nausea and bloating symptoms of pancreatic cancer?

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Posted on Wed, 1 Jun 2016 in Cancer
Question: I am fearful of pancreatic cancer. Do I have pancreatic cancer? Weight loss abdominal pain under ribs, Nausea, night sweats, excessive thirst, bloated.
doctor
Answered by Dr. Indranil Ghosh 4 hours later
Brief Answer:
unlikely to be pancreatic cancer

Detailed Answer:
Hi
Thanks for your query.

Your symptoms are unlikely to be due to pancreatic cancer. CT scan and MRCP are normal. I know that sometimes tiny lesions can be missed on scans but your symptoms can't be explained by tiny lesions.

Have you had an endoscopy in recent times? Going by your symptoms I would suggest that. At the same time, you seem to be under lot of stress. Unless that is reduced, these symptoms can't be controlled.

I would emphasize again that this is very much unlikely to be pancreatic cancer.

Hope this helps.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 12 days later
I have a pancreatic concern and need your assistance. Over the past 2 months, I have been suffering from loss of weight 5% of my body weight in 2 months, nausea, bloating, pain in my mid abdomen, frequent bowel movements. More recently, I have been suffering from night sweats and generally sweating after small tasks (walking up the stairs, lying with my daughters (heat)).

I have had several tests:
CT Scan- No mass lesions
MRCP- No Mass lesion, ducts look open
Endoscopic Ultrasound- No pancreatic mass lesions
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
there is nothing to suggest pancreatic cancer

Detailed Answer:
Hi
Thanks for following up.

Even EUS has failed to show anything. So pancreatic cancer is extremely unlikely.

On the other hand, helicobacter pylori gastritis is found in stomach biopsy. This can explain many of the symptoms. So complete treatment for it should be given and then re-evaluate again.

Overall, there is nothing to worry at this time.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 1 hour later
Hello Dr-

Thanks for responding so quickly. You have been an excellent resource. I live in Uganda and have very limited resources to ask my questions. I understand that the chances of getting PC is rare.

I have had both an endoscopy and colonoscopy done. Nothing was noted, except for the presence of H. Pilori in the stomach.

1- I know that the EUS is very accurate, however, could small tumours cause such problems (nausea, bloating, weight loss, muscle loss)? How often in your medical career have you seen something missed from an EUS? I know you mentioned this is not typical, however, I have been reading some cases where it was missed.

2- I have attached CT reports, and my MRCP reports for your review to see the findings and see if anything was missed.

3- I know you feel strongly that there is no PC, however, are there other malignancies that could cause this?

4- Would you recommend any other tests for Lymphoma or other malignancies that cause night sweats?

Thanks so much Doctor!
doctor
Answered by Dr. Indranil Ghosh 11 hours later
Brief Answer:
my answers below

Detailed Answer:
1. Very unlikely that these symptoms are from early onset disease which is so small to be missed on all these scans. Sensitivity of EUS is around 95%. So small tumors may be missed in 5% but they will not cause all these symptoms.

2. I have reviewed the reports. Nothing special is there to suggest cancer.

3. Yes stomach or intestinal malignancies can cause but the have been excluded as well.

4. Though I am not very suspicious of malignancy, for peace of mind you can consider a whole body PET-CT

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 1 hour later
Thanks so much Doctor!

I don't want to unnecessarily get a PET/CT if not required or if it will not provide additional value. Do you recommend this or not from a medical standpoint?

Also, I forgot to attach the MRCP and CT reports. Please see them now.

I think I am feeling much better! Just needed you to review these final reports and let me know what you think.








doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
no evidence of cancer in tehse reports

Detailed Answer:
CT shows possibility of Median arcuate ligament syndrome which can be diagnosed only after other causes have been excluded, as in your case.

This is a problem where a blood vessel in the abdomen gets compressed and may need surgery. Need to consult a surgical gastroenterologist for this.

PET-CT may not be absolutely necessary at this time.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 33 hours later
Doctor-

Thanks for giving my some really good answers. Before I close the thread and this discussion, there was just a last few questions that I hope to educate myself on. Being an oncologist, you can give me guidance:

1- What actually causes Pancreatic Cancer to cause pain in abdomen, side, and back?

2- Why do Pancreatic Cancer patients have high LFT (ALT, ASTs)?

3- Aside from CEA and CA 19-9, are there any other tumour markers that could assist?

4- DO you feel that I have comprehensively ruled out Pancreatic Cancer and can put this behind of me? Or would you recommend any other follow-up tests?

Many thanks Doctor! I await your response.


















doctor
Answered by Dr. Indranil Ghosh 9 hours later
Brief Answer:
my answers below..

Detailed Answer:
1. This pain is due to large tumor or lymph nodes infiltrating the nerves on the back

2. High ALT/AST may be due to liver metastasis and high alk phos or GGT may be due to bile duct block

3. No these are the ones which are useful

4. Yes I think it has been ruled out but you need to be in touch with your gastroenterologist fro followup and treatment of your symptoms
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 2 minutes later
Hello Dr.

Night sweats have continued and I am struggling to maintain my weight sir. I have pain in upper left quadrant and sides.

I just did my LFTs and it was high. see attached report.

Please help to direct me to any other malignancy?

Best-
doctor
Answered by Dr. Indranil Ghosh 3 hours later
Brief Answer:
Some skeletal muscle problem probably

Detailed Answer:
There is no suggestion of malignancy in this reports. Ck is definitely high but CK-MB not so much. So probably this is coming from skeletal muscle.
Hypothyroidism can also cause this. Was this ruled out?

Slight liver enzyme elevation can be due to fatty liver.

Both the CK and Liver enzyme can be elevated due to drugs. Which drugs are you currently on?
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 25 minutes later
Hello Dr.-

I am on H. Pilori antibiotic treatments. I take a course of antibiotics in the am and evening. I am not on statins.

Does the high CK levels indicated muscle degradation or injury? Would cachexia be a valid diagnosis? Could this explain why my muscles are achy and losing muscle mass?

Hypothyroidism was ruled out. Sweating can be caused by high metabolism, which is associated with malignant processes.

What are your thoughts? I sincerely appreciate your time and you have been an excellent resource.






doctor
Answered by Dr. Indranil Ghosh 6 hours later
Brief Answer:
various drugs can cause CK elevation

Detailed Answer:
Including drugs used for H pylori. If you have CK values before H pylori treatment then that can help.

However, this is just a lab abnormality and you don't need to stop treatment for this.

Cachexia is a symptom (wasting), not a disease. How much weight have you lost in last 3 months?
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 2 hours later
ck before treatment 223.
doctor
Answered by Dr. Indranil Ghosh 5 minutes later
Brief Answer:
Then must be drug induced

Detailed Answer:
No need to worry then. Get another sample after few weeks of completion of treatment
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 0 minute later
ok thanks
doctor
Answered by Dr. Indranil Ghosh 12 hours later
Brief Answer:
you are welcome

Detailed Answer:
if you do not have nay other query, then please close this query and give feedback
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1530 Questions

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