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    Are weight loss, nausea, night sweats and fatigue signs of pancreatic cancer?

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Posted on Tue, 31 May 2016 in Abdominal Pain
Question: I am certain based on my symptoms I am suffering from an early onset of Pancreatic Cancer.

Questions:

1- I am wondering if I have pancreatic cancer? I am a nervous wreck and need some help. I am afraid that all of my tests have missed the cancer and I am doing these tests too early. I have lost 4 kgs in 2 months, nausea, night sweats, Muscle mass had decreased, fatigue, and change in taste and smell. I dislike food and have to force myself to eat.

2- I had an Endoscopic Ultrasound done at XXXXXXX Asia Hospital XXXXXXX Is this a reputable place? 12 biopsies taken (Duodenum, Antrum, Jejunum) (See attached Report)

3- Can CT, MRCP, and Endoscopic ultrasound miss Pancreatic Cancer? How good is MRCP and Endoscopic ultrasound?

4- Can small tumours (< 2cm) cause many symptoms?

5- Should I get a PET for confirmation?

6- What is cancer cachexia? Do I have it? Are there any blood markers to detect it?

7- Should I have pancreas removed? I am concerned my timor is growing, however, cannot be detected just yet.
doctor
Answered by Dr. Grzegorz Stanko 4 hours later
Brief Answer:
You do not have symptoms of pancreas cancer.

Detailed Answer:
Hello!

Thank you for the query.

Before I will answer your question here is some very important information. There is no early symptoms of pancreas cancer. Not at all. It grows unnoticed for months. Its because you can live without a part of pancreas without knowing about it. Usually the first symptom of pancreas cancer is jaundice (if its in the head) or upper middle abdominal pain (when it infiltrates nerves). But the symptoms do appear when its advanced. Lack of symptoms is what makes this cancer so poorly treatable.

1. Your symptoms are not characteristic for any cancer. It may be something (especially night sweating), but not necessarily. All this symptoms can be caused by anxiety however. For sure thyroid tests should be done.

2.Please do not expect us to know every hospital in the World. Every tests sensitivity depends of the doctor who performs it, not the place where it is done. So even if reputable place, you can have false negative test result. EUS however is a very sensitive tests for pancreas cancer detection.

3.Yes, all this tests can miss a cancer. Its because we do not see single cells. We just see tumor which becomes visible for some tests depending of its size. MRCP is very good test if you know what too look for. EUS sensitivity is very high in pancreas cancer detection, even higher than MRCP.

4. Small tumors usually do not cause any symptoms at all. Only tumors which produce hormones (like Insulinoma) can cause symptoms before we can see the tumor.

5. PET also can not detect tumors smaller than 1cm. So its pointless.

6. Cancer cachexia is a severe malnutrition. We can say that someone has cachexia if you can see skin and bones only. No blood markers to detect it. Usually it is clearly visible.

7. Pancreas removal is not a good idea. Its a very serious surgery.

In my opinion there is no point in worrying about pancreas cancer in your case. You could be worried if someone in your family have had it and died of it. Otherwise, if you do not smoke, the risk of this cancer is very low. Its a rare cancer.
Worrying about it, would be similar to worrying that you will die of a car accident. The chance of getting pancreas cancer seems similar to the chance of dying from a car accident.

Hope this helps. Feel free to ask further questions.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 21 hours later
Hello Dr-

This was very helpful explanation. I had only one remaining question. Could these symptoms be precancerous? I also did a thyroid test that came out negative.
doctor
Answered by Dr. Grzegorz Stanko 40 minutes later
Brief Answer:
It does not seem to be from the cancer.

Detailed Answer:
This symptoms can be due to some gastrointestinal disease. Any cancer of GI tract is hardly probable at your age. So it makes inflammatory bowels disease much more possible. How about having colonoscopy done?
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 7 hours 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. Grzegorz Stanko 41 minutes later
Brief Answer:
Thyroid cancer should be ruled out.

Detailed Answer:
1. EUS is a very accurate test. Even more accurate than MRI is. So the chance of missing even a small tumor is very low. It is possible, if a doctor who performs EUS is not very experienced. Thats the main limitation of this method. Never heard about EUS missing a tumor.

2.From attached reports, everything seems fine. Except the CEA level which is extremely high. Are you sure its not a mistake? Apart from gastrointestinal tract cancer, CEA is also a marker of thyroid cancer. Have you had thyroid ultrasound done?

3. Thyroid cancer should be ruled out.
4. Thyroid ultrasound is a good idea as well as Calcitonine level. Lymphoma would be visible in most of performed tests (including regular blood work and CT). So lymphoma is not the case for sure.

The symptoms which you have can greatly appear due to H.Pylori presence. So why dont you try to eradicate it.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 13 hours later
You have been extremely valuable doctor! I have taken what you have said into consideration.

Please note the following:

1- I have had Thyroid tests and everything looks (T3,T4,TSH) looks normal.

2- I have repeated the CEA levels and they have reduced drastically. I suspect there was probably an error. Both Ca 19-9 and CEA are both normal. So is the CRP (< 1).

3- Antinuclear body negative.

4- I have attached the CT and MRCP reports for your review also.

I really appreciate all of your help.

Best-



3- I have also attached the MRCP report for your review. After doing the EUS, looks like there were only 2 gallbladder polyps.

4-









doctor
Answered by Dr. Grzegorz Stanko 10 hours later
Brief Answer:
No sign of a cancer.

Detailed Answer:
I have read carefully all attached reports. And believe me, there is no sign of any malignancy at all. You are examined as accurate as its possible nowadays, so even small tumors would be visible for sure. As the CEA and other markers are fine, this also makes lack of cancer evidences.
In simple words, there is absolutely no reason to even think about a cancer. Generally cancer is a disease which affects people over the age of 50. Thats the right time to worry about it. At your age, its time to live and use young body as much as it is possible. Your immune system is active and can deal with cancer cells (they do appear ever single day in every human body, just are constantly eliminated by immune system).

Your symptoms might be due to constant thinking about possible cancer. Some foods intolerance, small intestine bacteria overgrowth can cause them as well. But no sign of a cancer.

Just a thought. Why dont you try Rifaximine treatment (for small intestine bacteria overgrowth). Sometimes, when we can not establish the reason of GI tract symptoms, this special antibiotic becomes a great solution. As gasro doctor about it.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 22 hours later
Thanks a lot doctor! You were very helpful and have given some very detailed explanations.

Best-
doctor
Answered by Dr. Grzegorz Stanko 14 minutes later
Brief Answer:
You are welcome.

Detailed Answer:
You are welcome.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 8 minutes later
Doctor-

Before I close the thread, One final question came to mind.

1- What actually causes the pain in Panc. Canc. Is it the cancer cells themselves or something else?

2- If timor is large enough to cause pain, will it be picked up on CT, MRCP, EUS?

3- Why do many Pancreatic Cncer patients have high liver enzymes in blood?

That's it for me! Thank you very much!!

doctor
Answered by Dr. Grzegorz Stanko 18 minutes later
Brief Answer:
Please find the answers below.

Detailed Answer:
1. Pancreas cancer causes pain when it infiltrates nerves or blocks bile duct or pancreatic duct. So it must be pretty large to give such symptom. Single cells or small tumor are completely painless. Thats why the cancer (not only pancreas) is diagnosed so late. If it caused the pain as a small tumor, its treatment would be much easier.
2. Tumor is visible in this tests much earlier than it gives any symptoms.
3. It can be due to bile ducts obstruction or liver metastases.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5768 Questions

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