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Family history of ovarian cancer. Have had asthma and pneumonia. Feeling fatigue, nausea and back pain. Any ideas?

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Internal Medicine Specialist
Practicing since : 1996
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I'm a 34 y/o white female. Family history of ovarian cancer. I have a history of asthma. I've had pneumonia 6 times in this last year. I've had non painful bilateral swelling of my supraclavicular lymph nodes which are hard and non moveable for 80+days. I have had severe fatigue (when I used to take medicine for insomnia and haven't needed that for quite some time now), I have very noticeable abdominal distention (when I've always been thin), abdominal cramping, severe low back pain, incontinence, nausea and occasional vomiting, constipation and I feel feverish practically daily but haven't had one. Recently in the past few days I've had an increase in breathless/sob, shoulder pain and pain in my shoulders when I breathe in. Please help? I appreciate any ideas/advice!
Posted Thu, 18 Oct 2012 in Medicines and Side Effects
Answered by Dr. Prasad Akole 1 hour later
Dear friend,
A well asked query indeed!
I am a bit concerned here.

History of ovarian cancer in the family, hard supraclavicular nodes, abdominal distension, breathlessness all point to a possibility of a cancer somewhere. Usually intra-abdominal and gut cancers spread to the supraclavicular nodes on the left. Infections can sometimes cause these nodes to enlarge but are not hard as judged by an expert.

Asthma can cause breathlessness, but you must be used to the symptoms so you can differentiate if it is something different.

Please do not mind to answer some of my questions here.

What was salpingectomy done for?

Can you add details to the symptoms?

Have you been thoroughly evaluated for abdominal pathology?

If not, I would advise a complete physical check-up, complete blood lab work (routine), USG abdomen / pelvis, a PAP smear, Gynaecology consultation to look for new developments, supraclavicular lymph node biopsy (can tell sure-shot what it is), X-ray chest, ECG.

You may need CT scan of the abdomen/ pelvis and thorax after physical, if suspicious. If there is any fluid collection in the abdomen, it needs to be tapped and checked and tumour markers are required if cancer is a possibility.

A hunt for any cancer is first move; then the differentials remain for cardiac and respiratory sources of symptoms.

It would be great if you could upload any reports, images, details of past consults here using the site’s uploader below the text box. You have a feature to upload the reports / image by yourself at the right side of the query page, please utilize that so that I can answer your queries better.

Was the pleural effusion drained last time and checked for cytology/ cancer cells?

Take care and please keep me informed of your progress.
Good Luck!
I hope to have answered your query satisfactorily. Would be glad to answer any follow-up queries.
Thank you!
Above answer was peer-reviewed by
Follow-up: Family history of ovarian cancer. Have had asthma and pneumonia. Feeling fatigue, nausea and back pain. Any ideas? 57 minutes later
Hi, thank you for following up so quickly! I'm a nurse so I do understand terminology etc. I am aware that the left node supraclavicular filtrates for abd etc and right for lung etc. Is it common for both of my nodes to be so swollen and hard? I have no s/s of any infection anywhere. I do feel feverish every morning and some throughout the day but anytime I've taken my temp it has been normal. My recent intensity of my breathlessness/sob is unlike my normal asthma symptoms. Also recently, during inspiration I have pain in my shoulders/ supraclavicular area. My neck feels stiff almost constant recently also. With chest pain also. My asthma medication has not been helping me lately and my anxiety had increased due to my increased sob and pain. Along with my abd distention and cramping, constipation, incontinence (severe at night and I'm only 34), severe fatigue, nausea, back pain, I did forget to mention strange vaginal discharge quite often. I had a salphingotomy in 2004 for an ectopic pregnancy and then a lap w/ salpingectomy in 2009 for a ruptured ectopic. Both same side. I still have both ovaries and my left tube. When I had pleural effusion it was not drained or checked. I do not understand why I have had pneumonia so many times in one year. I have not been evaluated for abd pathology yet nor had any testing. Will a doctor do a bx of my nodes definitely? I would like that. I am hoping to get examined soon. Which doctor do you suggest would be the very best for all of my symptoms? What kind of cancer would you be suspicious of? Also I was wondering why you mention cardiac testing??? I in general just feel absolutely horrible. It's getting harder and harder to breathe everyday and all of my symptoms are so very uncomfortable. Especially the sob and incontinence. In your opinion, is incontinence a symptom of anything you have in mind? Cancer or ? I do not have anything I can upload or send to you as of yet since I have not been evaluated yet but once I do I would be happy to send to you for your opinion. One last thing, is this something you considered normal for a 34 yr old to be going through.
Thank you so very much!
I look forward to hearing back from you very soon!

Answered by Dr. Prasad Akole 1 hour later
Thanks for an elaborate description.

I know I am giving you a frightening picture of diagnosis.

But in my opinion, your picture is not good for a 34 year female and definitely makes me think of a genital tract or GI cancer with metastasis as first differential.

Granulomatous diseases, connective tissue diseases, lymphomas can cause bilateral/ multi-site lymphadenopathy, but no ‘hard’ nodes. Only cancer can cause hard, fixed nodes.

With your genito-urinary symptoms, I would advise you to see a good gynaecologist first, get a thorough gynaecologist check up and XXXXXXX exam, USG abdomen/pelvis and/TV USG.

I would now modify my suggestion to a full blood work including CBC, urine routine, LFT, RFT, ESR, PAP smear, X-ray chest, ECG as baseline evaluation.
Ask your gynaecologist to evaluate the nodes and if biopsiable, get them biopsied by a surgeon.

You may need a CT abdomen, pelvis and HRCT thorax to look for pathology there.

Recurrent pneumonia 6 times is surprising and I wonder if there is malignant involvement there and a malignant effusion which can cause increasing shortness of breath that you have.

Cardiac causes of breathlessness were in my mind early, but now seem less likely. Though an echo can show if there is a malignant pericardial effusion.

You can show an internist to differentiate causes of SOB.
You can get admitted to a good tertiary care centre, get all these done quickly and get a clue to the diagnosis and confirm or rule out malignancy. If no cancer found, will think of other causes as described above.

With distant consultation, I think this is best I can advise right now.
Would revert with more once you post more details and test results.
Be fast and positive about your evaluation.

Hope to have guided you well and you will happily rate it well before you close your query (if you have no immediate follow-up queries).

Will await follow-up.

Thanks and good luck.

Dr. Prasad Akole
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