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What Do My Lab Test Reports Indicate?

Posted on Tue, 31 May 2016

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.

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 does hyperechoic pancreatic duct wall but not dilated mean? Does this suggest pancreatitis or pancreatic cancer? Could you explain this in simple terms?

Had CT- Negative (John's Hopkins) -- See Discharge Report attached.
MRCP- Unremarkable
Endoscopic Ultrasound- Unremarkable (Columbia Asia Hospital Bangalore)

HEP A,B,C- Negative
Total Bilirubin- .82 AST-28 ALT- 40 ALP- 36 CA- 19.9- 9.1 T3- 1.1 T4- 7.88 TSH- 2.6

Answered by Dr. Indu Kumar (53 minutes later)

Brief Answer:
Only findings is gastritis and you may need specific medicines for H.pylori

Detailed Answer:
Hello
Thanks for writing to HCM ,
I've gone through your query as well as all the reports and understand your concern.

Investigations doesn't indicate pancreatic cancer. Combined investigations must had been detected cancer if there is any(even small size may be detected by these combined tests). Combined investigations are very sensitive and it almost can't miss cancer.

Only findings is gastritis and you may need specific medicines for H.pylori infection. I'd suggest you to check with a Gastroenterologist for the therapy for H.Pylori eradication..

Gall bladder polyps is a benign condition and it may only require follow up.

So, please don't worry much.Findings are almost safe.
XXXXXXX Asia Hospital in XXXXXXX is a very reputed hospital and we can trust the findings.

I don't think you need PET scan, it is not indicated in your case.

Pancreatic duct is also normal(dilated pancreatic duct is an abnormal condition and it may indicate pathology).

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Indu Kumar (1 hour later)

Hello Dr.-

Based on the imaging test, would pancreatic cancer be found? So, the fact that there is no dilated duct, does that mean no cancer?

Also, wouldn't a PET be conclusive test? Do you know if small tumors can be missed by EUS?

Hello Doctor-

Just following-up on your response.

Best-

Answered by Dr. Indu Kumar (16 hours later)

Brief Answer:
EUS is not expected to miss even small pancreatic mass.

Detailed Answer:
Hello
Thanks for writing to HCM
Sorry for replying late

Dilated main pancreatic duct is usually due to chronic pancreatitis,mass etc.
It is good that pancreatic duct is normal.

EUS is not expected to miss even small pancreatic mass.
EUS is highly sensitive and specific for tumours <1.0 cm,so don't worry at all.

I don't think you will require PET scan.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Indu Kumar (20 minutes later)

Thanks Dr.

I really appreciate your help and expertise. Speaking with you is definitely helping me out and I sincerely appreciate your time and effort especially on a Sunday. Your words are encouraging.

I just have a few more questions that I think if you answered could provide me with better relief as I have been provided with conflicting advice from a general surgeon.

1- The EUS report- I have one question about the report and am having trouble understanding what is meant by hyperechoic pancreatic duct wall, but not dilated? I am confused that the duct can be hyperechoic and not dilated? Does this mean it is the pre-malignncy stage of pancreatic cancer? I had a surgeon consultant tell me that this is edema and could be chronic pancreatitis, however, the gasterenterologist that performed the procedure indicated NO lesions and no Dialtion, which equates to no Chronoic Panreatitis?

2- In your years of experience, do you know if a tumor were less than 1 cm, would it cause problems like this? EUS i know is very accurate, however, do you know of how accurate it is for the diagnosis of pancreatic cancer? I know you mentioned CT scans were around 80%.

Thanks so much doctor!

Answered by Dr. Indu Kumar (15 hours later)

Brief Answer:
EUS is highly sensitive,it is almost 100 % sensitive.

Detailed Answer:
Hello
Thanks for writing to HCM
Sorry for replying late

I agree with your gastroenterologist. Findings doesn't indicate chronic pancreatitis.
Edema doesn't cause hyperechoic wall.Hyperechoic wall may be due to fat deposition. It is not a premalignant finding.

EUS is highly sensitive,it is almost 100 % sensitive.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Indu Kumar (3 hours later)

Thanks for your reply doctor.

Can a PET help to rule out other cancerous processes?

Answered by Dr. Indu Kumar (6 hours later)

Brief Answer:
PET is helpful in diagnosing and staging many type of cancer.

Detailed Answer:
Hello
Thanks for writing to HCM

PET is helpful in diagnosing and staging many type of cancer.
PET scan alone is not primarily used for diagnosing pancreatic cancer. It is generally combined with CT scan for diagnosis.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Deepak

Follow up: Dr. Indu Kumar (21 hours later)

Hello Thanks Doctor!

1- I have attached my MRCP and CT reports. Could you kindly have a look at let me know if there is anything of concern.

2- Have I sufficiently ruled out GI malignancy?

Thanks so much for your expertise and guidance!

Answered by Dr. Indu Kumar (16 minutes later)

Brief Answer:
Findings are benign and it may only require follow up.

Detailed Answer:
Hello
Thanks for writing to HCM

I have gone through all the reports in detail.
Findings are benign and it may only require follow up.
Gall bladder polyp is a benign condition.
Diverticulosis in colon may require follow up.

Findings dont support intestinal malignancy at all. So, don't worry at all.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Indu Kumar (48 hours later)

Dr-

Many thanks for all of your assistance and constant reassurance of a lack of malignancy.

My symptoms still persist, however, eus is clean. Could the symptoms not be related? I am unsure how pancreatic cancer manifests itself and perhaps you could educate me on how these symptoms present themselves.

Answered by Dr. Indu Kumar (1 hour later)

Brief Answer:
Pancreatic cancer may present in various ways.

Detailed Answer:
Hello
Thanks for writing to HCM

Pancreatic cancer may present in many ways like pain abdomen,jaundice,weight loss etc.

Unexplained vague pain abdomen may be due to psychological causes.I suggest you to consult psychiatrist once,it may be helpful.I have seen many such cases which are benefited.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar