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Chances of PANCREATIC CANCER with irritable bowel symptoms.

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Hi, I am a 51 y/o cauc male, 5'10", 228, have lost 14 pounds since Jan 1 due to diet and exercise. I have had irritable bowel symptoms for three months ie, regular stools, stools that float, loose stools. buttery foods give me diarrhea. I have had left sided rib pain for three months which I thought was related to sleeping on my side. I have twinges at the anterior left border of my rib cage- do not take any meds and the sensation is not constant. I lean over a lot in my work and I also have some upper back (middle/spine pain) and some left sided posterior muscle pain. My family history is positive for father with prostate cancer (age 75) successfully removed, father has had melanoma removed successfully, mother and father have hypertention, siblings have hypertension. My last physical exam revealed completely normal metabolic panel with low HDL and slightly elevated triglycerides- the total cholesterol was 164. My weight was 231 last year, was 232 last week. PCP has ordered urinalysis which came back unremarkable, I am waiting on C-reactive protein and sed rates (hopefully tomorrow) and Friday I have ultrasound and chest x-ray. note, last ultrasound was negative with the exception of two little cysts in my liver. So my questions are: What are my chances of having pancreatic cancer? 2) I am so stressed out by this- I am going to need medication to help with the anxiety. I'm looking for help here as I navigate this scary time of my life


Category: Internal Medicine Specialist

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Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello,

Thank you for choosing DoctorSpring.

I understand your concern and I will try my best to help you out here.

Your concern (and hence the anxiety) is because you might have analysed (or searched in google) your symptoms in isolation.

It is true that weight loss, floating stools and back pain can occur in pancreatic cancer. (Rest of the symptoms are not specific or suggestive). But the fact is that you do not have a symptom pattern. It is bit difficult to explain how a symptoms pattern will look like, but in a patinet with pancreatic cancer there will be very noticeable weight loss without any cause. There will be loss of muscle and body bulk. (I am sure that your weight loss was rather trimming). There will be jaundice and itching. Vague abdominal swellings, pain etc can occur. Back pain is kind of a boring radiating page. Of course all these occurs in later stage.

More over you had IBS, and diet modification which resulted in weight loss and other symptoms. Your symptoms are explainable otherwise. So what I feel is that there is no additional risk or suggestive features of Pancreatic cancer. (Although certain isolated symptoms are there. ). So you should relax. Out of my experience I am pretty sure that your USG will turn out normal.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Thank you for your informative response. I received the results of my urinalysis and all were WNL. I am waiting of C reactive protein and sed rate results. Two more questions for you. 1) Since I have been so stressed out about my ultrasound- will this affect the blood tests (which she is using as a general consensus of inflammation throughout my body? 2) The fact that my urine tests are normal- does this bode well for the fact that my pancreas is working as expected. 3) Last question... if I east something rich with fat/butter, it makes me run to the bathroom- would this be part of the IBS syndrome. Thank you for your compassion


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,

1. No being stessed will not affect the blood test. Anyway tests for inflammation are non specific in general, so it does not matter anyway

2. No urine analysis will not any solid clue regarding a Pancreatic Cancer. However certain findings (urobilinogen ) can suggest jaundice which in turn might suggest Pancreatic cancer. A normal urine test will not rule out pancreatic cancer.

3. Yes this is an IBS related symptom . Called Gastrocolic reflex induced by fat containing diets

Hope this helps
DO Feel free to ask followups
Thank you


Patient replied :

Thank you again for your help. I learned that my c reactive protein and sed rates are WNL. Tomorrow I have the ultrasound and a chest x-ray. I am praying that both are WNL. Any chance that the inflammatory markers are WNL should put my mind at ease? Going forward, I obviously am in need of some behavioral health care. I believe that I probably need some medication for past OCD and now this obsession with contracting pancreatic cancer (rationally I know it is rare, but since so many famous people seem to have expired from this disease). Any recommendations going forward regarding lifestyle and mental health so that I don't have to go through this hell again? I appreciate your compassion


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello,

The negative inflammatory markers is a good sign of-course (although it specifically does not rule out a cancer) . Do get an annual Physical examination done along with PSA (prostate specific antigen). This + chest Xray + Ultrasound can assure you that you are in good health. Do not worry about the Ultrasound. Most likely it is going to be very Okay.

Regarding the anxiety and apprehension. You DO NOT have an anxiety disorder or OCD. This is because you have what is called a preserved insight and a trigger. There is an anxiety precipitating event (the ultrasound and the fear of cancer). And you do have the realisation or 'insight' or realisation that your fear and anxiety is bit irrational. So you have this isight there is nothing much to worry. Once the issue is resolve it should be alright. Treatment need to considered only if this persists even after sometime.

Meanwhile you can keep yourself engaged in some hobbies you enjoy. It can be some relaxation techniques too. Music, movies, yoga , whatever works for your should be fine.


Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Thank you again doctor, the last question I'll ask deals with the reflux or heartburn that I have experienced over the past week or so worrying about these exams? could the stress give me temporary GERD? could dieting lead to reflux as well? Will this show up on an ultrasound as well? thank you


Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.


Stress in one among the top 3 cause for Gastric Ulcer symptoms. It can precipitate GERD. Dieting, if involves skipping any meal can result in erosion of stomach due to the acid secretions - worsening the symptoms of GERD. (These ulcer are indeed called stress ulcers). You can take an OTC anti ulcer medication like Prilosec once a day without food. (in the night just before sleep or early morning). This will take care of the symptoms

Thank you


Dr. Deepu Sebin Sebastian
Category: Select Speciality
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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