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Pain in chest with history of BREAST CANCER, IBS.

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49 yr old woman, history of breast cancer (double mast, ER/PR-, no nodes, no mets, regular checks, since 2008), with history of Irritable Bowel syndrome. 5'4", 133lb, BP 110/70, smaller build.

I recently developed new pain- abt a month now- under right rib cage. Coming and going. Defiitely worse in the am, relief with bm usually, alternating btw cons and diarrhea. Stools flatter or long. Have been in very stressful situation (moved loved one to hospice), so attributed to stress aggravated IBS. Pain started to refer to right back shoulder blade. Concerned, mentioned to gyn- no, not the correct doctor, but in for yearly, who suggested gallstones and order an ab ultrasound. Pain comes and goes, not severe, but seems to go when I am able to go to the bathroom.

US results are back and I'm very alarmed. There are no gallstones, but report is showing liver is at borderline size of large. Actually, as I am a smaller built woman, I fear it IS rather enlarger. (attaching report). "the liver is borderline in size measuring 17.3 cm in length. This may be related to Riedels' lobe."

I have had a few CTs done over the years and none have ever mentioned a larger liver. (There has been noted a less than 2mm hypodense spot too small to characterize, but it has remained unchanged over the years, so deemed not something to worry about.)

I also recently had bloodwork done. AST and ALT are normal, and in fact, lower than on past reports.

Of course-- I am fearing liver metastasis from the breast cancer. It's been 7 years now and I know that triple negs tend to metastasize early( Was Stage 1, 1 cm with no node involvement. Chemo and breast removal), so I'm hoping that counts in my favor.

I know ultrasounds have limits. My question is this--- with normal liver enzymes and no hepatic masses noted-- does this enlarged liver still point to cancer.

I guess I am just frightened and looking for a little clarity and hope to hang on to while I wait to get in for a CT.

Thank you for your consideration

Category: Family Physician-GP

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Patient replied :

Thank you for your response. I also know that I have irritable bowel syndrome, which ramps up when under stress or with my period- both of which I'm dealing with now. I've read there can be association with ibs and flat stools? Colonoscopy 3 yrs ago showed no polyps- I'm hoping that anything that might have developed since then wouldn't generally grow large enough to obstruct in that time. I know you can diagnose that without imaging. Trying to get in to see gastro doc but first appt a month month away. Trying to calm nervesuntil then. Could it also be a by product of ibs? Thank you

Yes you are right. Irritable bowel syndrome also can cause flat stools.
Since you did not mention about IBS in your medical history in the first post, I did not discuss about it.
So you need not worry about your one side flat stool.
And as I said earlier hemorrhoids do not cause it.

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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