Next Steps for Suspected Pancreatic Cancer: Essential Tests and Recommendations

If pancreatic cancer is suspected, what further tests should be conducted?

Hello Doctor, in mid-September, I sought medical attention due to abdominal discomfort and occasional back pain.
After undergoing an electrocardiogram and gastroscopy, I was diagnosed with erosive esophagitis and started medication treatment.
However, by early October, there was still no improvement.
The symptoms of abdominal discomfort and back pain worsened after eating, especially with slightly oily foods like instant noodles.
I lost 5 kilograms over 20 days, which made me anxious, so I underwent blood tests, an abdominal CT scan, and an abdominal ultrasound.
The doctor informed me that everything was normal, including pancreatic enzymes, liver enzymes, white blood cell count, and inflammatory markers.
I was prescribed pain relievers and muscle relaxants, but there has still been no improvement.
Currently, my symptoms include increased back pain while lying down, as well as discomfort that requires me to sleep on my side to fall asleep.
After eating, I experience discomfort in the left abdomen and back pain as well.
Sitting in a chair with my back against it is also uncomfortable.
I am very worried about the possibility of pancreatic cancer due to similar symptoms.
Should I undergo an MRI for confirmation, or do you have other recommendations? Thank you.

Awei, 30~39 year old female. Ask Date: 2021/10/14

Dr. Chen Shidian reply Gastroenterology and Hepatology

Monitoring is the primary focus, and there are currently no other recommendations.

Reply Date: 2021/10/14

More Info

When facing potential pancreatic cancer, especially with symptoms such as abdominal pain, back pain, and significant weight loss, it is crucial to approach the situation methodically. Your concerns are valid, and it’s essential to ensure that all necessary evaluations are conducted to either confirm or rule out a diagnosis of pancreatic cancer.

Recommended Next Steps:
1. Consultation with a Specialist: Given your symptoms and the ongoing discomfort, it is advisable to consult a gastroenterologist or an oncologist who specializes in pancreatic conditions. They can provide a more comprehensive evaluation and guide you through the necessary tests.

2. Imaging Studies: While you mentioned that a CT scan and ultrasound were performed, if there is still a high suspicion of pancreatic cancer, an MRI can provide additional detail. MRI is particularly useful for visualizing soft tissues and can help identify any subtle lesions that may not have been detected on previous imaging. Additionally, an MRCP (Magnetic Resonance Cholangiopancreatography) can be beneficial in visualizing the bile ducts and pancreatic duct, which can help identify any obstructions or abnormalities.

3. Endoscopic Ultrasound (EUS): This is a highly sensitive procedure that combines endoscopy and ultrasound. It allows for a closer examination of the pancreas and surrounding structures. EUS can also facilitate fine-needle aspiration (FNA) biopsy if any suspicious lesions are found, providing a definitive diagnosis.

4. Blood Tests: Although initial blood tests showed normal pancreatic enzyme levels, it may be useful to check tumor markers such as CA19-9 again. While CA19-9 is not specific to pancreatic cancer and can be elevated in other conditions, a significant rise could warrant further investigation.

5. Symptom Management: In the meantime, managing your symptoms is crucial. If pain persists, discuss with your doctor the possibility of adjusting your pain management regimen. Sometimes, medications such as stronger analgesics or even nerve blocks may be necessary to alleviate severe discomfort.

6. Dietary Modifications: Since you noted that fatty foods exacerbate your symptoms, it may be beneficial to adopt a low-fat diet and avoid trigger foods. Keeping a food diary can help identify specific foods that worsen your symptoms.

7. Follow-Up: Regular follow-up appointments are essential to monitor your symptoms and any changes in your condition. If symptoms worsen or new symptoms arise, it is important to seek medical attention promptly.

Conclusion:
While the initial tests have returned normal results, your persistent symptoms warrant further investigation. Engaging with a specialist and considering additional imaging or procedures like EUS can provide clarity. It’s also important to manage your symptoms effectively and maintain open communication with your healthcare team. Remember, early detection and intervention are key in addressing any potential issues, including pancreatic cancer. Stay proactive about your health, and do not hesitate to seek further evaluations as needed.

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