Pancreatic Tumors: Symptoms, Diagnosis, and Treatment Options

Pancreatic tumor

Dear Dr.
Zhang Yuting,
Hello! I would like to briefly summarize my medical history for your reference.

1.
Hepatitis B (maternal transmission)
2.
Car accident (fractured jaw, surgery performed)
3.
Uterine fibroids (surgically removed approximately 0.6 kg)
4.
Chronic pancreatitis (recently confirmed as "chronic," previously hospitalized multiple times for "acute" pancreatitis)
On September 1 of this year, I went to the emergency department at X General Hospital due to severe pain in the upper right abdomen.
During the consultation, I informed the physician that I had a visit at X Ai Hospital on August 13 for the same issue.
After an X-ray examination in the emergency department on August 13, the doctor suspected an unknown tumor and subsequently performed a CT scan.
The doctor mentioned that there might be a concerning tumor, but after consulting with a surgeon, he felt that due to my young age, it was unlikely to be a malignant tumor.

Due to work commitments, I was discharged on the fourth day of hospitalization, August 17, as I had been hospitalized multiple times for pancreatitis and was somewhat aware of my health condition, with abdominal pain having lessened.
After discharge, I returned to work normally.
However, on September 1, I experienced severe pain in the upper right abdomen again and went to the emergency department at X General Hospital.
The physicians were informed of my previous visit to X Ai Hospital, so they were particularly attentive and conducted numerous tests (X-ray, ultrasound, CT scan, contrast-enhanced CT, endoscopy of the pancreatic and biliary ducts, etc.).

The doctors advised me to proceed with hospitalization and informed me that they would wait for the test results to provide detailed information.
After being admitted, the doctor immediately issued a critical condition notice.
My roommate inquired about this, and the doctor explained that it was a routine procedure.
For the three days prior to admission, I had been experiencing dizziness due to pain medication.
After inquiries from myself and my roommate, the doctors gradually revealed that there might be a concerning tumor (still referred to as "possible"), located at the junction of the head of the pancreas, the bile duct, and the duodenum.
The doctor informed me that if surgery were necessary, it would be a very extensive procedure.

However, since the doctors could not confirm anything, after seven days of hospitalization and feeling well (able to eat soft food), with only mild discomfort in the upper right abdomen that did not affect my sitting or eating, I was discharged on September 7 (the doctor advised me to return for a follow-up examination in three months).
After discharge, my condition regarding sitting and eating was very good (I had a history of alcohol abuse from ages 23 to 31, but miraculously, I have not touched alcohol since discharge, which my roommate can attest to).

Starting September 10, I began to experience dull pain in the upper right abdomen again, but it was not unbearable, so I have been enduring it until now (the pain can be sharp but is still tolerable).
I am not afraid of seeing a doctor or seeking medical attention, but due to financial reasons and to maintain my job (I have already lost a significant amount of salary due to taking leave in late August and early September), I do not want to take time off unless absolutely necessary.
I am not worried that the concerning tumor is malignant (I have a positive mindset), but currently, major hospitals do not offer weekend examinations, so I am seeking help through this channel.

I kindly ask for your assistance! Currently, I still experience pain in the upper right abdomen, sometimes dull and sometimes sharp (but still within tolerable limits).
I would like to know if the location of the tumor is particularly sensitive (concerning or troublesome), whether surgery is necessary if it is not malignant, and if it is malignant, whether surgery is absolutely required (and what the risks are).
Both doctors from the two hospitals agree that due to my young age, it is unlikely for me to have a malignant tumor, which is why I have been discharged whenever my pain lessens or my condition improves.
Is this approach good for my health? Given my current condition, do I need to seek medical attention immediately (preferably not due to financial constraints)? How should I address this pain or situation?
I appreciate your guidance and assistance!
Thank you for your response and help!

Ching, 30~39 year old female. Ask Date: 2003/09/12

Dr. Zhang Yuting reply Gastroenterology and Hepatology

Your issue is quite complex, and based on your description, the most likely problem is a chronic pancreatic neck tumor.
There are several possibilities regarding your pancreatic neck tumor: one is that it is a malignant tumor (as chronic pancreatitis is a high-risk factor for pancreatic cancer), and the other is a pseudotumor resulting from chronic pancreatitis.
These conditions are often difficult to distinguish clinically.
Additionally, the cause of your abdominal pain needs further clarification beyond whether it is due to chronic pancreatitis.
It is also important to investigate the underlying cause of your chronic pancreatitis.
There are currently new methods and techniques for managing pain associated with chronic pancreatitis and for differentiating the benignity or malignancy of your tumor.
Therefore, I recommend that you visit the outpatient clinic at National Taiwan University Hospital on Saturday for further evaluation and treatment.

Reply Date: 2003/09/12

More Info

Understanding pancreatic tumors is crucial for timely diagnosis and treatment. Pancreatic tumors can manifest through various symptoms, including abdominal pain, jaundice, weight loss, and changes in appetite. Given your medical history, including chronic pancreatitis and recent abdominal pain, it is essential to approach this situation with a comprehensive understanding of the potential implications.

Symptoms and Diagnosis
The symptoms you are experiencing, such as right upper abdominal pain and changes in appetite, can be indicative of pancreatic issues. In particular, pancreatic tumors, whether benign or malignant, can cause significant discomfort and may lead to complications such as bile duct obstruction, resulting in jaundice. The presence of a mass in the pancreas, as suggested by imaging studies, raises concerns that warrant further investigation.

The diagnostic process typically involves imaging studies such as ultrasound, CT scans, or MRI to assess the pancreas's structure and identify any masses. In your case, the CT scan findings indicating a suspicious mass in the pancreatic head are particularly concerning. The characteristics of the mass, such as its size, shape, and relationship to surrounding structures, play a critical role in determining the likelihood of malignancy.

Treatment Options
If a pancreatic tumor is confirmed, treatment options depend on several factors, including the tumor's type, size, location, and whether it has spread to other areas. Surgical intervention is often the preferred treatment for localized tumors, especially if they are resectable. However, if the tumor is found to be malignant and has metastasized, treatment may involve chemotherapy, radiation therapy, or palliative care.

In your case, the two hospitals' differing opinions on the nature of the tumor highlight the complexity of diagnosing pancreatic masses. While one facility suggested a benign hemangioma, another suspected a neuroendocrine tumor, which could necessitate immediate surgical intervention. This discrepancy emphasizes the importance of obtaining a definitive diagnosis through biopsy or further imaging studies.

When to Seek Immediate Care
Given your ongoing symptoms and the potential for complications associated with pancreatic tumors, it is advisable to seek medical attention sooner rather than later. While economic factors are a concern, your health should take precedence. Persistent abdominal pain, especially if it worsens or is accompanied by new symptoms such as jaundice or significant weight loss, warrants immediate evaluation.

Conclusion
In summary, understanding pancreatic tumors involves recognizing the symptoms, pursuing appropriate diagnostic imaging, and considering treatment options based on the tumor's characteristics. Given your medical history and current symptoms, it is crucial to follow up with a healthcare provider for further evaluation. While the financial implications of medical care are significant, prioritizing your health and addressing these symptoms promptly can lead to better outcomes. If necessary, explore options for financial assistance or community health resources that may help alleviate the burden of medical expenses.

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