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Thread: Accuracy of CT Scan of the Pancreas

  1. #1
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    Accuracy of CT Scan of the Pancreas

    Hi,

    I'm interested to know if anyone knows how accurate a CT Scan is to detect pancreatic cancer? The doctor requested a ct scan with pancreatic protocol, I don't know exactly what that means, all it says on the radiologists report is 'multiple phase ct pancreas including non-contrast, post contrast during portal venous, arterial and delayed phases'. The scan came back clear.

    I would like to know how certain the above is in ruling out pancreatic cancer.

    A bit of background....

    I am a 41 year old male. I consider myself to be fairly healthy, I like to eat relatively healthy, enjoy exercise and rarely drink alcohol. I am 180cm tall and weigh around 74kgs.

    About 4 months ago I started to experience a vague pain that moved around my lower abdomen, this pain is now predominately in my lower right abdomen (to the right of the belly button) and sometimes in my right hand side. It is not constantly there, it comes and goes. About two months ago I developed a dull pain/ache deep in my upper back, in between my shoulder blades, a little to the right, again this is not there constantly, it comes and goes. I have had muscle pain in my back before from over exerting myself in sport or lifting a heavy object, this is different to that type of pain, no as intense.

    During the past 4 months, I have had various other symptoms....

    Episodes of light headiness and dizziness.

    A racing heart/heart palpitations.

    An indigestion type feeling the indigestion feeling isn't a heartburn type feel, but more of a feeling that something is stuck in my throat that is ready to come up back up (but doesn't), I have been getting a mild feeling of nausea with this as well. I went through a period of a few weeks where I was belching excessively immediately after eating (this had now subsided, though has come back more mildly on a few occasions)

    Periods of fatigue. I am normally an active 'get up and go' kind of guy, though I started to feel very lethargic and unmotivated.

    Instances of getting a bad chemical taste in my mouth, I also noticed that when drinking beer it tasted disgusting and not at all as it normally does.

    My belly constantly pulses up and down, which is especially noticeable when sitting or lying down. I have been told this is completely normal though it's something I have never experienced before. I also know that I'm not overweight though I certainly have belly fat.

    Changes to my normal bowel habits.

    No one has been able to give a diagnosis of my symptoms. Anxiety and depression have both been suggested and I was firstly prescribed Amytriptylene for IBS, then Mirtazapine for anxiety. I do think that I have anxiety regarding these symptoms, though that has happened since the onset of the abdominal pain and when the pain first occurred I was very happy in my life.

    I have had blood tests, a colonoscopy and endoscopy and nothing untoward has showed up. I appreciate that I have had a lot of testing, which has come back clear, though I also know that PC is not always picked up from CT scans and that sometimes it is missed or that alternative testing is required.

    I'm not saying I'm convinced I have PC, though it certainly has been a worry for me. I would just like to know how confidently it could be ruled out.

    Thank you

  2. #2
    Super Moderator Top User po18guy's Avatar
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    It is awfully hard for any cancer to hide from such a scan. Any cancer that was providing such wide-ranging and profound symptoms would have to be huge. No sign of any such thing was found. If a physiological cause cannnot be located, then a psychological cause may be at fault. I am quick to mention anxiety, inasmuch as the majority - if not all - of your symptoms are very easily anxiety-driven. 20% of people in our culture and society suffer from some form of anxiety. It is truly a major epidemic. As to the symptoms it can produce, have a read, and be certain to scroll all the way down the page: https://www.anxietycentre.com/anxiety-symptoms.shtml

    Who first thought "Cancer"?

    And who first suggested anxiety?
    05/08-07/08 Tumor appears behind left ear. Followed by serial medical incompetence on the parts of PCP, veteran oncologist and pathologist (misdiagnosis via non-diagnosis). Providential guidance to proper care at an NCI designated comprehensive cancer center.
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    DEXA scan reveals Osteoporosis.
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    09/16/16 Three skin punch biopsies.
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    To date: 1 cancer, relapse, second relapse/mutation into 2 cancers, then 3 cancers simultaneously, 20 chemotherapy/GVHD drugs in 11 regimens (4 of them at least twice), 5 salvage regimens, 4 clinical trials, 5 post-transplant immuno-suppressant/modulatory drugs, the equivalent of 1,000 years of background radiation from 40+ CT series scans and about 24 PET scans.
    Both lymphoid and myeloid malignancies lend a certain symmetry to the hematological journey.

    Believing in the redemptive value of suffering makes all the difference.

  3. #3
    Super Moderator Top User ddessert's Avatar
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    The CT scan using a pancreas protocol is our finest test for pancreatic cancer. It could detect a tumor smaller than 5mm. It is likely a tumor that’s all would not be causing all the problems you are seeing. Often tumors are 2cm or larger before symptoms appear. Those would be easily detected by your scan.

    You didn’t say how long after symptoms appeared that you had the CT scan, but if it were a tumor, it would have been increasing in size. That makes it even less likely to escape detection.

    Many of your symptoms are not related to pancreatic cancer. Pain would not be in the upper back, and it doesn’t generally cause heart palpitations, light headedness or dizziness.

    It’s not unheard of that a 41-year old could get pancreatic cancer, but it would be unusual. The median age of onset is about 70 years old.

    You’ve had the gold standard scanning method for pancreatic cancer and there’s nothing better.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - IMRT+Xeloda
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919
    @pancanology

  4. #4
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    Quote Originally Posted by po18guy View Post
    It is awfully hard for any cancer to hide from such a scan. Any cancer that was providing such wide-ranging and profound symptoms would have to be huge. No sign of any such thing was found. If a physiological cause cannnot be located, then a psychological cause may be at fault. I am quick to mention anxiety, inasmuch as the majority - if not all - of your symptoms are very easily anxiety-driven. 20% of people in our culture and society suffer from some form of anxiety. It is truly a major epidemic. As to the symptoms it can produce, have a read, and be certain to scroll all the way down the page: https://www.anxietycentre.com/anxiety-symptoms.shtml

    Who first thought "Cancer"?

    And who first suggested anxiety?
    Thank you for your reply. My rational side agrees with you, maybe it is irrational to get carried away looking up symptoms, but when it is ongoing for 4 months and no one can give a diagnosis or a reason for your symptoms, I guess it's human nature to go searching for answers yourself.

    I accept my anxiety, who wouldn't have anxiety reading about such a scary prognosis. Though, my symptoms appeared before the anxiety set in, I have got the anxiety more under control now, though the symptoms are still there.

    Thank you again for taking the time to reply, it has reminded me to be rational if the anxiety sets in again.

  5. #5
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    Quote Originally Posted by ddessert View Post
    The CT scan using a pancreas protocol is our finest test for pancreatic cancer. It could detect a tumor smaller than 5mm. It is likely a tumor thatís all would not be causing all the problems you are seeing. Often tumors are 2cm or larger before symptoms appear. Those would be easily detected by your scan.

    You didnít say how long after symptoms appeared that you had the CT scan, but if it were a tumor, it would have been increasing in size. That makes it even less likely to escape detection.

    Many of your symptoms are not related to pancreatic cancer. Pain would not be in the upper back, and it doesnít generally cause heart palpitations, light headedness or dizziness.

    Itís not unheard of that a 41-year old could get pancreatic cancer, but it would be unusual. The median age of onset is about 70 years old.

    Youíve had the gold standard scanning method for pancreatic cancer and thereís nothing better.
    Thank you for your reply.

    Please excuse my ignorance on this, but does 'multiple phase ct pancreas including non-contrast, post contrast during portal venous, arterial and delayed phases' mean I had a CT scan with pancreatic protocol?

    It was around 2 1/2 months from the onset of the first symptoms to the ct scan of the pancreas. I did also have a general abdominal CT scan before the specific pancreas one, the only thing of note was mild divertucolosis and two sub centimetre cysts on the liver, my gp said that neither were of any concern.

    Is that scan the 'gold standard' ? From my reading, I assumed that EUS was the most accurate imaging tool for diagnosis, is that not the case?

  6. #6
    Super Moderator Top User ddessert's Avatar
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    That CT scan sounds like the pancreas protocol. Both the EUS and that CT scan are considered the gold standards. The EUS is much more invasive but also allows for a biopsy if they find something.

    We like to look for one cause for our symptoms, but in the difficult cases, it’s quite likely that there may be multiple causes that make the diagnosis difficult. And as you say, the long period of testing heightens any anxiety and confounds the diagnosis even further.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - IMRT+Xeloda
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919
    @pancanology

 

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