12/06/02 Following a bout with extreme abdominal pain my gastroenterologist set up an abdominal Ultrasound. No gallstones were seen. The spleen is mildly enlarged measuring up to 14cm. 12/19/02 A blood test reveals a high Lipase level (156). Went on a liquid diet to rest my pancreas. 12/26/02 I had an abdominal CT that showed an enlarged pancreatic head and uncinate process. 12/30/02 An MRI showed an ill-defined lesion measuring about 3.0x4.0cm involving the head and uncinate process of the pancreas with mild pancreatic duct dilatation. 01/02/03 Went on a fat free/low fat diet & began taking Pangestyme CN20 with meals. 02/05/03 Endoscopic Ultrasound & fine needle biopsy showed a large mass at the head of the pancreas and uncinate process, along with multiple small nodes & obstructive chronic pancreatitis to the body & tail of the pancreas. The finding is highly suggestive of a neoplastic disease. The differential diagnosis will include pancreatic carcinoma and lymphoma. 02/07/03 The Cytopathology report from the EUS came back as follows: Microscopic: Smears and cytospin preparations reveal few clusters of morphologically benign-appearing pancreatic ductal cells in a background containing abundant red blood cells and few acute inflammatory cells. Few clusters of epithelial cells show slight enlargement of nuclei with prominent nucleoli suggesting a reactive change. Cell button concurs. However, one small cluster of few cells are identified which contain nuclei with irregular nuclear membranes and prominent nucleoli. Similar cluster are also identified on the sure path preparation.
I have since met with 2 surgeons & 1 Oncologist regarding the Whipple procedure. One thinks I need to go for it soon & the other would like to see results from a blood test for tumor markers that he ordered and a PET Scan scheduled for 02/18/03. The Oncologist wants me to do an ERCP, but the guy who did my EUS said it wouldn't serve a purpose. I keep getting conflicting reports from each Doctor.
Some questions I have: - I have heard that the tumor marker test and PET Scan are not considered reliable for pancreatic cancer. Am I just wasting time & money? - I have heard bad stories about pathology reports. Should I have these slides tested elsewhere? - How rare is it for someone my age to have pancreatic cancer? - My abdominal pains have subsided with the change in diet. If I have cancer wouldn't I be feeling progressively worse? - Are there any other diagnostics I can do before undergoing such a drastic surgery as the Whipple? - Is the Whipple my only chance at survival if it is pancreatic cancer? - How fast do I need to act? - I do have an appointment with Dr. Howard Reber at the UCLA Medical Center. I have heard he is regarded as a top pancreatic specialist. Do you know if I might be better served at another facility or other doctors to handle my case?
Thank you so much for your time. Please feel free to forward this e-mail to anyone that may be of assistance. E-mail me at steve22007 @aol.com.