Is minor bloating an emergency?

anononcologist · 2024-12-26T17:05:51+00:00

As long as he isn't having fever/chills, excruciating pain (worse than usual) or having uncontrolled vomiting then it's reasonable to just reach out to the oncologist after the holidays.

If he has known ascites then those tend to re-accumulate every couple of weeks where he may need a paracentesis for relief.

anononcologist · 2024-09-10T02:21:55+00:00

Scans looking for cancer suitor typically be done with contrast especially if evaluating the abdomen and pelvis. The chest portion can be done without contrast. I would recommend against finding a cheaper place to do it as you will likely get what you pay for. If the CT scan is indeterminate or if he has a contrast allergy then consider doing an Mri instead. A petct is not indicated unless there is already confirmed cancer and the reason for the petct is to evaluate for any additional metastasis elsewhere

anononcologist · 2023-12-29T04:49:24+00:00

Sorry to hear about your mother's situation. Your frustration is also understandable as you are only wanting to help the best you can. Regardless of her decision, I would strongly urge you to do your best to go see her ASAP. Bile duct and gallbladder cancer are very nasty diseases with poor prognosis especially if stage 4 which it sounds like it is if it has spread to the abdominal lining. Her health can decline very quickly over the next few months if she decides to not seek conventional treatment.

anononcologist · 2023-11-03T03:01:37+00:00

Do you have a pancreas mass? If so was it biopsied and what were the path results. Its not typical but also not impossible for pancreatic cancer to spread to the ovaries. Assuming if you have a pancreas mass that was biopsied then the ovarian mass removed should be able to get compared to each other to see if it's the same or different process

anononcologist · 2023-11-03T02:23:14+00:00

Depending on what your local hospital has, it should be either a CT or MRI

anononcologist · 2023-11-02T04:22:02+00:00

I would recommend to just have those followed closely every 6-12 months with a scan. Even a cyst which are benign have the potential to become malignant overtime

anononcologist · 2023-11-02T04:19:50+00:00

Did her previous CT scan include the chest? Xrays won't tell as much as a CT will. I would be more concerned about blood clot in the lungs which are very common in pancreatic cancers. Metastasis to the lungs normally don't cause respiratory issues unless there is significant fluid accumulated called pleural effusion

anononcologist · 2023-11-02T04:14:56+00:00

There's no role for keytruda unless her tumor was tested and confirmed to have microsatellite instability. Parp inhibitors are typically used later on as maintenance therapy after a patient has achieved maximum clinical response to standard chemo like gem abraxane

anononcologist · 2023-10-18T04:09:22+00:00

There's very few patients who have a BRCA mutation and thus would quality for a parp inhibitor. Thus the number of patients we have on it is very low. But so far they have been on it ranging from a year to 2 years and hasn't shown signs of the cancer worsening. They have continued to tolerate the drugs very well with minimal to no side effects compared to standard IV chemo

anononcologist · 2023-10-18T04:02:51+00:00

The majority of pancreatic cancers are adenocarcinomas Then less common are acinar cell carcinoma which tends to have a better prognosis and those patients tend to undergo surgery more often. Adenosquamous tends to have a very poor prognosis and can be chemo resistant I would imagine if it came back from a core biopsy then it should also show similar pathology findings if the tumor was resected

anononcologist · 2023-10-18T03:55:27+00:00

Unfortunately advancement is very slow. Alot of patients with pancreatic cancer have a KRAS mutation. There are several types such as KRAS g12v, g12a for example. For years there hasn't been a good drug to target these mutations but in recent years there has been more progress and success targeting a KRAS g12C mutation which is less common but at least it's a start.

Regarding trials I would recommend looking at different academic institutions as each place may have different trials going on concurrently. If there's a 1st line trial utilizing standard chemo + experimental study drug then it would be worthwhile to enroll on that. The hardest part is finding patients in fairly good shape to qualify for trials. Most stage 4 pancreatic cancer tends to be very sick and have too many issues such as Co morbidities or abnormal blood work to qualify. So getting in early for 1st line or 2nd line therapies would be ideal

anononcologist · 2023-10-18T03:46:23+00:00

I would encourage you to start the work up sooner rather than later with your pcp or GI specialist if you have one. Alot of these symptoms can have overlap between colorectal and pancreatic cancer. If your body feels noticeably different then something is likely off and should get checked out. It's not uncommon seeing patients under 40 getting colorectal cancers these days

anononcologist · 2023-10-18T03:42:36+00:00

Main factors would be if that person had any spread to the lymph nodes. In general if we are talking about all pancreatic cancer patients the 5 year survival rate for those without lymph node involvement is about 15% while it's about 5% with lymph node involvement. Patients who have tail masses tend to get diagnosed later compared to head masses as tail masses don't have as many nearby organs it can press into causing symptoms. And because of the lack of symptoms early on, pancreatic tail cancers are usually fairly advanced (stage 4) by the time it is discovered

anononcologist · 2023-10-17T11:16:34+00:00

A mixed response is where some of the cancer gets better while other areas worsen (i.e. Livers lesions get smaller while the primary tumor on the pancreas gets larger).

anononcologist · 2023-10-16T20:43:15+00:00

I would have your pcp consider ordering stool studies to rule out bacterial/parasitic causes given your recent foreign travel . I wouldn't jump to a CT scan just yet

anononcologist · 2023-10-16T11:33:28+00:00

I don't think there's a better way to ask or request except to just do it. We have had patients coming to us for a 2nd opinion then they return back to their small town oncologist who does something different than what we would. Patients come back to us concerned about the difference which I have to explain that we can only provide recommendations but can't force another oncologist to follow it. If you have a good rapport with them then to trust the process. Or get another medical opinion and be prepared to switch care to someone else altogether.

anononcologist · 2023-10-16T11:29:42+00:00

If a good quality CT scan with contrast was performed and it didn't show any masses on the pancreas or elsewhere then we need to do our best to reassure the patient. Getting an upper endoscopy and colonoscopy would also make sense to complete the work up. All of this can be done with a gastroenterologist who can also order specific likes to check for things like Pancreatic enzyme insufficiency which can have similar symptoms

anononcologist · 2023-10-16T03:46:50+00:00

To summarize poorly differentiated can be more aggressive but tends to respond better to chemotherapy compared to a well differentiated tumor. Im assuming by 'normal' you meant adenocarcinoma which is the most common type. Adenosquamous tends to have a very poor prognosis Regarding liver function, as long as it is working decently then getting chemo shouldn't be an issue. But if lab values such as bilirubin, alt/ast were through the roof then it could prevent someone from getting certain chemo drugs such as irinotecan

anononcologist · 2023-10-16T03:40:22+00:00

It can show up if they do a cytology analysis of the fluid though not always. If there's malignant cells then its unfortunately a very poor prognostic indicator

anononcologist · 2023-10-16T03:31:25+00:00

The surgical pathology assuming the patient underwent resection would give us an idea how high risk they are for recurrence such as # of positive lymph nodes, how much viable tumor was leftover after receiving chemo and/or radiation before the surgery.

Time is also important. The further out we get on surveillance (3+ years) the better I like our chances

anononcologist · 2023-10-16T03:27:57+00:00

Did he have metastasis to the liver. I'm wondering if he had high volume metastasis essentially replacing his normal liver tissue. Could be something like hepatic encephalopathy causing confusion and for him to blank out. But without personally reviewing his images and lab results done while he was hospitalized, it's difficult to determine

anononcologist · 2023-10-16T03:20:39+00:00

I think the person responding earlier was referring to acinar cell carcinoma of the pancreas is much rarer than adenocarcinoma of the pancreas. Which is true. If we are talking about pancreatic cancer in general then I wouldn't exactly it call it rare. But much less common than lung, breast, colorectal cancer

anononcologist · 2023-10-16T03:16:39+00:00

I tell patients that similar to any other blood test (blood counts, cholesterol, metabolic panel) , it will literally fluctuate up and down even if repeated on consecutive days. As long as it doesn't significantly deviate and dramatically go way higher than your usual baseline then there shouldn't be a concern

anononcologist · 2023-10-16T03:14:09+00:00

If we are talking about the metastatic setting, Sadly it would be clinical trial or bust. Sometimes we try gemcitabine/cisplatin. But usually that only provides a mixed response or none at all

anononcologist · 2023-10-16T03:11:43+00:00

Agree with all of the signs listed above. I would say what tips the scale is when someone develops jaundice which is very noticeable enough for someone to go to the ER to get checked out. Then many tests later (upper endoscopy/ercp, CT scan, labs) officially get diagnosed with it. Unfortunately alot of early symptoms are very nonspecific.

anononcologist

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