Scans, Scans and More Scans

Last night's CT scan with contrast showed a "possible pancreatic neoplasm" and a "possible ovarian  tumor."  It stated that the 4 cm structure in the pancreas could also represent a "pseudocyst" rather than a mass.    The structure on the ovary measured 3 X 5 X 3 cm.

The oncologist visited with mom bright and early this morning and my brother was present to ask questions and take notes.  The plan to biopsy the pancreas via a fine needle aspiration was scrapped as I guess removing the needle runs the risk of potentially spreading the disease.  Instead, an endoscopic ultrasound will be performed and a biopsy will be collected that way.  A GI doctor would be in to discuss the procedure, which would hopefully take place today or tomorrow.  A thoracic/abdominal surgeon would also be in to discuss potential pancreatic surgery.  And finally, an OB/GYN would be in to discuss the mass on the ovary and how we would go about addressing that issue.  More lab work would be collected, specifically to look at two cancer markers, but that would take several days to get back.  Mom's case could potentially be turned over to the surgeon, depending on how test results come back.  In some cases radiation and chemotherapy are needed before surgery, or sometimes after, or sometimes not at all.  The oncologist is going out of town for two weeks, but has updated his partner about mom's case and so we can move forward if need be before he returns.

The hospitalist also came in and informed us that mom's case had the team of doctors perplexed.  Mom isn't presenting the typical symptoms of someone with pancreatic cancer.  But she isn't presenting the typical symptoms of someone with a "pseudocyst" either.  Mom isn't presenting the typical symptoms of someone with ovarian cancer.  But she isn't presenting the typical symptoms of someone with a cyst on her ovary either.  Her medical history isn't consistent with these diagnoses either.  So, they're all scratching their heads.  There are a lot of potential scenarios and they are going down the list to eliminate things one by one.  It is hard to answer questions about what is going to happen when we are not even sure what we are dealing with.  Because the pancreas seems to be the most serious issue, I think that is why that is where all the attention is focusing on first.  The endoscopic ultrasound was scheduled for today, but because of some miscommunication, mom had already eaten lunch (oops).  Therefore, the procedure will now be conducted tomorrow.

Mom had to do yet another CT scan.  This was a more detailed and localized CT (with and without contrast) specifically of the pancreas.    It indicates that the "hypodense sharply marginated mass of the body of the pancreas" is 4 cm in diameter and does not obstruct the pancreatic duct.  It states it could be a "cystic neoplasm or other cystic lesion."  I'm not really sure how much more information that gave anybody.

The GI doctor came in and reviewed the endoscopic ultrasound procedure.  The information he collects during his procedure will give the surgeon additional information to make necessary surgical decisions.  He will also collect tissue samples for immediate preliminary biopsy review.  The samples will then be sent to pathology, where we will have final pathology results in 3 or 4 days (or probably a bit longer with the Christmas holiday around the corner).

The thoracic/abdominal surgeon also visited with us.  Because there is so little information available about what we are dealing with, we spoke in a lot of hypothetical terms.  In all likelihood, this mass will need to be removed.  It appears to be in a "good" location for removal, being in the middle of the pancreas, although if it's a little more to the right or to the left, that could change things.  The pancreas is a very intense organ with lots of nerves and blood vessels and so surgery is a complicated matter.  Sometimes, chemotherapy and radiation are required pre or post surgery.  He would not be able to make any decisions until he was able to review the endoscopic ultrasound and see the biopsy results.  If mom did in fact require surgery, he didn't anticipate that it would take place until after the first of the year.

Mom is comfortable.  She complains of a burning in her upper stomach, right below where the ribs meet.  She receives pain medication as needed and that seems to control things superbly.  She is definitely not a fan of hospital food and has not missed an opportunity to let people know that.  Other than that, things are good.  Her spirits are good, her attitude is feisty and she's taking things as they come.