Ask a doctor on the topic of Internal medicine

Chronic pancreatitis or pancreatic carcinoma

December 1, 2017 | 30,00 EUR | answered by Dr. med. Ive Dr. Schaaf

Dear team,

Here are the details:

Since 2007, I have been dealing with issues in my abdomen. Pain, pressure, burning, etc. Blood tests, ultrasounds, and MRIs have been done, but nothing was found. These episodes have continued. MRIs were done in 2010, 2011, and numerous endoscopies and colonoscopies were performed. Nothing was found.

In 2013, an endosonography of the stomach was done due to another issue. It was mostly normal, but there was suspicion of a chronic fibrosing pancreatitis. The same suspicion was described in the same hospital in 2014.

In between, there were more endoscopies, colonoscopies, blood tests, ultrasounds, etc.

In 2015, I visited the pancreas center in Bochum for the first time, with a well-known professor. Here, MRIs, MRCP, glucose tests, endoscopies were done, and everything seemed normal. Only minor ductal changes observed since 2007, which seemed consistent.

In 2016, I visited the Bochum pancreas center again for MRIs, MRCP, CT scans, ultrasounds, endoscopies. They noted "possible beginning chronic pancreatitis" during the endoscopy.

In 2017, another visit to Bochum for MRIs, MRCP, ultrasounds, endoscopies. Diagnosis was "no chronic pancreatitis visible. No changes in MRI/MRCP."

However, I am currently experiencing new issues with back pain, different and more intense. I had blood tests done (GOT, GPT, yGT, lipase, amylase, CA 19-9, CEA, etc.), all normal. M2pk in stool is also normal. Pancreatic elastase in serum is normal.

For the first time, I am experiencing occasional nausea, which I have never had before. The pain or pressure (not sure how to describe it) is located just under the sternum, feels like it's under the bone. The last endoscopy was in August this year, showing mild reflux esophagitis and antrum gastritis. But it was okay!

My question now is: I am concerned that chronic pancreatitis increases the risk of pancreatic cancer. No one can tell me how high the risk is. I don't trust the report from Bochum this year stating there is no chronic pancreatitis visible. I read online that it also depends on the examining doctor. Could this have developed into cancer because of the risk?

Dr. med. Ive Dr. Schaaf

Hello,

If your question is: Is there a pancreatic carcinoma behind all this, then I would say "No, because that would not result in consistent symptoms and findings for years."

If your question is: Do I have chronic pancreatitis, then I would say "No, because you have always had normal lab values and have been examined by highly competent professionals (Bochum)."

On the internet, where one does not know the individual findings, it is especially important to consider all possibilities so that no one can later say "You should have mentioned / considered this as well." In contrast, individual examinations aim to reduce the many theoretical possibilities to the actually existing individual changes. It is therefore useful to inform oneself on the internet beforehand. But it makes little sense to question the individual findings via the internet.

A carcinoma means uncontrolled cell renewal/proliferation. In chronic inflammations, repair processes must constantly be carried out, which is also a form of cell renewal/proliferation. The longer the chronic inflammation persists, the more likely this repair process can become autonomous, almost "explode," and then you have malignant cell growth = carcinoma. This applies to all chronic inflammations, with the example of esophageal cancer in chronic reflux esophagitis being particularly well-known. However, there are no exact percentages if you wish.

Based on your description, I would exclude that your symptoms fit into pancreatitis at all. Your stomach and intestines were apparently extensively examined without findings. In my opinion, the cause of your symptoms would therefore be found elsewhere. If you would like some ideas, please describe your symptoms as thoroughly as possible within the follow-up function.

Of course, you can also ask any other questions that are still open.

Best regards,

Dr. Ive Schaaf