I have severe gas and bloating, also abdominal swelling. I have pain in my left side which radiates down my leg. I have difficulty breathing . I am worried about this being symptoms of ovarian cancer. I have had ultrasound about 2 years ago. I also had a colonscopy within the last year. I did take fertility meds about 15 years ago

Posted by omegaupdates on February 24, 2008

Early symptoms of ovarian cancer include bloating, abdominal pain, pelvic pain, early satiety (feeling full quickly after beginning a meal), and frequent urination.However, just going by your symptoms, there are many other possibilities which are more likely than ovarian cancer to be the underlying cause in your case.

Symptoms similar to yours may be seen in women eith gastro-intestinal infection/infestation (eg giardiasis or amebiasis) along with musculo-skeletal pain radiating down the leg. Obese woman may also present with breathlessness, abdominal swelling and low back pain radiating to the legs. Women with ovarian cysts too may present with distension and pain.

You need to undergo a medical evaluation and a few tests. I suggest that you get routine blood works (hemogram, renal function tests, and liver function tests), stool examination, X-ray chest, X-ray of the lumbo-sacral
spine, ECG, and an ultrasound of the abdomen. Based on these reports, we can decide on the next course of action. If ovarian involvement is indicated by ultrasound, we can proceed to confirm or refute ovarian cancer.

Also, it would be helpful if you could provide additional details about yourself. What is your age? Do you have a family history of breast cancer or ovarian cancer? Do you normally suffer from gastritis, heartburn, or belching? Why did you have a colonoscopy done? Have you got symptoms of irritable bowel syndrome (frequent passage of stool, diarrhea, constipation) or inflammatory bowel disease (diarrhea, bloating, pain,blood in stool, fever)? Are you a smoker? Have you had cardiac or chest conditions causing breathlessness before? What is your build (slight,normal, or obese)? DO you have back pain? DO you have children? Have you ever injured your back?

Get you questions answered by certified oncologists. Visit www.askanoncologistnow.com. First consultation free.

Posted in Expert Opinions | Tagged: abdominal swelling, colonscopy, Ovarian Cancer | Edit | No Comments »

lost 10 lbs in 3 weeks without trying, urinating at night 3 times after going to bed, CT of head pelvis neg. ct of liver show two hemangiomas, psa,24 hrs urine, thyroid okay. no blood in urine, no loss of appeptite.no headaches, DM ruled out. I feel normal. what are the chances I have some type of cancer?

Posted by omegaupdates on February 24, 2008

The symptom worrying you the most is unintentional weight loss, and you would like to rule out cancer as the underlying cause. Another symptom bothering you is that you have to get up a few times at night for urinating.There are many causes of weight loss. Gastro-intestinal causes of weight loss include infections (salmonella etc), infestations (giardia, amebiasis etc), bacterial overgrowth syndrome, inflammatory bowel disease, pancreatic causes (diabetes), short bowel syndrome etc. The predominant symptom in most of these conditions is diarrhea and abdominal discomfort. From your short description, it appears that you do not have significant gastro-intestinal symptoms. Diabetes too has been ruled out in your case.

Hyperthyroidism causes heat intolerance, tremors, palpitations, and weight loss. Your normal Thyroid Profile result rules this out. Prostate Specific
Antigen (PSA) too is normal, and argues against prostate cancer as a cause of your urinary symptoms.

You have undergone imaging of head (because midline meningiomas can cause urinary complaints), abdomen and pelvis (to look for prostate enlargement and any abdominal mass like lymphoma, colon mass etc). The CT scans were normal.

Urine test negative for blood indicates that there is no gross involvement of renal pelvis, ureter, bladder, or urethra by any lesion.

Your appetite is good, and you “feel normal”. These are all good signs.

So now, we have to look harder to find the cause of your weight loss, and rule out less likely causes. These include connective tissue disorders, malabsorption, and colon lesions.

First you need to get all baseline investigations done including hemogram,liver and renal functions, Chest X-ray, HIV serology, HBsAg, routine stool
microscopy, and routine urine microscopy.

Additionally you should get a colonoscopic examination, stool for occult blood, fat estimation and parasites, erythrocyte sedimentation rate (ESR),serum LDH, and serum CRP.

From your current symptoms, it is unlikely that cancer is a cause of your weight loss. However, you need to work with your doctors to identify the underlying cause. Are you a smoker? What is your age? Do you have low grade fever? Have you noticed any joint pain or skin rashes? Have you had diarrhea recently? Have you traveled to a foreign country recently? Did your CT scan include a Thorax CT too? Have you noticed the presence of any lymph node swelling?

Get you questions answered by certified oncologists. Visit www.askanoncologistnow.com. First consultation free.

Posted in Expert Opinions | Tagged: cancer, diabetes, giardia, inflammatory bowel disease, weight loss | Edit | No Comments »

I was diagnosed with B-cell non-Hodgkin’s lymphoma status post splenectomy in 12/2006 and have had CAT scans every 4 months since then and am in Watch and Wait. My last CAT scan showed a prominent pancreatic tail adjacent the gastric fundus. Should this be further evaluated with MRI for possible spread to the pancreas? I am 45 years old. What specific B-cell lymphoma do you have?

Posted by omegaupdates on February 24, 2008

If you have an indolent type of lymphoma, you can continue to watch and wait until symptoms develop.  There are indications for starting treatment in indolent type of lymphoma.  However, if your lymphoma is an aggressive type, you may need to undergo treatment.It would be best to go back to your oncologist/hematologist for evaluation of your CT scan result.  Laboratory examinations like determination of serum LDH may be needed.  An elevated level may mean that the lymphoma is in relapse or progressing.

What was the indication for you to have had a splenectomy in the first place? What were your signs and symptoms at that time?

Currently, you are naturally worried if the new findings in the latest CT scan could possibly represent non Hodgkins lymphoma (NHL)relapse.

MRI is superior to CT in detecting subtle soft-tissue pathology. However, in your case, MRI would not clinch the diagnosis, nor provide much additional information to your oncologist. To prove or disprove the relapse of NHL, a biopsy or a cytology study is needed.

As far as imaging studies are concerned, I feel that you may consider getting a PET (Positron Emission Tomography) scan done. Tumor cells concentrate more glucose than normal cells. In PET scanning, radio-labelled glucose is injected into the patient. If tumor is present, it shows up as a metabolically active spot as it has a higher concentration of radio-active glucose in it.

Thus in your case, a PET scan, ot a combined PET-MRI or PET-CT may give additional information to your doctor.

What is the size of the new lesion detected in the pancreatic tail on CT? Do you have any history of pancreas pathology (like pancreatitis, diabetes, etc)? Do you take alcohol?

Currently do you have any of these signs/symptoms: fever, weight loss, weakness, sweating, abdominal discomfort, or any swollen lymph glands?

It would be advisable to get a complete panel of routine blood tests, including LDH level estimation.

Get you questions answered by certified oncologists. Visit www.askanoncologistnow.com. First consultation free.

Posted in Expert Opinions | Tagged: CT Scan, lymphoma, MRI, PET | Edit | No Comments »

My 57yo brother in law was diagnosed in October with lung cancer with mets to the bones, brain and liver. His lung ca was Stage III or IV to he had palliative XRT to the sacrum and T9-11. The liver has not been treated of course and now he is getting whole brain radiation x10. He was having right shoulder pain and his wife felt it was rotator cuff but it involves several tumors for which he will have one high dose XRT. He’s having pain in that shoulder which isn’t responding to his routine Oxycontin 40 mg QID. He’s also on Decadron 4 mg since diagnosis. He had a popliteal thrombosis in December and is on coumadin. His INR is all over the place. As a palliative care RN I feel his shoulder pain should be treated before the XRT next week but his wife is obsessed with the liver. She feels everything he takes is ruining his liver. I feel that no one should have to live with pain if they can help it because pain creates damage of its own. She said there are several lesions in the liver (? size) and numerous small tumors. So in your opinion, with him being terminal, does she have to worry about his liver this much?

Posted by omegaupdates on February 24, 2008

Your brother, unfortunately, has advanced cancer with disseminated disease. He has stage IV lung cancer, with distant metastasis.In such cases, the aim of any treatment is palliation, not cure. As you correctly pointed out, pain management is a very important component of your brother’s treatment plan. The idea is to keep him as comfortable as possible. Principles of palliative care state that he should be given adequate pain relief during end-of-life. Pain clinics in cancer hospitals are well equipped to effectively control pain in a majority of cancer patients.

Your brother is on Decadron, which is a corticosteroid. This drug has been prescribed to reduce brain swelling (cerebral edema) as he has metastatic involvement of the brain. Decadron also has a mild benefit in reducing bone pain.

The other drug he is getting is Oxycontin, which is an opioid analgesic called oxycodone. This is useful in severe cancer related pain syndromes.

Pain-killers in cancer patients are prescribed according to the World Health Organization Three-Step Analgesic Ladder. Your brother is currently on WHO Step 2. Since he is not getting adequate relief, he should be prescribed Step 3 medications. This means that in addition to opioids, he should also receive non-opioid analgesics like ibuprofen, naproxen, or ketorolac. He may also benefit from adjuvant drugs for neuropathic pain (anti-convulsants, antidepressants, etc) and adjuvant drugs for bone pain (bisphosphonates, gallium nitrate, etc).

The approach to his bone pain should include palliative radiation and bisphosphonate therapy. In my experience, bisphosphonates like zoledronic acid are well-tolerated by most patients, and result in moderate reduction in bone pain within a few days.

Get you questions answered by certified oncologists. Visit www.askanoncologistnow.com. First consultation free.

Another effective therapy that your treating oncologist or palliative care physician may like to consider is fentanyl trans-dermal patch. This can simply be applied to his skin like a sticker, and changed every 3 days.

His wife too is understandably worried about him, and does not want any harm to occur to his liver. She needs to be counseled and gently explained that these interventions are for his overall benefit, and will make him much more comfortable during his last days. She may then be more willing to accept adequate pain-relief therapy for him.

Posted in Expert Opinions | Tagged: cancer, lung cancer, metastasis, stage IV lung cancer, zeledronic | Edit | No Comments »

What does IgG Kappa monoclonal protein detected in serum immunofixation test mean? This is a follow up test for the protein electrophoresis test which detected a presence of monoclonal protein band.

Posted by omegaupdates on February 24, 2008

The patient in question is being worked up for suspected multiple myeloma. Patients with multiple myeloma secrete abnormal levels of certain proteins called M protein. The investigation of M protein involve the following steps. First, the M protein is detected using protein electrophoresis.

Second, the nature of the M protein is identified using Immunoelectrophoresis or Immunofixation. Lastly, the amount of M protein  may be quantified using a test known as Single Radial Immunodiffusion or other techniques.

To give a brief background, Protein Electrophoresis is used to seperate out the different protein classes present in blood serum using a small lectric current. The seperated protein classes form different bands, and these are labelled as Albumin, Alpha 1, Alpha 2, Beta, and Gamma. The octors are specifically interested in the Gamma band, and check if this Gamma band on electrophoresis is broad or narrow. Normal patients have a diffuse, broad Gamma band. In patients with multiple myeloma, PEP reveals a single, sharp protein band in the Gamma region.

The initial protein electrophoresis (PEP) of the patient revealed a monoclonal protein band. This strengthened the clinical suspicion of Multiple Myeloma, and the next test, or serum Immunofixation test was ordered.

A brief background of the Immunofixation test: We know that patients of multiple myeloma secrete immunoglobulins. These contain sub-parts called heavy-chains and light-chains. The heavy chains are usually of a type called IgG, may sometimes be IgA, and rarely be IgM, IgD, or IgE. The light chains in multiple myeloma patients are either Kappa or Lambda but not both. Normal patients have both Kappa and Lambda. The Immunofixation test thus identifies the type of light chain that a particular patient has; in this case the test was Kappa positive.

The patient in question should now undergo other routine blood investigations, liver function tests, renal function tests, bone marrow aspirate and biopsy examination, radiological skeletal survey, and serum beta microglobulin test. Treatment should begin after confirming diagnosis and appropriate staging procedures.

Get you questions answered by certified oncologists. Visit www.askanoncologistnow.com. First consultation free.

Posted in Expert Opinions | Tagged: electrophoresis, Immunofixation, myeloma | Edit | No Comments »