Long standing symptoms and nothing on CT scan: Does it happen often?

Hello everyone. Iam new here and don't really know if this is the right place for my question, but I am literally having the most difficult times in my life. I think I have PC and still waiting for tests for it.
I am a previously healthy 39 yo female, I don't smoke or drink and have no family history of any cancer.
I started to feel unwell in October 2022, first symptom was menopause-like hot flushes, followed by feelig gassy and flatulent. I then thought this must be my hormones messing up with my gut. In November I got some abdominal pain, increased frequency of stools (occasionally loose but no color or smell change or floating ..etc) and new unusual burping.
I was thinking of colon cancer, had some tests, ultrasound and CT with contrast, all clear.
I then had colonoscopy and gastroscoy, all clear.
I had mild symptoms since January to mid-March when I started to have mid-back pain, just where a bra strap sits (The typical location of PC pain).
I got terrified, went to a gastroenterologist and had (poorly done) ultrasound which showed nothing.
Almost 3 weeks ago, I started to have severe upper abdominal pain refered to the back, mainly after eating (also typical for PC) and noticed that I lost weight +/- 10 kg since October.
I had a new CT scan with IV contrast tumor marker, amylase and lipase blood tests, surprisingly ALL were just NORMAL.
I took second and third opinions regarding the CT scan from other consultant radiologists, all said there was nothing suspicious!!!
I wish I could believe them but I have symptoms that can't be explained by anything else. I am now waiting for an MRI scan and I am dreading as i think it will defenitely show the cancer.
The question is : did anyone have PC that showed severe and long standing symptoms and did not show on CT scan ? and if so, how was it diagnosed ?

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@hopethereisnothing

Many thanks for your reply. I am glad that you have been reassured you don't have cancer , this is a huge relief. I hope I get this result soon.
To be honest, I do have health anxiety and it is all about cancer..I don't care about any other illness even if I have symptoms.. as long as they don't match a cancer.
I first thought of PC in February.
At that time I had burping, flatulence and some increasd stool frequency (not actual diarrhea).I googled (burping and cancer) and found that it can be associated with esophageal, stomach and pancreatic cancer. I had an endoscopy that ruled out esophageal and stomach cancers.
I was somewhat assured that I didn't have PC as I had a clear ultrasound and CT scan 2 months earlier. I also had tumor markers at that time and all was normal. I tried to distract myself and forget about it but I couldn't.
I googled again and found a lot of studies about (missed PC on CT scan) and had an impression that missing PC on CT scan is fairly common, sometimes I thought this was (the rule) according to what I have seen on Google, that was when I started to believe that I had PC.
Fast forward to mid-March, I started to have back pain and it was the typical type of pain associated with PC, few weeks later I got upper abdominal pain also typical for PC, so I had almost all the (pieces of the puzzle together,) pointing to PC. I had another CT scan , ilI thought that the tumor which was small and undetectable must have grown to a size that is easily caught by any scan, especially that (it) is now causing severe symptoms, but again, nothing could be caught.
Concerning radiological diagnosis, I know radiologists can't diagnose cancer but they interpret the scans and should know if there is an abnormality, that should be further investigated by clinicians.
Here where I live (not US or Europe), clinicians in general are not good at interepreting scans. They totally rely on reports given by radiologists so if the radiologist sees no abnormality, no one will believe that there is something abnormal in the area. For that reason, among others (age, general appearance , history of HA) I was told by many doctors that I don't have PC, but the truth is that I have intolerable pain and other symptoms that could be PC or something else. Unfortunately, nobody could give me another explanation of my symptoms so the priority now is to rule out PC .
By the way I had tumor markers slightly rising but within normal range and pancreatic enzyme tests within normal. It is really mysterious condition I feel like I am in a nightmare.

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So basically, you are playing your own doctor. It seems you don't have doctors. I have pancreatic cancer that was diagnosed from a scan. It isn't fun. Why do you want it so badly?

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@tomrennie

So basically, you are playing your own doctor. It seems you don't have doctors. I have pancreatic cancer that was diagnosed from a scan. It isn't fun. Why do you want it so badly?

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You are right but may be a combination of health anxiety and not having a good medical system where I live, were the factors leading to my self-diagnosis.

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@hopethereisnothing

Congratulations on that news!!! Good luck with the hunt on resolving the rest of your issues.

As @gardenlady1116 mentioned, pancreatic insufficiency can also lead to some of the bowel symptoms. Since your pancreatic enzyme tests were normal, that's a good sign. But hang on to those results, since they give you a baseline when you're "otherwise healthy" (no cancer detected yet), then try to get repeat testing on those (enzymes, A1C, CA19-9, CEA) as appropriate (quarterly?) to see if they start trending in a good/bad direction, or just have a slightly "noisy" variation above and below some healthy average.

With my PDAC, increased stool frequency came along before the color and consistency changes, but not radically so. There may have been a trend toward reduced pancreatic efficiency as my cancer developed, but I didn't have baseline numbers to compare against. Data is a good thing to have! The bowel experience after having half my pancreas removed was "steatorrhea" ( https://www.ncbi.nlm.nih.gov/books/NBK541055/ ), requiring well-timed enzymes for me, since meat (and sigh, fat...) are still components of my daily diet.

Something else to keep at the back of your mind is the association between PC and late-onset diabetes. In my 50's, I had often been admonished by my primary care doc that I was starting to show signs of a pre-diabetic, but never in the active concern area. I'm guessing my PC development was rather rapid, because I was diagnosed with "diabetes associated with pancreatic disease" (similar to Type I?) the same week as my PC diagnosis.

Regarding your question about MRI vs CT: The center treating my PC had always relied on MRI for the abdomen/pelvis, but CT for chest. They also considered their MRI equipment and radiologists to be far superior to what I had at a local facility closer to home. When I went to another center for a second opinion, they did CT for chest (checking for mets), but also did CT instead of MRI for abdomen/pelvis. And it was the consulting surgeon (not the radiologist) who spotted the first met elsewhere in my abdomen. I asked him if they could review my six-weeks-prior MRI from the "superior" center to see if the met was visible on that. His radiologist said it appeared to be present there as well, but not clear due to the "inferior outside imaging."

So, in that setting, the CT did better than the MRI, and the clinician (surgeon) there did better than his radiologist AND the surgeon+radiologist at the other center. I sense there is some degree of rivalry between centers that own their own equipment. There *might* be some conflict of interest with centers making more money off their own imaging, but there is clearly a comfort and familiarity level with their own equipment/results and personnel they can easily follow up with.

One thing that surprised me was their common lack of PET imaging in my case (at two centers of excellence). Although you can combine PET with CT or MRI, it gets rather expensive on the PET/MRI side. When they combine PET+CT, I think the CT is used more to help localize the PET results with respect to other structures & organs. One doctor told me they didn't depend on PET to find "the needle in the haystack" so much as obvious mets far from the original tumor location.

In my case, when the MRI showed the recurrent "mass" at my surgical site, we all thought the EUS biopsy would be the definitive answer, as it was in the initial PC diagnosis, but it was a false negative that delayed treatment by a couple months. I asked if the increased sugar uptake that's observed on PET scans would help determine whether the mass was cancerous or not. Nobody ever answered yes, but they didn't provide clear explanation of their answers either. 🙁

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@markymarkfl

@hopethereisnothing

Congratulations on that news!!! Good luck with the hunt on resolving the rest of your issues.

As @gardenlady1116 mentioned, pancreatic insufficiency can also lead to some of the bowel symptoms. Since your pancreatic enzyme tests were normal, that's a good sign. But hang on to those results, since they give you a baseline when you're "otherwise healthy" (no cancer detected yet), then try to get repeat testing on those (enzymes, A1C, CA19-9, CEA) as appropriate (quarterly?) to see if they start trending in a good/bad direction, or just have a slightly "noisy" variation above and below some healthy average.

With my PDAC, increased stool frequency came along before the color and consistency changes, but not radically so. There may have been a trend toward reduced pancreatic efficiency as my cancer developed, but I didn't have baseline numbers to compare against. Data is a good thing to have! The bowel experience after having half my pancreas removed was "steatorrhea" ( https://www.ncbi.nlm.nih.gov/books/NBK541055/ ), requiring well-timed enzymes for me, since meat (and sigh, fat...) are still components of my daily diet.

Something else to keep at the back of your mind is the association between PC and late-onset diabetes. In my 50's, I had often been admonished by my primary care doc that I was starting to show signs of a pre-diabetic, but never in the active concern area. I'm guessing my PC development was rather rapid, because I was diagnosed with "diabetes associated with pancreatic disease" (similar to Type I?) the same week as my PC diagnosis.

Regarding your question about MRI vs CT: The center treating my PC had always relied on MRI for the abdomen/pelvis, but CT for chest. They also considered their MRI equipment and radiologists to be far superior to what I had at a local facility closer to home. When I went to another center for a second opinion, they did CT for chest (checking for mets), but also did CT instead of MRI for abdomen/pelvis. And it was the consulting surgeon (not the radiologist) who spotted the first met elsewhere in my abdomen. I asked him if they could review my six-weeks-prior MRI from the "superior" center to see if the met was visible on that. His radiologist said it appeared to be present there as well, but not clear due to the "inferior outside imaging."

So, in that setting, the CT did better than the MRI, and the clinician (surgeon) there did better than his radiologist AND the surgeon+radiologist at the other center. I sense there is some degree of rivalry between centers that own their own equipment. There *might* be some conflict of interest with centers making more money off their own imaging, but there is clearly a comfort and familiarity level with their own equipment/results and personnel they can easily follow up with.

One thing that surprised me was their common lack of PET imaging in my case (at two centers of excellence). Although you can combine PET with CT or MRI, it gets rather expensive on the PET/MRI side. When they combine PET+CT, I think the CT is used more to help localize the PET results with respect to other structures & organs. One doctor told me they didn't depend on PET to find "the needle in the haystack" so much as obvious mets far from the original tumor location.

In my case, when the MRI showed the recurrent "mass" at my surgical site, we all thought the EUS biopsy would be the definitive answer, as it was in the initial PC diagnosis, but it was a false negative that delayed treatment by a couple months. I asked if the increased sugar uptake that's observed on PET scans would help determine whether the mass was cancerous or not. Nobody ever answered yes, but they didn't provide clear explanation of their answers either. 🙁

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Thank you for your reply. I am sorry that you have suffered a lot with this illness and hope things get better for you.
The points you mentioned on lab tests and symptoms are worth considering.
Here where I live there is essentially no medical system. Almost all medical service is private apart from some governmental and university hospitals which typically serve the poorest and least educated group of patients. Otherwise everyone should manage their own medical issues : choosing the doctor/ center, having tests and so on, all of course out of pocket.
That is why I was extremely confused and almost feeling lost facing my mysterious symptoms and my dependence on Google to search and guide diagnosis and tests !! Turned out to be a really bad idea as it only fueled health anxiety and lots of stress.

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It seems that more workup is needed.
Doctors say PC can be hodden and not detected in CT and MRI, in some cases.😭😭😭😭.EUS is very difficult to get here, I don't know what to do 😭😭😭

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Good news rapidly vanished..
EUS is still needed as there is still a possibility of PC given the symptoms especially weight loss. This is the conclusion of the consult I had today with a gastroenterologist. Will have to arrange for EUS. I started to panic as they might find something 😭😭😭😭

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I have been having weird GI symptoms for more than 7 months, done everything possible to find the cause however none was found.
Recently I am having abdominal and back pain that are sometimes intolerable.
CT and MRI done within the last few days were negative. No suspicious finding seen by the radiologists.
I had a GI consultation today, the doctor still suspects PC and requested EUS to rule it out .
I am terrefied now but can't think of anything.. even can't cry ..the past months were very hard...my life was on hold ...I don't remember how normal life feels like anymore .

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@hopethereisnothing

Many thanks for your reply. I am glad that you have been reassured you don't have cancer , this is a huge relief. I hope I get this result soon.
To be honest, I do have health anxiety and it is all about cancer..I don't care about any other illness even if I have symptoms.. as long as they don't match a cancer.
I first thought of PC in February.
At that time I had burping, flatulence and some increasd stool frequency (not actual diarrhea).I googled (burping and cancer) and found that it can be associated with esophageal, stomach and pancreatic cancer. I had an endoscopy that ruled out esophageal and stomach cancers.
I was somewhat assured that I didn't have PC as I had a clear ultrasound and CT scan 2 months earlier. I also had tumor markers at that time and all was normal. I tried to distract myself and forget about it but I couldn't.
I googled again and found a lot of studies about (missed PC on CT scan) and had an impression that missing PC on CT scan is fairly common, sometimes I thought this was (the rule) according to what I have seen on Google, that was when I started to believe that I had PC.
Fast forward to mid-March, I started to have back pain and it was the typical type of pain associated with PC, few weeks later I got upper abdominal pain also typical for PC, so I had almost all the (pieces of the puzzle together,) pointing to PC. I had another CT scan , ilI thought that the tumor which was small and undetectable must have grown to a size that is easily caught by any scan, especially that (it) is now causing severe symptoms, but again, nothing could be caught.
Concerning radiological diagnosis, I know radiologists can't diagnose cancer but they interpret the scans and should know if there is an abnormality, that should be further investigated by clinicians.
Here where I live (not US or Europe), clinicians in general are not good at interepreting scans. They totally rely on reports given by radiologists so if the radiologist sees no abnormality, no one will believe that there is something abnormal in the area. For that reason, among others (age, general appearance , history of HA) I was told by many doctors that I don't have PC, but the truth is that I have intolerable pain and other symptoms that could be PC or something else. Unfortunately, nobody could give me another explanation of my symptoms so the priority now is to rule out PC .
By the way I had tumor markers slightly rising but within normal range and pancreatic enzyme tests within normal. It is really mysterious condition I feel like I am in a nightmare.

Jump to this post

You can send your scans to a cancer center and a radiologist will re-read them. My pancreatic cancer was missed on first MRI read locally - I agree - it can be missed.

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@lvtexas

You can send your scans to a cancer center and a radiologist will re-read them. My pancreatic cancer was missed on first MRI read locally - I agree - it can be missed.

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I was thinkinhlg of this

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In reply to @hopethereisnothing "I was thinkinhlg of this" + (show)
@hopethereisnothing

I was thinkinhlg of this

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Check around and see if any of the major centers--Mayo, Memorial Sloan Kettering, John's Hopkins, Dana Farber Cancer Institute, MD Anderson, will do a radiology consult. My sister has been diagnosed with esophageal cancer. She could have had a virtual second opinion at Cleveland Clinic but she went in person because she didn't seem to be getting enough information at the University of Michigan. Might take a little doing to get a second reading, but start at the top and work your way down, there are 150 Pancreatic Centers of Excellence, see the National Pancreatic Foundation listing. Taking your CD and being seen in person by someone at a center of excellence is likely going to be the most helpful.

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