Anyone have/had BD-IPMN?

Posted by pattyclaire @pattyclaire, May 17, 2023

CT showed it as a hypodensity then MRCP showed it is a 1 cm BD-IPMN. I had to push for the MRI/MRCP because the gastroenterologist completely dismissed it as “nothing” and wanted to follow up with “another CT in a year” even though my symptoms are abd pain, nausea, and weight loss. So now MRCP shows it is a IPMN. I was referred to a different GI doc but I am afraid he will also not take it seriously due to it being small, only 1 cm. In my gut I believe I have PC. I just want a GI doc to take it seriously and get the diagnosis. Has anyone had a IPMN that was benign or malignant on biopsy? Also, can’t 1 cm still be PC? I imagine it is unusual to catch it so small but shouldn’t we still be aggressive for diagnosis even though it is < 2 cm? These docs make me feel like I’m over-reacting and it is so frustrating. I know I won’t be satisfied until I have it biopsied. Am I over-reacting?

Interested in more discussions like this? Go to the Pancreatic Cancer Support Group.

@hopeful33250

Thanks for the added information, @fionac. I suppose you have already had an upper endoscopy and/or a swallowing study for the swallowing difficulties?

I took a look at my most recent MRI and see that there are three listed in the MRI. One is .9 and that is the largest. As I said, these have been showing up for many years now. The Lipase blood test is within normal limits.

The important thing is not to put too much emphasis on one particular test but to look at it from different angles. I think the oncologist, or your PCP should be agreeable to doing the Lipase blood test and if that is within normal range it might help to put your mind at ease.

Keep asking questions and keep researching. I know that anything out of the ordinary with the pancreas can create panic but try your best to approach this as calmly as possible. I know that this is easier said than done. I've panicked myself and I know that it is not easy to be calm, especially when you are first diagnosed.

Of course, it is always your right to get a second opinion if you feel you are not getting answers to your concerns.

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Can you tell me more about the Lipase blood test?

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@fionac

Can you tell me more about the Lipase blood test?

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Hello @fionac

Here is a link from WebMD, about the Lipase blood test.

https://www.webmd.com/digestive-disorders/what-is-a-lipase-test
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@gardenlady1116

Being seen at a pancreatic center of excellence is key. I live near NYC or no difficulty with being seen at a top pancreatic center of excellence. A local oncologist is a good start, but wouldn't accept as definitive. I helped my brother research for resources in North Carolina. Because of my history of pancreatic cancer and BRCA, and his status as a BRCA carrier, I encouraged him to pursue screening. He started by seeing a local gastroenterologist who did an endoscopic ultrasound. The gastroenterologist suggested a follow up CT for screening. I do not see anywhere that CT is advised for screening for pancreatic cancer (repeated radiation exposure) so I have encouraged him to seek a higher level of care for ongoing screening. The closest center of excellence to his home is Duke University. We looked through the gastroenterologists to see who might have the needed expertise and found two with an interest in pancreatic cystic disease and screening high risk individuals. Definitely need to do your own research in seeking experts. Sometimes a local doctor will know where you can go in your area so worth seeing what the oncologist suggests.

I think everyone who participates in this forum would agree about the importance of finding the best resource you can access. The group can give feedback on their own personal experiences. Hope you will find an expert to help you. Self advocacy is essential!

Some resources:
Listing of 155 National Pancreatic Foundation accredited center of excellence
https://pancreasfoundation.org/patient-resources/

Pancreatic Cancer Action Network
Can call or contact on line and they will be able to help find resources local to you
https://pancan.org/facing-pancreatic-cancer/patient-services/contact-us/

American Gastroenterological Association
Guidelines for Screening for Pancreatic Cancer
https://gastro.org/clinical-guidance/pancreas-cancer-screening-in-high-risk-individuals/

National Library of Medicine
Scientific review of the topic of screening
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390120/#:~:text=Screening%20of%20patients%20with%20IPMN,%2Dderived%20and%20%2Dconcomitant%20PDAC.

TOP CENTERS
Memorial Sloan Kettering Cancer Center, New York City New York
https://www.mskcc.org/cancer-care/types/pancreatic-cysts/treatment/pancreatic-cyst-surveillance

New York University Langone, New York City, New York
https://nyulangone.org/locations/pancreatic-cancer-center/pancreatic-cancer-early-detection-prevention-center

Mayo Clinic, Rochester Minnesota
https://www.mayo.edu/research/centers-programs/pancreatic-cancer-early-detection-research-program/overview

Johns Hopkins University, Baltimore Maryland
https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatic-cancer/pancreatic-cancer-screening

Massachusetts General Hospital, Boston Massachusetts
https://advances.massgeneral.org/digestive-health/video.aspx?id=1132

MD Andersen Cancer Center, Houston, Texas
https://www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/gastrointestinal-cancer-center/pancreatic-cyst-clinic.html

Pancreatic Cancer Early Detection Consortium
https://precedestudy.org/

Any one of the 30 participating centers should be a good bet for an especially strong center. The participating centers are listed on the home page

The Pancreatic Cancer Early Detection (PRECEDE) Consortium is an international, multi-institutional collaborative group of experts to increase survival for pancreatic cancer patients by improving early detection, screening, risk modeling and prevention for those with a heritable risk for pancreatic cancer, through a novel model of collaboration and data sharing. PRECEDE’s mission is to transform the early detection and prevention of pancreatic cancer, with the aim of increasing the 5-year survival rate from 10% to 50% within the next 10 years. With over 30 leading academic medical centers across the globe, PRECEDE has assembled the largest high-risk patient cohort, with longitudinal clinical data and biospecimen acquisition and tracking.

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Thank you. This one is hard because the closet center to us is 4 hours. I was surprised to see Darmouth is only on the list for pancreatitis. That was a bummer.

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