Wednesday, January 21, 2009

Prostate & stomach problem CT-Scan updates

Prostate PSA test -- My Jan 5, 2009 PSA test was .84 so that was a continuing decline from last time.

Recurring Stomach Problem -- Following a 5th episode of stomach pains that began around 9 pm Monday, Jan 19th, I had a CT Scan at PAMF on Tuesday, Jan 20, and it showed that there was a "focal area of marked abnormal appearance to the proximal jejunal loop in the left upper quadrant suspicious for possible mass ..." Dr. Matthews believes this is the cause of my recurring problems and I have a follow-up meeting with a general surgeon at PAMF, Dr. Marks on Friday, Jan 23 at 1:30.

Also, received an email response below from Dr. Hancock with his thoughts including referral to 3 Stanford GI surgeons:

Mr. Stevens,

Sorry to hear of the new problem. I have difficulty relating this to your radiation, given that the treatment fields were confined to the pelvis and well below the area where, I think, this is being described. Most radiation-induced tumors arise more than 15 years after exposure, and small bowel tumors have been extremely rare, even when radiation fields directly included the region. I looked back at the images from your MRI scan from December 2007 but could not identify any definite abnormality. Might be more useful to look with the new study side by side with the old to see precisely where the mass is located. It would be interesting to see how thearea with the current problem looked 13 months ago.

Jejunal problems are pretty rare. I usually think of tumors causing such masses. I would guess that the list of possibilities would include gastrointestinal stromal tumor, leiomyosarcoma of the jejunum, primary adenocarcinoma and lymphoma of the bowel. Abnormal masses in this area could also arise due to diverticulosis, lipoma (benign fatty tumor) and other benign or inflammatory causes.

There are some reports of jejunal masses being successfully removed by laparoscopy, which usually features less cutting and more rapid recovery than open surgery. I am not certain what the pros and cons of each approach might be--particularly if there is concern that there may be air outside of the bowel.

I don't know if Dr. Marks is a general surgeon or one who specializes in GI tumors. There are three GI oncologic surgeons here: Shelton, Welton, and Norton. Sounds like a law firm. I understand that Jeff Norton is usually the fellow who does most of the cases where GIST tumors are a possibility (GI stromal tumors). They, incidentally, are the rare tumors that put the drug Gleevec on the market because they have a unique genetic mutation (c-kit) that makes them quite responsive to Gleevec. Sometimes when tumors are a consideration, surgeons have evaluated the area first with an angiogram to determine the source of blood supply. This may not be necessary, since the area will be directly explored, anyway. It will be interesting to see what your surgeon(s) recommend.

First to figure out what this is, however. I would be happy to have a look at the CT if the PAMF folks want to ship it over on a CD.

Best, Steve

Steven L. Hancock, MD
Professor, Radiation Oncology
Stanford Cancer Center, CC-G-230
875 Blake Wilbur Drive
Stanford, CA 94305-5847