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I would like to request Doctor Uzaier. I spoke to you at…

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I would like to request Doctor Uzaier. I spoke to you at great length in August. My husband has a side branch IPMN in the uncinate process of the pancreas head. It's 2.6 cm, no mural nodules, ductal dillitation, etc. we saw a surgeon and he said the CEA level is greater than 1,000 but didn't seem to concerned about that level in predicting malignancy alone. He feels it's still benign but will change to cancer eventually. We are considering the Whipple surgery. How does he know it's benign?
Submitted: 6 months ago.Category: Oncology
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Answered in 18 minutes by:
10/15/2017
Oncologist: Dr Uzaer, Cancer Surgeon replied 6 months ago
Dr Uzaer
Dr Uzaer, Cancer Surgeon
Category: Oncology
Satisfied Customers: 9,893
Experience: I am in a Hepatobiliary and Pancreatic surgery unit, dealing with all kinds of cancer surgeries.
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Hello, my name is***** and I shall be assisting you today. I'm reviewing your query & will get back to you shortly. Thank you for your patience.

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Oncologist: Dr Uzaer, Cancer Surgeon replied 6 months ago

Thanks for requesting me. I recall our conversation.

According to what I recall, your husband is being investigated thoroughly and the reason your doctor knows it is benign is because of the characteristics of the lump, its symptoms and its presentation. As I mentioned before, malignancies in the pancreas are very frank in their presentations and have particular clinical signs and tell tale characteristics on imaging.

Having said that, whipples is an extensive procedure and will remove the lump completely. The lump/ specimen will be sent to the lab for a detailed pathology analysis. This will give us a detailed insight on what the lump really is. So, everything will be clear.

Hope this helps.
Please do leave a positive rating for the service by clicking on the stars on top of the screen.

Best wishes.

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Customer reply replied 6 months ago
What about the CEA level being so high?
Customer reply replied 6 months ago
Are you familiar with side branch duct IPMNs?
Oncologist: Dr Uzaer, Cancer Surgeon replied 6 months ago

CEA levels do not differentiate between malignant and benign pancreatic mucinous cysts. Yes, I am familiar with side branch intraductal papillary mucinous neoplasms in the pancreas.

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Customer reply replied 6 months ago
The amylase level was low and I thought it should be high in IPMNs. How did the surgeon know it's an IPMN versus an MCN? What would you recommend as a doctor? Monitoring every 3 months or surgery? How fast do they turn malignant?
Oncologist: Dr Uzaer, Cancer Surgeon replied 6 months ago

Amylase is only raised in acute conditions of the pancreas. Not all IPMNs have increased Amylase levels specially not side branch IPMNs.

The surgeon has all the investigations reports and imaging, that is how he knows.

I would recommend that you have this operated as that is the best chance of removing the lesion and giving you peace of mind since for as long as the lesion is in there you will always be anxious about it being a malignancy. In my practice, I inform my patient about his/her options and then let him/her take the decision on how to proceed.

They are a precursor to malignancy, there is no time prediction about how fast they can turn.

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Customer reply replied 6 months ago
How soon would you recommend surgery? He has a follow-up MRI in December. Does the high CEA level worry you and what does it mean?
Customer reply replied 6 months ago
Does it change to malignancy in weeks or months? I just want to make sure it doesn't change by December
Oncologist: Dr Uzaer, Cancer Surgeon replied 6 months ago

It can take years to change in to malignancy.

The CEA level does not worry me. It is a tool to assess treatment rather than diagnose malignancy.

I suggest, get the MRI in December and go from there.

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Take care.

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Customer reply replied 6 months ago
What does a CEA level of greater than 1,000 in a side branch IPMN mean exactly?
Oncologist: Dr Uzaer, Cancer Surgeon replied 6 months ago

It doesn't mean anything for now. The CEA levels are usually done as a baseline. Once, the lesion is removed, the CEA levels will come back to normal and the doctor will monitor and observe your husband by doing 6 monthly and then annual CEA levels. If the CEA levels increase then that means there is a recurrence, if they stay the same, that means there is no recurrence.

Don't worry about the CEA levels.

Please do leave a positive rating for the service by clicking on the stars on top of the screen.

Take care.

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Customer reply replied 6 months ago
Ok, the surgeon said they are normally single digit numbers but his was very elevated. Have you seen beinign cysts with CEA levels <1,000?
Oncologist: Dr Uzaer, Cancer Surgeon replied 6 months ago

CEA levels do not correspond with malignant and benign nature. I have seen many benign lesions with levels < 1000 and many with levels >1000. I do not look at CEA levels to judge the severity of a lesion, neither does any other oncological or hepatobiliary surgeon. They are used for monitoring.

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I will appreciate a rating at this point in time.

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Oncologist: Dr Uzaer, Cancer Surgeon replied 6 months ago

Please let me know if you have followup questions.

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