Expert: Claes-Gustaf Nordquist, M.D. - 6/16/2005

Question
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Followup To
Question -
I am a 45 year old female with a complex medical history which includes SLE, FMS, Interstitial Cystitis and the problems that long term prednisone therapy can bring (diabetes, osteoporosis, cataracts...etc.). Last year, I had emergency bowel surgery due to Ischemic Colitis and now have an Ileostomy. Earlier this year, a pelvic ultrasound showed a dermoid cyst on my right ovary. Blood tests came back with some abnormalities including a high white cell count, above normal CEA and above normal CA 19-9. It seems likely that I may have some form of cancer. What tests do you think should be done to make the picture a bit clearer?
Answer -
Well first of all you need a clinical investigation! I'm at least 5000 miles away from you, so it is impossible for me to give you a good advice based only on these previous tests and earlier events. Before any more decisions are made with regards to what new tests should be done a dr. should give you a thorough examination from top to toe including an evaluation of earlier tests. Please remember that those cancer marker tests are rather diffuse and uncertain. They are NOT precise in pointing in a specific direction. That is why a clinical examination is necessary. Go to your dr. and let your dr. proceed with the next stage of the program.

Question part 2 -

Thanks for your prompt reply.

Extensive clinical examination was done by both a gynaecologist and my colorectal surgeon and it was decided to search for any evidence of cancer. Today, I will be having an abdominal x-ray, a pelvic CT and a mammogram. I am also scheduled to have a colonoscopy, gastroscopy and barium meal follow through. I just thought you might have some futher ideas, considering your specialities. There were tests for other tumor markers which came back within the normal range. The only symptom I have has been an increase in stomach pain and the fact that my stomach has been increasing in size without weight gain.

By the way, you are more than 5000 miles away from me. I am in Australia!  

Answer
I see! I'm in Sweden! Well honestly speaking you seem to be in good hands! I was not aware of what had been done Or planned. It seems that most important things have been decided already. Now we will have to wait for the results. When they are in we can discuss this further! Please do keep me posted!