s********j
发帖数: 71 | 1 妈妈50＋，两周前腹痛，去医院B超初步诊断急性胰腺炎。随后血检显示CA19-9非常高
，700多。医生怀疑是胰腺癌。接着做了CT，加强CT，并没有看到有问题。周一拿了核
磁共振MRI结果，也没看到问题。本来稍微松了一口气，但是这周四再查血，经过十天
的输液消炎，那个CA199不降反而升到900 了！
我们现在非常困惑，这是怎
么回事呢？想求问这里的专家们一下。到底会是什么导致CA19-9不降反升呢？现在医生
建议去做PET/CT，说有可能是早期，影像还无法显示，只有血液里有信号，PET/CT可以
进一步检测。家里人已经在约了，希望可以尽早做吧。我在网上查，说PET对胰腺癌的
敏感性和特导性比CT高。但另一方面，又说PET对肿瘤大小测定存在偏差，因此多用于
CT难以鉴别肿瘤的良、恶性以及是否存在远位转移时，好像不是用在肿瘤很小或者是还
没有形成的时候啊？请问医生建议的这个next step到底对吗？请赐教！不胜感激！ |
m**********r
发帖数: 2099 | 2 这个有点太高了，虽然胰腺炎也可以升高，但150是上限，再往上良性疾病可能性就很
小了。
【在 s********j 的大作中提到】
: 妈妈50＋，两周前腹痛，去医院B超初步诊断急性胰腺炎。随后血检显示CA19-9非常高
: ，700多。医生怀疑是胰腺癌。接着做了CT，加强CT，并没有看到有问题。周一拿了核
: 磁共振MRI结果，也没看到问题。本来稍微松了一口气，但是这周四再查血，经过十天
: 的输液消炎，那个CA199不降反而升到900 了！
我们现在非常困惑，这是怎
: 么回事呢？想求问这里的专家们一下。到底会是什么导致CA19-9不降反升呢？现在医生
: 建议去做PET/CT，说有可能是早期，影像还无法显示，只有血液里有信号，PET/CT可以
: 进一步检测。家里人已经在约了，希望可以尽早做吧。我在网上查，说PET对胰腺癌的
: 敏感性和特导性比CT高。但另一方面，又说PET对肿瘤大小测定存在偏差，因此多用于
: CT难以鉴别肿瘤的良、恶性以及是否存在远位转移时，好像不是用在肿瘤很小或者是还
: 没有形成的时候啊？请问医生建议的这个next step到底对吗？请赐教！不胜感激！
|
s********j
发帖数: 71 | 3 确实。但愿没事，有也是早期。唉，心里真是七上八下的
这个有点太高了，虽然胰腺炎也可以升高，但150是上限，再往上良性疾病可能性就很
小了。
【在 m**********r 的大作中提到】
: 这个有点太高了，虽然胰腺炎也可以升高，但150是上限，再往上良性疾病可能性就很
: 小了。
|
n***a
发帖数: 1373 | 4 I am not an expert of this. I think PET is reasonable. If find something,
can do endoscopic ultrasound. But I don't know if such procedure is
available in China. Don't want to scare you, but pancreatic cancer is not
good even in early stage. So be quick. Find more experts for opinions.
【在 s********j 的大作中提到】
: 妈妈50＋，两周前腹痛，去医院B超初步诊断急性胰腺炎。随后血检显示CA19-9非常高
: ，700多。医生怀疑是胰腺癌。接着做了CT，加强CT，并没有看到有问题。周一拿了核
: 磁共振MRI结果，也没看到问题。本来稍微松了一口气，但是这周四再查血，经过十天
: 的输液消炎，那个CA199不降反而升到900 了！
我们现在非常困惑，这是怎
: 么回事呢？想求问这里的专家们一下。到底会是什么导致CA19-9不降反升呢？现在医生
: 建议去做PET/CT，说有可能是早期，影像还无法显示，只有血液里有信号，PET/CT可以
: 进一步检测。家里人已经在约了，希望可以尽早做吧。我在网上查，说PET对胰腺癌的
: 敏感性和特导性比CT高。但另一方面，又说PET对肿瘤大小测定存在偏差，因此多用于
: CT难以鉴别肿瘤的良、恶性以及是否存在远位转移时，好像不是用在肿瘤很小或者是还
: 没有形成的时候啊？请问医生建议的这个next step到底对吗？请赐教！不胜感激！
|
s********j
发帖数: 71 | 5 谢谢回复！已经过了很害怕的时候了，也清楚这个病多可怕，唉，但愿treatable
I am not an expert of this. I think PET is reasonable. If find something,
can do endosco........
【在 n***a 的大作中提到】
: I am not an expert of this. I think PET is reasonable. If find something,
: can do endoscopic ultrasound. But I don't know if such procedure is
: available in China. Don't want to scare you, but pancreatic cancer is not
: good even in early stage. So be quick. Find more experts for opinions.
|
m**********r
发帖数: 2099 | 6 PET协和医院在我离开中国的时候就有N年了，地上专门挖了个坑装加速器。那个地方可
能是坑没挖够深，人走过去还有点坡的感觉。
【在 s********j 的大作中提到】
: 谢谢回复！已经过了很害怕的时候了，也清楚这个病多可怕，唉，但愿treatable
:
: I am not an expert of this. I think PET is reasonable. If find something,
: can do endosco........
|
n***a
发帖数: 1373 | 7 Bless. Ask for possibility of endoscopic ultrasounds.
【在 s********j 的大作中提到】
: 谢谢回复！已经过了很害怕的时候了，也清楚这个病多可怕，唉，但愿treatable
:
: I am not an expert of this. I think PET is reasonable. If find something,
: can do endosco........
|
s*******2
发帖数: 1182 | 8 http://www.mitbbs.com/article_t2/Medicine/31272305.html
【在 s********j 的大作中提到】
: 妈妈50＋，两周前腹痛，去医院B超初步诊断急性胰腺炎。随后血检显示CA19-9非常高
: ，700多。医生怀疑是胰腺癌。接着做了CT，加强CT，并没有看到有问题。周一拿了核
: 磁共振MRI结果，也没看到问题。本来稍微松了一口气，但是这周四再查血，经过十天
: 的输液消炎，那个CA199不降反而升到900 了！
我们现在非常困惑，这是怎
: 么回事呢？想求问这里的专家们一下。到底会是什么导致CA19-9不降反升呢？现在医生
: 建议去做PET/CT，说有可能是早期，影像还无法显示，只有血液里有信号，PET/CT可以
: 进一步检测。家里人已经在约了，希望可以尽早做吧。我在网上查，说PET对胰腺癌的
: 敏感性和特导性比CT高。但另一方面，又说PET对肿瘤大小测定存在偏差，因此多用于
: CT难以鉴别肿瘤的良、恶性以及是否存在远位转移时，好像不是用在肿瘤很小或者是还
: 没有形成的时候啊？请问医生建议的这个next step到底对吗？请赐教！不胜感激！
|
s********j
发帖数: 71 | 9 谢谢！endoscopic ultrasounds是不是中文叫内镜？
Bless. Ask for possibility of endoscopic ultrasounds.
【在 n***a 的大作中提到】
: Bless. Ask for possibility of endoscopic ultrasounds.
|
s********j
发帖数: 71 | |
|
|
l*h
发帖数: 4124 | 11 did the "doctor" receive any oncology training?
how did he focus his attention to the pancreas? it's possible it's from the
pancreas, but it's utterly wrong to think the pancreas should be the only
main focus.
CA19-9 is neither sensitive nor specific for pancreatic cancer. there have
been numerous guidelines and advisories on the diagnosis of pancreatic
cancers and the proper use of CA19-9.
Transgastric pancreatography, endoscopic ultrasound and transgastric ERCP
have been available in China since early 1990s.
【在 s********j 的大作中提到】
: 妈妈50＋，两周前腹痛，去医院B超初步诊断急性胰腺炎。随后血检显示CA19-9非常高
: ，700多。医生怀疑是胰腺癌。接着做了CT，加强CT，并没有看到有问题。周一拿了核
: 磁共振MRI结果，也没看到问题。本来稍微松了一口气，但是这周四再查血，经过十天
: 的输液消炎，那个CA199不降反而升到900 了！
我们现在非常困惑，这是怎
: 么回事呢？想求问这里的专家们一下。到底会是什么导致CA19-9不降反升呢？现在医生
: 建议去做PET/CT，说有可能是早期，影像还无法显示，只有血液里有信号，PET/CT可以
: 进一步检测。家里人已经在约了，希望可以尽早做吧。我在网上查，说PET对胰腺癌的
: 敏感性和特导性比CT高。但另一方面，又说PET对肿瘤大小测定存在偏差，因此多用于
: CT难以鉴别肿瘤的良、恶性以及是否存在远位转移时，好像不是用在肿瘤很小或者是还
: 没有形成的时候啊？请问医生建议的这个next step到底对吗？请赐教！不胜感激！
|
n***a
发帖数: 1373 | 12 内镜B超。大概是通过胃镜到十二指肠，再特殊仪器进胰腺的管道，B超探头看胰腺。太
专业。我只看过。知道个大概其。
【在 s********j 的大作中提到】
: 谢谢！endoscopic ultrasounds是不是中文叫内镜？
:
: Bless. Ask for possibility of endoscopic ultrasounds.
|
s********j
发帖数: 71 | 13 您说的是，我们也在想，影像为什么查不到。希望PET/CT可以帮助找到根源。有病好早
治。
the
【在 l*h 的大作中提到】
: did the "doctor" receive any oncology training?
: how did he focus his attention to the pancreas? it's possible it's from the
: pancreas, but it's utterly wrong to think the pancreas should be the only
: main focus.
: CA19-9 is neither sensitive nor specific for pancreatic cancer. there have
: been numerous guidelines and advisories on the diagnosis of pancreatic
: cancers and the proper use of CA19-9.
: Transgastric pancreatography, endoscopic ultrasound and transgastric ERCP
: have been available in China since early 1990s.
|
l*h
发帖数: 4124 | 14 there is little to believe in your posted history. this is not your fault,
but rather showing the lack of training of the "doctors" in China.
i am doubtful about the "急性胰腺炎." if it was diagnosed by B超 as you said
, the pancreas would have had severe damage to be unequivocally imaged by B
超.
CA19-9 is neither sensitive nor specific. it doesn't give you much clue as
to where to look.
as for PET/CT, what purpose do you want it to serve? which tracer are you
going to use?
You need to go back to the beginning, that is, to determine what caused her
abdominal pain. what led the "doctors" to believe it was the pancreas? CA19-
9? do they understand CA19-9? why not gallbladder and bile ducts?
i am amazed at how bold some were at talking nonsense in this thread.
【在 s********j 的大作中提到】
: 您说的是，我们也在想，影像为什么查不到。希望PET/CT可以帮助找到根源。有病好早
: 治。
:
: the
|
s*******2
发帖数: 1182 | 15 young girl, why so aggressive?
said
B
her
【在 l*h 的大作中提到】
: there is little to believe in your posted history. this is not your fault,
: but rather showing the lack of training of the "doctors" in China.
: i am doubtful about the "急性胰腺炎." if it was diagnosed by B超 as you said
: , the pancreas would have had severe damage to be unequivocally imaged by B
: 超.
: CA19-9 is neither sensitive nor specific. it doesn't give you much clue as
: to where to look.
: as for PET/CT, what purpose do you want it to serve? which tracer are you
: going to use?
: You need to go back to the beginning, that is, to determine what caused her
|
s********j
发帖数: 71 | 16 B超，CT还有MRI这些影像我们也看了胆囊胆管的，但也没看出什么问题。B超结果胆囊
写的是“大小正常，壁光滑不厚，囊内未见异常回声”。胆管写的“肝内外胆管未见扩
张及结石”。胰腺写的“轮廓欠清晰，胰头厚约2.1cm，胰体厚约2.4cm，胰尾显示欠清
，实质回声增强，主胰管内径约0.3cm，胰周未见液性暗区”。诊断提示写的“胰腺回
声改变：胰腺炎”。
给您发了短信，我们想着做PET/CT是为了确认病因，CA199持续升高是什么引起的，炎
症或者tumor？既然它是个tumor marker, 如果有tumor，它在哪里。请问是不是我们方
向想错了？
there is little to believe in your posted history. this is not your fault,
but rather sh........
【在 l*h 的大作中提到】
: there is little to believe in your posted history. this is not your fault,
: but rather showing the lack of training of the "doctors" in China.
: i am doubtful about the "急性胰腺炎." if it was diagnosed by B超 as you said
: , the pancreas would have had severe damage to be unequivocally imaged by B
: 超.
: CA19-9 is neither sensitive nor specific. it doesn't give you much clue as
: to where to look.
: as for PET/CT, what purpose do you want it to serve? which tracer are you
: going to use?
: You need to go back to the beginning, that is, to determine what caused her
|
s********j
发帖数: 71 | 17 妈妈的PET/CT报告上说，胰腺糖代谢活跃，性质：？，疑似炎症病变，建议密切随访。
糖代谢活跃好像特别不好，性质那儿就给了个问号。请问这个病变指的什么啊？我也不
懂，家人在约医生的门诊，今天还约不上，真着急。 |
l*h
发帖数: 4124 | 18 to have a meaningful discussion about a case, a clear summary of history,
physical and lab and imaging studies is needed. the history needs to include
a reasonably detailed description of the symptoms.
so far there is no description of her abdominal pain. there is no
description of findings of her physical.
if "acute pancreatitis," there is no mention anywhere about amylase, how it
was treated etc. there is no mention whether other things were considered,
such as autoimmune pancreatitis.
regarding PET/CT, there is some usefulness in differentiating pancreatic
diseases. this is still debated, because there is not much information there
just by looking at FDG uptake. this also requires careful analysis of the
imaging patterns. this is among the reasons nuclear medicine training takes
4 years. even if you have completed diagnostic radiology training, if you
want to do nuclear medicine, it still takes one full year.
you should ask your mom's doctors all your questions.
【在 s********j 的大作中提到】
: 妈妈的PET/CT报告上说，胰腺糖代谢活跃，性质：？，疑似炎症病变，建议密切随访。
: 糖代谢活跃好像特别不好，性质那儿就给了个问号。请问这个病变指的什么啊？我也不
: 懂，家人在约医生的门诊，今天还约不上，真着急。
|
