What are the possibilities of malignancy?

My father, aged 64, complained of stomach ache and back ache around 20 days back. But the ache stopped in less than a week. He was diagnosed in 3 different hospitals. Intially with CT scan, it showed a mass in the pancreas and the pancreas had dilated to 9mm. Initial report suspected there could be malignancy in the pancreas and spread to liver as there was lesion found in the liver. After that, an EUS was done (Endoscopic Ultrasound) for biopsy. They could not take the correct biopsy, so the report said normal. All the pathological tests were normal, liver functioning was normal except CA 19.9 test showed 1975 count, which doctor says is very very high. They also suggested liver biopsy (ultrasound guided) but said the risk involved is high. The following 4 steps have been suggested by the doc.
1. Repeat EUS.
2. Liver biopsy (FNAC)
3. Laproscopic bipsy of the pancreas.
4. If none of the above get the correct diagnosis then open the abdomen and do the biopsy. Is it pancreaticcancer?

Few more details. FNAC done with CT scan and showed only mass but didn't detect malignancy. EUS didn't detect either. May be it must hv missed pancreas and only showing deodenum normalcy. Surpisingly he doesn't hv any pain now and appetite is ok. What are the risks invloved in above mentioned tests? How many more test do we hv to do? we've already done 3 times. Is there any other way of knowing whether it's binign or malignancy? Doc says if it was normal pancreatic cancer, it wudn't hv allowed pancreas to dilate but instead wud hv metastasized much faster. He says it wud hv been there for quite some time. If it's malignancy, qhat's the life span he's left with? Whats the best palittaive method? How do we prolong his painless life?

I can't say much about the diagnosis or advice, as in medicine there are lots of other things you need to consider, check and perform on the patient before reaching a correct or nearly correct diagnosis......In the above mentioned case, what i believe is that it is too early for that enlargement in the pancreas to be called as CANCER. It might be an inflammation, might be a cyst, a lesion. .....So for correct diagnosis, what i believe is that biopsy will be a better option because unless cancerous cells are found in the sample of both liver and pancreas, we can't declare it CANCER... Now what i suggest is that, biopsy should be the first priority.......Enlargement of pancreas or liver abscess might also be related to SLE (systemic lupus erythmatosus) or some auto immune problem. So plz consult your physician and start the symptomatic treatment and meanwhile go for biopsy...it might be dangerous but it seems the only possible solution which will lead to a correct diagnosis and treatment...............I WISH YOUR FATHER HEALTH.

A biopsy is not surgery. Any mass in the pancreas is highly suspicious. The choice is yours(well his) on the tests. The lesion in the liver is worrisome as well. I'd get the tests done. At least you can make some choices on what you want to do if you have too. Some cancers won't manifest themselves until their well established and have spread. That's how my dad's cancer was.
Don't be too surprised if it's cancer but don't panic neither. Have you gone to WebMD.com? I'm sure you'll find more resources there. Good luck

Looking to his age & finding a mass in pancreas & lesion in liver too possibility of ca is high. Many times the EUs may miss the lesion site & hence biopsy report normal. Repeat EUS biopsy & FNAC may be helpful & are safe in doing. USG guided FNAC may get the tissue for biopsy from different locations. Other test may be normal for time being & altered only after certain time. So u should again have biopsy & if nedded than open abdomen & get the biopsy done ( frozen section )if says malignancy ,surgery may be done in that situation in same sitting if possible.

Lets do this step by step:
1. The symptomatology MAY be indicative of CA but of another series of diseases such as gallstones.
2. If your father has jaundice this would confirm the gallstones diagnosis.
3. All pancreas tumors are not necessary malign.
4. Point 3 of the recommendations is not consistent with point 4: a biopsy in general is ENDOSCOPIC, not LAPAROSCOPIC (where they open up the abdomen).
5. If a biopsy could not be taken how in the world could pathology conclude that the growth is normal?
6. I recommend doing an endoscopic biopsy of all the pancreas regions (4 samples at least) and carry out pathologic examination of the tissue.
7. In case the growth is malign, the only therapy is operative removal (Whipple resection)
All the best

Another possible procedure which does not involve a major surgery is something called ERCP (Endoscopy Retrograde CholangioPancreatography). It involves endoscopy where the operator advances the scope to the level of the duodenum where the pancreatic duct exits and inserts a scope into the duct and a brushing of the duct or a biopsy maybe performed.

If once all the less invasive tests have been done and still no answer. Then the best choice would be to do an exploratory surgery. Ideally, a laparoscopic surgery may be less invasive and involves less recovery time than an open procedure. Regardless, this allows the best way for the pancreas to be visualized and the surgeons can also look at the liver and perform biopsy of the liver lesions if they are visible on the surface.

Tissue diagnosis is probably the most important part of the work up, so good luck.