Spotting Neonatal Cholestasis Early: A Q&A With Dr. Pamela Valentino

Man, 32, Who Blamed 'bone-white Poos' On A Hangover Is Left Fighting For Life With A Year To Live

A MAN who blamed his 'bone white poos' and dark pee on a hangover was given a year to live after doctors diagnosed him with cancer.

Matthew Rosenblum was just 32 when he noticed his poop was jarringly light after a night out but a doctor reportedly told him: "If you have cancer, I will roll over in my grave."

6

Matthew Rosenblum was 32 when he noticed his poos were strangely light and his pee darkCredit: The Patient Story

6

It took months before he was diagnosed with stage 4 pancreatic cancerCredit: The Patient Story

6

Doctors told Matthew he'd probably only live one to three years, even with treatmentCredit: The Patient Story

Initially, the former PhD candidate wasn't too phased by the colour of his stools and pee, chalking them up to hangover as he'd had a few drinks the previous night.

"I had dark urine and bone-white stool," Matthew told The Patient Story.

"I didn't even notice the stool colour for a while," he recalled.

"At first, I thought I was hungover. I had a few beers the night before so I drank some Gatorade and lay in bed, but the urine did not get lighter."

It wasn't until Matthew's palms and feet started to itch uncontrollably that he decided to visit a doctor.

Even then, it took months, multiple trips to doctors before he was diagnosed with pancreatic cancer.

Doctors gave Matthew a bleak prognosis, giving him one to three years to live even with treatment.

"People think that pancreatic cancer is an old person's disease," he told The Patient Story.

Most read in Health

NEW THREAT

Discovery of mutant mpox strain with 'pandemic potential' sparks 'urgent' calls

HUNGER PANGS

The 5 foods that release the same 'fullness' hormone as weight loss jabs

JAB HORROR

Woman, 21, develops 'lethal toxic blood' after using weight loss jab for 3 weeks

'RAY OF SUNSHINE'

Girl, 12, died at school as 'frantic' final moments revealed by teachers

"I think that's why no one ever looked, because no one ever even thought that I could have pancreatic cancer.

"I've heard over and over again that I'm too young."

I'm a doctor, NEVER ignore these pancreatic cancer symptoms

In the UK, pancreatic cancer is most commonly diagnosed in people over the age of 75. Around 10,500 people are affected each year.

FIRST SIGNS

Having been diagnosed with Crohn's disease seven years earlier, Matthew was no stranger to "gastrointestinal distress", one of the most obvious symptoms of pancreatic cancer.

"I probably wouldn't have noticed even if I didn't have Crohn's," he said.

Aside from tummy troubles, Matthew also lost some weight in the months leading up to January 2021.

This is when he was struck with more "distinct" symptoms, such as the "bone-white" poop, dark urine and itching on the palms of his hands and bottom of his feet.

Matthew said: "The bathroom symptoms were pretty jarring, seeing urine that dark and poop that pale, but the itching was probably the worst.

"It was worse at night. I never felt anything like it before and those are hard places to scratch.

"After a whole night of itching, I put my hands and feet in the tub under hot water to numb the sensation."

He noted that not all pancreatic cancer patients experience itching.

"The earlier symptoms are very nuanced, can go unnoticed, and can also be misdiagnosed as a multitude of other things," Matthew said.

"By the time you're experiencing symptoms, the cancer has spread outside of the pancreas. I don't want to say it's too late, but that's what conventional wisdom is."

What the colour of your poo means

YOU might think paying attention to your poo is gross, but it can give you vital clues about your health.

Here's different colours can tell you:

Brown - this colour of poo is normal and healthy

Black - liquorice, iron tablets or certain medicines can dye your poo a darker hue, but it can also indicate bleeding in your stomach. Contact your GP if it's black, tarry and smells bad, and you have tummy pain

Grey - medicine to treat diarrhoea can cause this but very pale or grey poo might mean your pancreas or liver is not working properly. Contact your doctor as soon as you can if your poo suddenly becomes pale, especially if there has been no change in your medicine

Green - antibiotics or eating lots of green veggies can be the cause, as well as a gut infection like food poisoning or gastroenteritis. This will also change the consistency and frequency of your poos

Red -  caused by beetroot and red food dye in food and drinks but it could also indicate bleeding in the bowel. Contact your doctor if you haven't eaten red foods

Orange - vitamin A supplements and eating large amounts of food with beta carotene (e.G. Carrots) can cause this, as well as condition called bile acid diarrhoea, where bile stays in the stools without being reabsorbed

Yellow - this can indicate too much fat in the poo (steatorrhoea), a marker of IBS, Coeliac disease or pancreatic exocrine insufficiency

Silver - a very rare colour of poo and is not a good sign. Discuss it with your doctor urgently as it may be a symptom of cancer

Mucusy (clear) - sometimes people with IBS see visible mucus around their poo and this can also happen sometimes if someone is constipated. See a doctor if this is a new symptom

Source: Guts UK

THE ROAD TO DIAGNOSIS

Matthew visited an urgent care centre 48 hours later where he was told that his blood was high in bilirubin - a byproduct of broken-down red blood cells that influences stool colour - and told to go to A&E.

High levels of bilirubin can indicate a blockage in the bile duct, a tube-like structure that connects the liver to the small bowel. 

Ultrasounds revealed narrowing of this tube, which doctors attempted to stretch using a stent. 

Matthew recalled: "There was no sense of urgency. I was an otherwise healthy person with a history of colitis.

"They didn't think that this was anything scary."

But his symptoms returned after they removed the stent, leading doctors to conclude that they were caused by his gallbladder.

Matthew had surgery to remove the organ, but still suffered symptoms.

Visiting his gastroenterologist in late April 2021, she told him: "I don't know what's happening, but you for sure don't have cancer.

"If you have cancer, I will roll over in my grave." 

Matthew left her office feeling "pretty confident" but just three hours later, his results came back to show that he had a tumour in the opening at the start of the small intestine where the pancreatic and bile ducts join, known as the ampulla of Vater.

'ABRASIVE' TREATMENT

Matthew was scheduled for surgery to remove part of his pancreas and small intestine - but this didn't go to plan.

"My surgeon told me that they cut me open and, contrary to what they thought, found a tumour on the head of my pancreas that had spread outside of the pancreas.

"Metastatic pancreatic cancer is considered inoperable so when they saw that, they closed me up," he explained.

Doctors suspected that Matthew had a mutation of his BRCA2 gene, which is associated with several forms of cancer, including breast and pancreatic.

He was told by his oncologist: "With treatment, you might have one to three good years left, but that's it."

Matthew started a six-month course of chemotherapy in May 2021, using a potent concoction of drugs which were '"really, really abrasive" but failed to stop the cancer from growing and spreading to his liver.

"At this point, I was not confident that I would be a special case or a miracle. I thought this was it," he said.

What are the symptoms of pancreatic cancer?

PANCREATIC cancer doesn't usually cause symptoms in the early stages.

As the cancer grows it can start to cause symptoms like:

Tummy or back pain

Yellowing of the skin or whites of your eyes (jaundice)

Unexplained weight loss

Changes to your poo

Symptoms of pancreatic cancer can be vague. They can be caused by other conditions, but it's important to get them checked by a doctor.

Source: CRUK

BEATING THE ODDS

Doctors switched Matthew to a new combination of chemo drugs, which banished some of the spots on his liver.

"I thought I was still dying sooner rather than later so I was trying to have fun and it certainly made having fun a lot easier."

By March 2022, doctors couldn't identify any cancer outside of Matthew's primary tumour and were able to perform a successful Whipple surgery to remove the majority of the cancer.

Since then, Matthew has had scans to monitor his cancer on a three-monthly basis.

"I get a scan every three months for the next six years, but the chances of me living out those six years are astronomically small," he explained.

"Pancreatic cancer has a remarkably low five-year survival rate. It's unlikely that I will see all of that time, at least on paper."

Despite his bleak prognosis, Matthew advised others in his situation not to lose hope.

"We assume that if treatment will work, it will work immediately.

"In my experience, that's not true. Sometimes things get worse before they get better and it's not a reason to lose heart."

He went on: "It's important to remember that you are not a statistic.

"I was diagnosed with something I wasn't supposed to have at my age. It was very unlikely.

"It was supposed to kill me and I didn't die so, in a sense, I beat the odds not once, but twice."

6

Matthew underwent two gruelling rounds of chemotherapyCredit: The Patient Story

6

He also had surgery to remove the cancer from his pancreasCredit: The Patient Story

6

"It was supposed to kill me and I didn't die so, in a sense, I beat the odds not once, but twice," Matthew saidCredit: The Patient Story

Why Pancreatic Cancer Can Be Difficult To Diagnose Early

Though the pancreas is one of the most overlooked organs in the body, many bodily functions rest on it. It plays a critical role in improving digestion and also releases insulin and glucagon, which work together to regulate blood sugar levels.

Unfortunately, just like any other organ, the pancreas isn't immune to abnormalities.

Pancreatic cancer is a life-threatening condition that occurs when cells in the pancreas start to grow uncontrollably, leading to tumour formation. But what makes this type of cancer different and particularly concerning is people's inability to detect it in its early stages. This can be attributed to various factors, some of which are listed below:

Also Read: Pancreatic Cancer: How To Know If The Cancer Has Spread?

The Location

Speaking with the OnlyMyHealth team, Dr Puneet Gupta, Chairman - Oncology, Asian Hospital, Faridabad, says, "The pancreas is nested deep in the abdomen and obscured by other organs (including the stomach, small intestine, liver, gallbladder, spleen, and bile ducts), which makes it exceedingly difficult to identify any tumours of this organ."

Therefore, medical professionals cannot detect or feel early malignancies while doing normal physical examinations, he adds.

Lack of symptoms

Most chronic diseases cause symptoms, which help us detect the condition easily and in its early stages. However, that is not the case with pancreatic cancer, according to the National Cancer Institute (NCI).

The health body shares that there are either no noticeable signs or symptoms in the early stages of pancreatic cancer or that the signs and symptoms of pancreatic cancer, when present, are like the signs and symptoms of many other illnesses.

In case symptoms occur, here's what you should watch out for:

Progressive loss of appetite

Weight loss

Pain that spreads to the sides or back

Itching

Dark-coloured urine and light-coloured stools

Depression

A new diagnosis of diabetes or diabetes that is harder to control

Yellowing of the skin and the whites of the eyes, called jaundice

Tiredness or abnormal physical weakness

Pain and swelling in the arm or leg

Nausea, vomiting

Pain in the gallbladder or liver region

Blood clots

Diagnostic challenges

Diagnostic methods, such as imaging studies and blood testing, may be used to determine if there is a tumour in the pancreas, says Dr Gupta.

However, even though a pancreatic tumour may be seen with many imaging modalities, microscopic examination of a biopsied tissue sample is the only method of diagnosing a special tissue type of pancreatic cancer, the doctor highlights.

Also Read: Warning Signs Your Pancreas Is Struggling: Important Tests To Take

Complications That May Arise With Delayed Pancreatic Cancer Diagnosis

A delayed diagnosis of pancreatic cancer can be concerning, particularly because it could mean that the cancer may have spread to adjacent organs. 

According to Cancer.Net statistics, approximately 45–55% of pancreatic cancer patients are diagnosed in the advanced stages.

If left untreated, pancreatic cancer can spread to other organs such as the liver, lungs, and bones, which can restrict treatment choices and cause further issues.

"Obstructive jaundice, blood clots, infections, and excruciating pain are other symptoms of advanced pancreatic cancer. All things considered, the prognosis for people with pancreatic cancer is poorer when detection is delayed and therapy is not received within months of developing invasive cancer," Dr Gupta says.

Preventive Measures

To prevent pancreatic cancer or to avoid diagnosing it at a later stage, Dr Gupta recommends undergoing regular screening procedures like Magnetic Resonance Imaging (MRI) and ultrasound, especially if you have a high risk of developing pancreatic cancer because of genetics or family history. According to him, these can be performed once a year.

The doctor further notes that early cancer detection is preferred since it allows for more effective therapy. However, it's uncertain if screening reduces pancreatic cancer deaths, and there are risks like unnecessary surgery, he warns.

"Discussing with your healthcare provider is crucial to weighing benefits and risks. Under the supervision of a medical practitioner, genetic testing may be able to detect DNA alterations that raise the risk of cancer in people with a family history. Modifications to lifestyle such as quitting smoking, keeping a healthy weight with exercise, and a balanced diet may also help reduce risk," he concludes.

Disclaimer

All possible measures have been taken to ensure accuracy, reliability, timeliness and authenticity of the information; however Onlymyhealth.Com does not take any liability for the same. Using any information provided by the website is solely at the viewers' discretion. In case of any medical exigencies/ persistent health issues, we advise you to seek a qualified medical practitioner before putting to use any advice/tips given by our team or any third party in form of answers/comments on the above mentioned website.

What To Know About Pancreatic Cancer And Yellow Skin

There is a definite link between pancreatic cancer and a yellowing of the skin, called jaundice. Jaundice can happen when a cancerous growth presses on the bile duct, a tube that takes bile from the liver to the small intestine.

Most people with pancreatic cancer have jaundice as one of their first symptoms. Jaundice also causes a yellow tinge in the whites of the eyes, dark-colored urine, light-colored stools, and itchy skin.

Management approaches include the insertion of a tube into the bile duct to keep it open or surgery that bypasses the blockage.

This article examines pancreatic cancer and yellow skin, including management approaches. It also discusses other symptoms of this form of cancer, survival rates, and commonly asked questions.

Most people with pancreatic cancer experience jaundice as one of their first symptoms.

Cancer in the head of the pancreas can cause these symptoms. Cancers in other locations of the pancreas may not present with jaundice unless the cancer has spread to other areas of the body.

Jaundice refers to the yellowing of the skin and the whites of the eyes. Other indications of jaundice include:

What causes jaundice?

Jaundice occurs due to a buildup of bilirubin. This dark, brown-yellow substance is a component of bile, a liquid the liver makes.

Bile travels through the common bile duct into the small intestine, where it works to break down fats. Eventually, bile leaves the body through the stool.

Jaundice occurs when an obstruction in the common bile duct prevents bile from reaching the small intestine, resulting in an accumulation of bilirubin.

When does jaundice occur in pancreatic cancer?

Jaundice may occur during any stage of pancreatic cancer, depending on its location.

Cancer that begins in the head of the pancreas is close to the common bile duct. This can cause pressure on the duct and lead to jaundice, starting in the early stage when a tumor is still fairly small.

In contrast, cancer that begins in the body or tail of the pancreas may not cause jaundice until a later stage. This is because it may not exert pressure on the bile duct until it has spread through the pancreas.

By the time this happens, the cancer has frequently spread past the pancreas. When pancreatic cancer spreads, it often reaches the liver, which may also cause jaundice.

It is worth noting that conditions other than pancreatic cancer can also cause jaundice.

Learn more about jaundice.

In some cases, placing a stent in the bile duct may help reduce symptoms of jaundice. A stent is a short, narrow tube that keeps the duct open.

Another option is pancreatic biliary bypass surgery. In this procedure, a doctor cuts the bile duct above the blockage and reattaches it to the small intestine. This is almost always effective in relieving jaundice.

These two approaches may not be appropriate for every person. In these cases, using antihistamines and keeping the skin cool and moist may decrease itching. Diphenhydramine (Allermax, Banophen, Benadryl) is an example of an antihistamine.

Learn more about pancreatic cancer treatments.

Other symptoms of pancreatic cancer include:

Unintended weight loss: This is very common, as people with the condition have little appetite.

Back or belly pain: This is also common, as cancer that begins in the body or tail of the pancreas can become very large, putting pressure on nearby organs and causing pain. However, back or belly pain is most frequently due to a condition other than pancreatic cancer.

Nausea and vomiting: Cancer that puts pressure on the far end of the stomach can result in a partial blockage, making it difficult for food to get through. This can lead to vomiting or nausea.

Blood clots: In some individuals, the first sign of pancreatic cancer is a blood clot in a large vein, frequently in the leg. This can cause redness, pain, warmth, and swelling in the leg. If a piece of the clot breaks off and travels to the lungs, it can cause chest pain. This can even be life threatening.

Liver or gallbladder enlargement: A blocked bile duct can cause bile to accumulate in the gallbladder, enlarging it. If the cancer spreads to the liver, it will also cause liver enlargement.

Diabetes: This can occur when the cancer destroys insulin-making cells, but this is rare. More often, pancreatic cancer causes small blood sugar changes.

Learn more about pancreatic cancer symptoms.

A person's outlook will depend on when a doctor first makes a diagnosis.

The 5-year relative survival rate (RSR) refers to the percentage of people with pancreatic cancer who will be alive at the end of 5 years compared with those who do not have the condition.

The Surveillance, Epidemiology, and End Results (SEER) database provides RSRs for pancreatic cancer. Instead of classifying stages according to the American Joint Committee on Cancer's Tumour, Node, Metastasis (TNM) system — stage 1, stage 2, and so forth — the SEER database classifies them as follows:

Learn more about the survival rates for pancreatic cancer.

Below are answers to commonly asked questions about jaundice due to pancreatic cancer.

Is jaundice the last stage of pancreatic cancer?

Jaundice may appear at any stage of pancreatic cancer, depending on where the cancer starts. Cancer that begins in the head of the pancreas may cause jaundice at an early stage, while cancer that begins in the body or tail of the pancreas may not produce jaundice until later.

What are the symptoms of the last stage of pancreatic cancer?

People with pancreatic cancer typically have no symptoms until after the tumor spreads to other organs or becomes very large. For this reason, symptoms may appear in the late stages rather than the early stages. Symptoms may be nonspecific, such as unintentional weight loss, loss of appetite, or belly pain.

Yellow skin, also called jaundice, is a very common symptom of pancreatic cancer. Jaundice can occur when a tumor puts pressure on the bile duct, causing an obstruction and resulting in the buildup of bilirubin. Other signs of jaundice include yellowing of the whites of the eyes, dark urine, and light-colored stools.

There are two approaches to managing jaundice. A doctor may insert a stent into the bile duct to keep it open, or they may do pancreatic biliary bypass surgery.

Pancreatic cancer may also cause unintentional weight loss, blood clots, nausea, and vomiting. Survival rates depend on how early a diagnosis occurs, but the overall 5-year relative survival rate is 13%.

---