Wife Diagnosed with Intrahaptic CC

On April 14, 2014 it was discovered that my wife Robin had cancerous tumors on her liver. This was discovered during a laparoscopic procedure for the gastric sleeve. The procedure was aborted and we were informed that the life changing event was not the one we had hoped for. Within five days we had seen two oncologists, had a CT scan, a EUS and a positive diagnosis of Intrahepatic CC, with one 6.5 cm tumor on the left lobe and numerous small tumors scattered about both lobes. We were sent for surgical consultation. He determined that due to size and location of main tumor, the involvement of both lobes, the involvement of lymph nodes and the amount of liver affected by fatty liver that surgery was not an option. We were than referred to a radiologist for a possible TACE procedure on the main tumor. Again that was ruled out for the same reasons. She then began a Gem/Cis chemo regiment of 2 weeks on and one off. This began on May, 2, 2014.

The first cycle was uneventful with the exception of mild mucosities after the second treatment that lasted about five days. Second cycle went well, but started getting very tired leading up to start of third cycle. Blood work on 8th day of 3rd cycle showed low red blood cell counts. Received chemo, but was sent for two units of blood the same day. Blood transfusion worked and she returned to normal. 4th cycle started with RBC numbers still low, received chemo but ordered IV fluids before next treatment. Cycle 4 day 8 received chemo RBC still low, two more units blood the following day. Scheduled for CT scan one week after last Chemo. Was very weak, dizzy and the mucosities start again during off week. By the time we went for the scan she was too weak to walk. After scan we went to oncology office they drew blood right away. Was sent to hospital right away with low RBC and creatinine of 1.7 and BUN of 81! Admitted and immediately started another two units of blood, and IV fluids to try to hydrate kidneys, But the scariest part was when I saw her weight, she had gained 50 lbs. in two weeks!! This was all fluids, so she was dehydrated and full of fluid. Her kidney numbers got worse and they were concerned that she would be put on dialysis. Within five days her kidney numbers were stable but the fluid was worse and she was having trouble breathing. Sent to the ICU at night because she was struggling to breathe. ICU three days stable, sent to a step down ICU for another 15 days to remove fluids. Was sent home on 4 liters O2, back in ER within 48 hours not able to breathe and BP very high. Readmitted to hospital, she still had bad pulmonary edema and they were concerned about congestive heart failure. She was released after a total of 28 days in hospital. Slowly returning to normal, whatever that is at this time.

Local oncologist reports that the CT scan taken before hospital stay shows a stable cancer, but due to her kidney function, blood issues and the pulmonary edema, he doesn’t think it safe to resume chemo. We decided to get a referral to MD Anderson for another opinion. On 9/10/14 we had an appointment with Doctor Rachna Shroff at MDA in Houston. We met with Dr. Shroff and her staff who reviewed all medical records and prior CT scans. She explained that Robin would never be a candidate for surgery, radiation or any type of embolism because of the cancer location and spread, also she does not believe that she is healthy enough to handle these procedures. Her recommendation was to start a “maintenance” dose of Gemcitabine only, 600 mg/m2 IV given over 60 minutes every other week. There hope is to keep the cancer stable. Later that day Robin was scheduled for a baseline CT scan. About 20 minutes into the procedure one of the techs came and got me saying that Robin was having a reaction to the contrast. When I got to her she was already on a gurney surrounded by two doctors and several nurses. She could barely breathe and was coughing non-stop. She was brought to ER and it took about 30 minutes to get her stable. The ER doc came in and said that she was clear from the contrast reaction, but that she had a “flash pulmonary edema” and that her lungs that were clear on the CT scan, were now 1hour later, full of fluid. They started her on diuretics to remove the fluid. The next morning the cardiologist reviewed her blood enzymes and believed she had suffered a heart attack during the reaction. They performed an angiogram which revealed no heart issues. She remained in hospital for three days while they removed the fluids with diuretics. Dr. Shroff was now concerned about even the low dose gemcitabine, but in the end she agreed to this recommendation as long as the onc at home agreed that the first sign of problems the chemo would stop. We scheduled a return visit to MDA in December.

Does anyone have any advice on how we should proceed? It does not seem like the low dose of gem alone would be effective and they don’t have anything else to offer as far as treatment.

Sorry about the long post, but sometimes it helps just to write it down. She has been through so much in the last 150 days, with no cancer symptoms. Please let me know if you have any ideas for additional treatment.

Thanks
Mitch