General Information about CC- a reprint from previous message

Hi,
Side effects of blood transfusions are fever and transfusion allergic reactions such as itching ,rash and shortness of breath ,which if occur, will be in the begining of the transfusion and generally will be managed by premedicated with Tylenol 605mg and Benadryl(antihistamine. 50mg) before transfusion.
CEA and CA19-9 are tumor markers ,along with ALK phosphatase, to MONITOR the progress of the chemo treatment. Doctors are looking for a TREND rather than single value ,together with the Cat Scan result to determine the course of treatment.
If you have advance cancer or cancer metastasized ,CEA is more likely to have higher value;a steadyily rising CEA value often is the first sign of tumor recurrence.
If you have CC in your liver(intrahaptic),you will most likely to have a much lower CA19-9 value than if you have the ductal CC in or near the main bile ducts .
CA19-9 is ordered for checking bile duct blockage and that is why after putting in a new stent the CA19-9 will be lower.
ALK phos is indicated for bile duct’s health;ALT and AST are related to the liver’s health.AFP is biomarker for liver cancer.
Cat Scan is for diagnosis purpose.(including initial diagnosis and follow up after resection or chemo treatment for CC. Both MRI and Cat Scan are used to look for structural changes(ie:the size ).PET scan is used to look for functional changes (activity)of the CC.
According to one study compared 20 intrahepatic patients images ,the extent of the tumor enhancement was similar with both MRI and CT methods,however the relationship of the tumor to the vessels and surrounding organs was more easily evaluated on CT scan as opposed to MRI.But for perihilar tumors CT also has limited sensitivity for extra regional nodal disease(ie metastases to the periaortic,pericaval or celiac artery lymph nodes.)—from uptodate .com.
I myself think that MRI with contrast is a good choice after initial CT with contrast when inconclusive reported in the early stages of CC development(ie: size of the cc<2cm.) to rule out recurrence.
PET Scan allows visualization of CC because of the high glucose uptake of the bile duct epithelium(the lining )– the “Hot spots” will light up on the PET scan.
A PET scan therefore can help to tell if the bile duct obstruction is caused by a cancer or not.PET scan can also be useful in determining the cancer may have spread or return after treatment.
Some hospitals equipe with machine that is able to perform both A PET and CT scan at the same time(PET/CT scan) ;this allows the radiologist to compare areas of higher radioactivity(SUVmax) on the PET with the appearance of that area(the location) on the Cat scan. But according to the radiologist I talk to , A (PET/CT scan ) is not the SAME as if you take them SEPARATELY;(PET/CT scan is PET plus CT scan WITHOUT contrast). Remember Ct scan is for structural and PET is for functional( activity) visualization. That is why sometimes doctors order a PET scan on this 3 month checkup and on the next checkup, he/she orders a CAT Scan with contrast or MRI instead.
Additional info. from uptodate.com
MRI and CAT SCAN (CT) have similar resolution for liver lesions.
CT has been considered to be superior to MRI for evaluating extrahepatic organs and calcifications. MRI is more specific than CT for differentiating cavernous hemangiomas,diffuse hepatic steatosis and focal fatty infiltration.Also MRI should be reserved for the evaluation of lesions less than 2 cm,or lesions located adjacent to the heart or to major intrahepatic vessels.If you are allergic to the IV iodinated contrast agent used for CT,then MRI is the alternative because the contrast agent used is different than CT. and MRI is not involved radiation .
Having SUVmax value show up on the PET scan does not automatically means you will have cancer activity on that “hot spot” location. It is highly depending on the location such as the liver,the lung or the prostate; and the condition of your health(ie: infection or inflammation on that part of the body).
I hope the above info. helps.
God bless;.