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Intro – Intrahepatic CCA found by coincidence

Discussion Board Forums Introductions! Intro – Intrahepatic CCA found by coincidence

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  • #99394
    bglass
    Moderator

    Hi Hatice,

    While not qualified to speculate about medical matters, your recounting of your radiology consult reminds me that diagnosis and treatment planning for our cancer is complex and usually requires a team of doctors with different specialties – oncologist, radiologist, surgeon, pathologist, and possibly others.  It may be just that the radiologist was not comfortable presenting next steps til he could consult with others.

    Please do not assume the worst until you hear something back from your doctors with a definite assessment and plan.  I know it is hard not to worry, but for now you can safely let your doctors think through what they observe in your tests and scans, which will no doubt lead to a plan of action.  Your recurrence was caught early, and I am hoping the next phase in your treatment stabilizes the cancer.

    Take care, regards, Mary

     

     

     

     

    #99391
    Haticeaks
    Participant

    Thank you for your response Mary. Yes, we have already sent some sample tissues from the surgeries for genetic testing. Hopefully, we will hear back from it in the following weeks.

     

    Today I also saw my radiologist and had an ultrasound. He didn’t say much though. He took some sample from the abdominal fluid and said that they will investigate what causes it. He didn’t say much about the lesion in the liver. When we asked about RFA (initially they were thinking about the RFA + chemotherapy, but my oncologist then requested additional tests such as PET, biopsy from the fluid), he said that he doesn’t consider RFA at this point. Based on the test result, he and my oncologist will talk and let me know about the results. But right now, I am so worried that something wrong is going on. What could be a reason not to consider RFA for a liver tumor? Can peritoneal mets cause ineligibility to RFA? Or do they suspect from infection or something else? By the way, he also asked me about which of my recovery from surgery took longer time. I said the second one which was 5 months ago. It is like a puzzle, and  I cannot interpret anything based on this conversation.

    #99365
    bglass
    Moderator

    Hi Hatice,

    It is nice to hear from you, but I wish you had gotten better news from your scan.  It sounds from your reports that you have good doctors so I am hoping you will very quickly have a new treatment plan to address the recurrence.

    Cholangiocarcinoma does sometimes turn up in the peritoneum.  Our patients usually report being given systemic treatments (e.g., chemo) to address peritoneal recurrence.  A very small number have reported being sent for a treatment called HIPEC, which involves directly bathing the peritoneal area with chemo, sometimes after surgical reduction of the cancer implants found there.  HIPEC is a severe treatment, and not very commonly used for cholangiocarcinoma but I mention it in case it is something you want to ask your doctors about.

    Have you had genomic profiling done?  There may be additional treatments available through clinical trials if your profiling showed a genomic defect for which there are new drugs now in testing.  There is information on the Cholangiocarcinoma Foundation website about the testing if you are unfamiliar with this topic.

    From what you describe, the new recurrence was found very early, your doctors are on it, and you are in generally good health.  These are all positives that you can bring to the next round of treatment which hopefully will bring the cancer under control.

    Take care, regards, Mary

    #99358
    Haticeaks
    Participant

    Hi everyone, after my two surgeries and last chemo treatment, the last CT scan shows 1.5 cm lesion in my liver and minimal abdominal fluid (with a suspicion of peritoneal carcinomatosis). I guess I will have additional tests (PET, ultrasound) and so on. I am just wondering if anyone has dealt with peritoneal carcinomatosis with intrahepatic cholangiocarcinoma?

    #99099
    bglass
    Moderator

    Hi Hatice,

    Your CA 19-9 and CEA results were not what you wanted to hear after two surgeries and chemo, but please hold judgment on what this means til you see your oncologist.

    Tumor marker tests are more difficult to interpret during treatment because for some patients, an effective treatment itself can cause tumor markers to initially rise before subsequently falling.  (In other patients, an effective treatment can result in their reducing right away.)  In my own case, after surgery I had both chemo and radiation, and my CA 19-9 more than doubled from what it was just after surgery.  It drifted down afterwards.

    Generally, if doctors suspect a possible recurrence, they will look for other evidence for example by ordering scans.  It can take up to nine months or so after a rise in CA 19-9 for a recurrence to be visible in a scan, so it may take your doctors a little time to figure out what is going on.

    Patients are usually reminded that there can be non-cancer reasons for tumor marker test results to fluctuate.  I had a personal experience with this earlier this year when I had both a higher CA 19-9 and a scan finding related to colitis (essentially a bout of stomach flu).  I learned that colitis is a benign factor affecting CA 19-9.  My CA 19-9 has since returned to its prior level so hopefully that was the cause.

    In sum, a higher CA 19-9 (or CEA) is not welcome news but the number alone does not tell us much.  Your doctor will work with you to figure out the cause and then take action.  Please don’t worry too much until you hear from your oncologist.

    Regards, Mary

     

    #99098
    Haticeaks
    Participant

    After 6 cycles of Folfirinox followed by 2 resections and after that 1 cycle of Gem-Cis chemo, I had blood tests today and it looks like my CA 19-9 is 87.9 (which was 55.6 after the second resection) and CEA is 26.7. We will show these results to my oncologist and will see how he wants to proceed. I am sad and very anxious that there is recurrence. Has anyone had persistent elevated CA 19-9 for long years after diagnosed with ICC?

    #99054
    bglass
    Moderator

    Hi Hatice,

    It is good to learn you are recovering well from your second surgery and tolerating the chemo reasonably well.  I hope you continue to feel better and have good scans ahead.  There always seems to be anxiety with scans, but they are a necessary part of keeping this cancer under control.

    Take care, please stay in touch, Mary

    #99041
    Haticeaks
    Participant

    Hi all,

    It has been a while to write here. After having my second resection in July (the first one was in May), I have been feeling better just now. I have lost too much weight and I still have pain. In my last scans, they didn’t see any tumors. I started my chemo regime (Gem-Cis) and just finished the first cycle. We will see how long my oncologist will continue that. I want to feel better now but I am anxious about the next scans and how this will continue.

    Best regards.

    -Hatice

    #98879
    bglass
    Moderator

    Hi Derya,

    My experience after surgery was similar to what Hannah reports.  A liver resection is a major re-plumbing, and it can take a while for the digestive tract to settle down and for patients to adjust to the new normal.  Also, my recollection is that recovery from the anesthesia and the post-surgery pain medication also affected my appetite.  The usual recommendations for small meals, avoiding hard to digest foods and supplementing with juicing or protein drinks are helpful.  If there are severe disruptions to eating, this should be reported to the surgeon.  My recollection was that it took maybe three weeks to get back to semi-normal eating, and I was not eating much at all in the first week after surgery.

    I hope your mom recovers quickly from her surgery and is feeling better.

    Regards, Mary

    #98869
    Haticeaks
    Participant

    Hi Hannah,

    My mom lost her gallbladder in her first surgery. As I mentioned before, she had her second surgery after 2 months of the first surgery. What she says is that she gets full very quickly and none of the foods seem appealing to her. She constantly feels hungry but doesn’t want to eat anything. I am really seeking any advice/tips to help her overcome this appetite issue.

    Thanks for your response and best wishes to your mom, too.

    -Derya

    #98867
    Hannaha
    Participant

    Hi Derya,

    So glad to hear that your mom had her surgery and hoping that you get good pathology results soon.

    Regarding getting her back towards a more ‘normal’ diet and intake of food, it is a very slow process after this kind of surgery. After my mom’s resection in February (in which she lost her gallbladder – not sure about the status of your mom’s but losing a gallbladder really messes with your ability to digest things), she ate nothing at all for several days, and then was limited to a few bites here and there for several weeks before she really got back to anything like a normal-sized meal. If something sounds tasty, try it. Be wary of things with lots of fat or lots of fiber, as these both require more work to digest. If she is able to eat 2 or 3 bites of something, consider it a success and return to the project after a couple of hours. With a little luck and a little time, she’ll be having a half dozen bites, and then more. I know that others have had success with nutrition drinks and similar. My mom thinks they’re revolting, but if your mom is more open-minded about them, they might be a good way to ensure she’s getting the nutrients she needs.

    Good luck and best wishes for your mom’s recovery!

    Hannah

     

    • This reply was modified 5 months ago by Hannaha.
    #98866
    Haticeaks
    Participant

    Hi,

     

    I am Hatice’s daughter and just wanted to give an update regarding her. She decided to have the second surgery which happened last Saturday (July 13). In the CT scan, there were 2 and 1 suspicious masses in her liver. During the operation, the doctors saw that one is actually three small tumors next to each other. Overall, they were able to resect all 6 tumors and sent them to pathology. We still haven’t heard about the pathology result. She is still in the hospital and they plan to discharge her tomorrow. She is very tired and having some pain. Also her appetite is too low. She is saying that I am very hungry but I cannot eat. Has anyone had the same complaint? If so, what did you do to overcome that?

     

    Best regards.

     

    -Derya

    #98841
    bglass
    Moderator

    Hi Hatice,

    The decision you are being asked to make is very specific to the geography of your liver (namely, where the tumors are located relative to other features such as bile ducts, veins, other organs, etc.) so it is not possible to generalize.  But here are some thoughts:

    It is definitely possible to have a second resection.  I have read a few medical studies reporting results from second resections, and they seem to be in general similar to results from initial resections in terms of patient outcomes.  But it would take an experienced surgeon to give an opinion as to how this would work for you.

    If surgery is not possible, both RFA and Cyberknife are also effective in defeating tumors, especially if they are small.  You are fortunate that your cancer is only in your liver because, as you are seeing, there are more treatment options than if the cancer has spread.

    Recommendations as to whether a proposed treatment is a good choice in part depends on what the doctor feels comfortable with.  The surgeries needed for cholangiocarcinoma can be exceptionally complex, and sometimes one surgeon will say it is not feasible but a more experienced or specialized surgeon may be more positive.  In my own case, I was initially told I was inoperable, but subsequently a liver transplant surgeon was brought into my case.  He thought the surgery was feasible and was able to get the tumor out.

    The best path may be just as you are doing – seeking out multiple opinions from experienced doctors, asking a lot of questions including about risks, recovery time, and likely outcome, then choosing the course of action that seems best to you after hearing them out.

    I have sent you a private message with some additional information.

    Regards, Mary

    #98840
    Haticeaks
    Participant

    Hi Mary,

     

    Thank you for your response. Right now, I am in a situation where I need to make a critical decision. The surgeon who did my operation is negative about having another surgery because of these two lesions. He thinks that my cancer is aggressive and if it comes again will they always do an operation? My oncologist recommended me to get other surgical opinion. I saw 3 additional surgeons. Two of them said that surgery could be an option but RFA+CyberKnife could also be tried. The other one strongly suggested surgery. When I spoke with my oncologist he stated all the risks of the options and left the decision to me. I have an appointment for RFA this Thursday and I have to make a decision whether I want surgery or not. How are the others experience who had consecutive liver resection? One part of me does not want surgery, but the other part of me wants to give a chance. I am very confused and don’t know what to decide.

     

    Hatice

    #98838
    bglass
    Moderator

    Hi Hatice,

    Welcome to our community.  Thank you for relating your story.  It was, as you describe, disappointing to have your happily planned trip turned upside down with your diagnosis.  Cholangiocarcinoma can be symptomless initially, and it is a very unwelcome surprise when finally revealing itself through pain or jaundice.

    From what you describe, your doctors recommended very aggressive treatment and your results have been generally positive with a few bumps in the road.  Folfirinox is a tough chemo regimen, but it got you to surgery.  The more recent lesions are going to get zapped, and hopefully the RFA and Cyberknife will do their job for you.

    Best wishes as you pursue the next round of treatment.  Please let us know how it goes, and send any questions our way.

    Take care, regards, Mary

     

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