Mom’s recurrence

HI all,

I haven’t been on the site in a while. To recap, my mom, 57yrs old, was diagnosed with a 6 cm tumour of the bile duct last July,2010 and had a partial hepatectomy with a Roux-en-Y procedure. There were clean margins all around, but they said there was one close margin. She had many complications, like biliary sepsis and biliary peritonitis. But recovered and was discharged 3 months later from a Canadian hospital, as her surgeon is in Canada. We took her to New York, to Memorial Sloan- Kettering. She then got anxious and refused the radiation therapy for the close margin, and waited till December 2010 to start Chemo IV Gemzar/Xeloda combo as suggested by the folks at Memorial Sloan- Kettering. Her PET-CT scan was done in the first week of December, which lit up pretty much everywhere…they told us it was post surgical and inflammatory in nature and nothing to worry about. She was doing fine on the chemo until her 5th week in, where she began to develop jaundice, itching, fever, and chills. They stopped it and treated her cholangitis where she spent another 6 weeks in hospital this past Feb. She was stented with a plastic stent in the bile duct and we were told she had a biliary stricture of unknown cause, as the brushings were negative, so they kept telling us she was cancer free, although her tumour markers were high and her CT scans were clear. Her follow up PET CT in March showed some progression with involvement of lymph nodes in the abdomen (called the paraortic nodes). But still they said it didn’t look typical of the cancer coming back. So she was sent home with an IV pump of pip-tazo and the plastic stent for 13 weeks…which we felt was excessive. So we sought a third opinion in Seattle, and they actually gave her a clean bill of health based on all the Canadian reports and told her to come in August for a surveillance MRI and BW. But a week later, she had a huge GI bleed and needed 12 units of a blood transfusion and they said she had an ulcer that was bleeding out of control due to taking advil and aspirin. They stopped the bleeding and she was out of hospital again the week later; they said the biopsies of the ulcer came back negative. She stayed home for a mere 2.5 weeks and was back in hospital again with RUQ pain and fever (i forgot to mention she had a bile bag on the whole time). They replaced the bile drain and started the antibiotics, and this time the surgeon said we’re not letting you go until we actually repair this bile duct for you!! Since she had four CT scans in the month of Feb alone that all showed her ‘clear’. She just had her surgery 2 days ago, they found a 2cm by 2cm tumour (I am not sure yet of the exact location), but they said it was inoperable due to proximity to blood vessels. Of course we’re all devastated.

Now my sweet mom is 5’2, and only 95 lbs, (43.2 kilos), and has severe post op anemia for which she not yet received a blood transfusion. The cancer care team in Seattle has said that she can receive chemo and radiation as soon as she’s out of hospital. I am not sure she is strong enough? Has anyone been in a similar situation to my mom’s? Would starting TPN for nutrition before treatment be worth a try to help her gain weight as her appetite has been nil over the last few weeks??Or is it going to harm her even further??

Thanks for your time….