dukenukem

Quote from the Abstract:

RESULTS:
“The sole curative treatment for CCA is surgery, but 40-85% of all patients have recurrent disease even after radical excision. Because of this high recurrence rate, adjuvant treatments are now under intense discussion. For unresectable CCA without distant metastases, small case series have shown that liver transplantation can yield promising survival rates of over 50% at 5 years. For many patients with CCA, however, only palliative treatments can be offered, including endoscopic clearing of the biliary pathways. Because of the low prevalence of the disease, there have been only a few phase 3 studies of palliative chemotherapy for CCA. On the basis of one positive phase 3 study, chemotherapy with gemcitabine and cisplatin is considered the standard and now plays an established role in palliative care.

CONCLUSION:
CCA presents a special challenge in gastroenterology, oncology, and visceral surgery because of the difficulty in establishing the diagnosis, local complications in the biliary pathways, and a high recurrence rate after resection. Future studies should address not only the role of adjuvant chemotherapy, but also the efficacy of combined local and systemic treatment.”

That pretty well sums it up what we already know.

Duke

I was looking for something else and I came across this. Jason, if you read this post, thank you for your message. It should be required reading for all those on this site. Everything Jason said in this post is still valid, especially his closing statements:

“There is no denying that cholangiocarcinoma is a very bad cancer to have. Even so, there are reasons to be hopeful. The variety of treatment options available today provides new hope for extended survival. Moreover, the evolution of the clinical trial process gives real hope that new treatments will be far more likely to benefit rare cancers compared historical experience.”

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?id=11791

Duke

Hercules –

Thanks for the visual of the waterfall. Some of know we won’t get to the harbor at the end of the river but that is no reason not to make it the ride of a lifetime.

Look at the faith of Reepicheep at the end of the Voyage of the Dawn Treader:

“Where the sky and water meet, Where the waves grow sweet, Doubt not, Reepicheep, To find all you seek, There is the utter East.”

Duke

Must be something to do with the moon. I’m feeling the same way. I can see a big fork in the road coming and have no idea which way I’ll go or even how I will decide.

Duke

Sorry about the meltdown folks, Just had a major pity party last night. Feeling better now.

Duke

Following up on Matt’s post: getting a majority of doctors to agree on a standard set of guidelines borders on the improbable, especially from those without a great deal of experience with CCA. You can’t get in trouble if you stay in the middle of the pack. I believe there are oncs out there who are making treatment decisions based on textbooks, not experience. And some add their own spin/conservatism on it. So, unless these new guidelines are carved in stone, they won’t be universally accepted.

This is why I find palliative surgery so intriguing. In my mind, if you can cut out some of the cancer, that has to be as effective as killing it with chemo or radiation, without the side effects. And if you can reduce the tumor sites to just the lungs and lymph nodes, other treatments should be more effective than chemo. I’ve been told that my chemo is going after tumors in the liver; anything else is bonus. ==> palliative care.

There’s a lot more I’d like to say but I’m afraid it would be too emotional.

I’ve climbed down from the soapbox and the whine and cheese is finished.

Duke

“Surgical palliation” is a term I never expected to hear. Too often “palliation” seems to lose sight of the fact that people want to live and not be written off as terminal. Once that determination is made it’s hard to recover lost ground.

Duke