Eli
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Here’s another previous discussion that might be worth a look.
Adjuvant treatment in biliary tract cancer: To treat or not to treat?
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?id=8426Hi Genevieve,
Here are my thoughts.
1. Did your oncologist explain why you have to make the choice between Gemcitabine and Capecitabine? Why not do both at the same time?
Take a look at this link:
Biliary Tract Cancer Treatment Protocols
http://emedicine.medscape.com/article/2003836-overviewGem/Cap protocol is an acceptable regimen for good performance status patients.
Also take a look at NCCN Treatment Guidelines, the current standard of care in the US. You might need to register to open the PDF:
http://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf
Page 22 (INTRA-2), footnote i. Gem/Cap is listed as one of the protocols that can be used in the adjuvant setting.
2. Have you discussed Gemcitabine/Cisplatin protocol with your oncologist? Gem/Cis improves survival in the unresected/metastatic cases, compared to Gem alone. As you probably know, this was proven in a large randomized Phase 3 trial done in the UK (ABC-02 trial). It’s reasonable to extrapolate these results to the adjuvant setting.
3. BILCAP trial results are not out yet. In any case, I don’t see how BILCAP trial can help you to make the choice between Gemcitabine and Capecitabine.
BILCAP trial tests Capecitabine vs. no treatment at all. The trial might help to establish Capecitabine as the standard of care in the resected cases. However, it’s not going to tell us anything about relative merits of Gemcitabine vs. Capecitabine. They chose to test Capecitabine because it’s an oral chemo. Patients take it at home. This is much easier on the patients after surgery… no need to travel to the hospital to receive IV. But, it’s still possible that Gemcitabine is better overall.
Hope this helps and good luck!
Eli
I agree with Marion. I wouldn’t worry too much about the blood numbers. That is the job of the oncologist to check them to make sure your mom is fit to receive chemo.
Tumor markers, such as CA19-9, are not part of the basic blood test. The oncologist has to request the markers on the blood requisition form. My wife’s oncologist didn’t want to test CA19-9 because – in his opinion – it’s not very useful. It took some convincing before he agreed to test it on a regular basis.
Tiffany, this is great news! I hope with all my heart you get the green light from the transplant team. Please keep us posted.
She should request a bed when she checks in for a chemo. Our chemo ward had lots of beds. More beds than chairs.
This article about alkaline diet is easy to understand:
Alkaline Diet: What to Know Before Trying It
http://www.webmd.com/diet/features/alkaline-diets-what-to-knowMayo Clinic nutritionist answers a question about alkaline water:
Is alkaline water better for you than plain water?
http://www.mayoclinic.com/health/alkaline-water/AN01800This article is a bit more advanced, but still quite understandable:
Acid/Alkaline Theory of Disease Is Nonsense
http://www.quackwatch.com/01QuackeryRelatedTopics/DSH/coral2.html===============
My opinion:
Alkaline diet is mostly vegetarian diet so it’s basically a healthy diet. At the same time, it doesn’t have any magic properties to cure cancer. If you are going to follow this diet, buy regular food at the supermarket. No need to pay extra for “special” alkaline foods.
Alkaline water is a waste of money.
Marion, it’s complicated!!
This site shows all cancer trials across Canada:
http://www.canadiancancertrials.ca/
I see different kinds of trials:
* provincial trials done at one hospital
* provincial trials done at multiple hospitals within a province
* national trials done at multiple hospitals across multiple provincesMy wife and I live in Ontario. We are covered by Ontario Health Insurance Plan. We can get treatment at any hospital in Ontario, no questions asked. It would be fairly easy for us to join any trial within the province (travel notwithstanding).
Joining a trial outside the province is more problematic. I assume that our provincial insurance will refuse to cover the costs. I know for sure that US trials are not covered.
Marion, I recall reading about another key factor that intensified cancer research in the UK.
They established a *single* administrative authority that manages all clinical trials across the country. The trials are no longer tied to one hospital or a group of hospitals in one region. Instead, a trial can be spread across the entire country. This administrative change sped up patient enrollment in the trials.
If I remember correctly, this is a relatively recent development.
Dianne,
I can answer two of your questions, based on what I learned on this board.
Yes, a patient can do more than one chemoembolization. One of our regular members did six of them.
Yes to the next question as well. A patient can do further systemic chemo after undergoing chemoembolization.
I’m sorry I cannot answer the rest of your questions, as my wife never had chemoembolization.
Best wishes,
EliMy wife did 6 cycles of Gemzar and Cisplatin after her surgery. 12 treatments in total. Her hair thinned a lot by the end of chemo but she didn’t lose all of it. She started wearing a wig after a while. In retrospect, she regrets it. A very short haircut would have been more comfortable.
Nausea is hard to predict. Some people get very nauseated right off the bat, others don’t. Keep in mind, she will receive anti-nausea medication before/after each treatment. It makes a huge difference.
Depends on the chemo. 5-FU is given continuously 24/7. Gemzar with or without platinum compound: one treatment a week. Oral chemo such as Xeloda: one or more pills every day.
Gemzar is often given on a 3 week cycle. Two weeks on, one week off. One treatment per week. That works out to 3 treatments a month, sometimes 4.
My wife developed mouth and throat sores when she was on 5-FU. Our oncologist gave us prescription for Sucralfate suspension. The dose was 200mg/ml or 1g/5ml (same thing).
http://www.drugs.com/mtm/sucralfate.html
The brand name in the US is Carafate. Canadian brand name is Sulcrate Suspension Plus.
The great thing about it, you can drink it as well as use it as a mouth wash. Our oncology nurse told us that sores usually extend all the way down to the stomach. In other words, mouth sores are just the tip of the iceberg. When you drink the suspension, it coats the sores in the throat and esophagus.
Zilactin-B is another medication we used. It’s a local anesthetic (numbing gel). My wife applied it to the mouth sores before meals, to make eating more comfortable. Zilactin-B is an over the counter medication.
Good luck!
Almost two years to the day, a new article about Dr. Kahaleh and pCLE technology.
Deep Inside the Body, Tiny Mechanical Microscope Diagnoses Disease
http://www.sciencedaily.com/releases/2012/08/120814213250.htmFrom the article:
Quote:Tiny space age probes — those that can see inside single living cells — are increasingly being used to diagnose illness in hard-to-reach areas of the body.New York-Presbyterian Hospital/Weill Cornell Medical Center’s Dr. Michel Kahaleh often threads a tiny microscope into the narrow bile ducts that connect the liver to the small intestine to hunt for cancer.
The U.S. Food and Drug Administration approved pCLE diagnostic systems for use in the bile duct and pancreas two years ago. The pCLE is a mini microscopic probe that is threaded inside a larger “spy glass” probe. The pCLE can then image blood vessels, mucosal structures and epithelial tissue in real-time, broadcasting these images on a large monitor for physicians to examine.
But the vast majority of institutions may still use a rather hit-or-miss technique to determine if a bile duct is cancerous. The traditional technique is to thread a probe inside the duct to where it is abnormally narrowed and then to use a small brush or tiny forceps to gather some cells that can then be biopsied in a lab. “But we still miss 20-30 percent of bile duct cancer or other tumors in this way, and that is unacceptable,” Dr. Kahaleh says.
LeeAnn,
Take a look at the following post. If I remember correctly, Margaret (the author of that post) works for an insurance company. She provided some tips as to how one can appeal the denial.
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=59735#p59735
