Eli
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Bruce, I keep finding more reading material for you.
You may want to review two recent papers that I linked in this thread:
Adjuvant treatment in biliary tract cancer: To treat or not to treat?
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?id=8426See the links in the first and the last posts.
Bruce, one more thing:
If you want to read the discussion behind NCCN recommendations, see slides 59 – 62.
Yes, you are correct.
Keep in mind, the evidence to recommend or not recommend chemo/radiation is weak. CC is a rare cancer, so large randomized Phase 3 clinical trials are difficult to conduct. Most CC trials are small and non-randomized (aka Phase 2 trials). The evidence that comes out of such studies is not conclusive.
Also keep in mind, your wife had a positive lymph node. That’s a significant risk factor. Take a look at the similar slide for extrahepatic cholangiocarcinoma (Slide #24, EXTRA-2). The patients with positive lymph nodes follow the same path as patients with R1/R2 margins. But note the wording. They say Consider chemoradiation or chemotherapy, rather than Do.
No, they would not. They radiate the area surrounding the tumor.
EDIT:
If you want to read medical papers on the subject, search PubMed database. It indexes all articles published in the peer-reviewed medical journals.
http://www.ncbi.nlm.nih.gov/pubmed
EDIT 2:
But…
NCCN Guidelines are based on the published medical papers. The expert panel that writes the Guidelines reviews all new papers twice a year or so. Whenever new evidence comes out, they update the Guidelines.
Now that I thought about it a bit more, I remember another member who received radiation after a clean resection. That’s two in the last year, just going by memory.
As to what they radiate:
Parts of liver, bile ducts, the surrounding lymph nodes.
Hi Bruce,
NCCN Hepatobiliary Cancers Guidelines (the current standard of care in the US) do not recommend radiation for R0 margins.
You need to register for a free account to see the guidelines.
See slide #22 (INTRA-2)
http://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdfHowever, some oncologists take more aggressive approach. This is not entirely unreasonable, given high recurrence rate after resection.
I’ve been on this board for about a year. Off the top of my head, I recall one other patient who received radiation after R0/N0 resection.
I strongly recommend that you seek 2nd and 3rd opinions about this.
Best wishes,
EliSome spammers are very sneaky.
For example, see these posts by ‘Michael222’:
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=65624#p65624
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=65622#p65622He started by posting a few generic messages in the Nutrition section on Sep 20th. He came back on Sep 25th and edited his own posts to add spammy links to a commercial web site.
Here’s another spammer (‘jimmy82’) doing the exact same thing.
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=63841#p63841
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=63842#p63842
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=63843#p63843
http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=63870#p63870Again, he started by posting a few generic messages not related to CC. Then he came back to edit his own posts. He added spammy links to ‘aged care homes’.
I reported all these posts as SPAM long time ago. Either Rick is too busy to clean them up (which is perfectly understandable!!!!!), or he doesn’t share my view on what constitutes spam.
These examples of spam are rather benign. It just irks me that some people are trying to make a buck off this site.
I wonder if Rick can tweak forum settings, so our fine Moderators can delete SPAM themselves, without waiting for Rick to act.
Skin rash can be caused by emotional stress.
http://www.medicinenet.com/script/main/art.asp?articlekey=79117
http://medicalpictures.net/stress-rash-pictures/
Marion,
No, the very same study is not conducted on women.
Physicians’ Health Study II was specifically designed to test common vitamins and multivitamins. It was randomized and placebo-controlled.
Nurses’ Health Study is a much broader study. It looks at many different health issues. And it’s not randomized. They ask nurses to fill in questionnaires on a regular basis.
That said….
Nurses’ study did look at the multivitamins. I found the summary of their results in this article:
Do Multivitamins Make You Healthier?
http://www.wellsource.com/articles-mhc/Do-Multivitamins-Make-You-Healthier.htmlHere’s the summary:
Quote:[Nurses’ Health Study] found no significant health advantage to taking multivitamins, except for a slightly lower risk for colon cancer in women taking multivitamins for more than 15 years. (Some research shows folic acid to be protective against bowel cancer.) Researchers also found a slight increased risk for fatal non-Hodgkin’s lymphoma in multivitamin users.The article mentions another large study called The Women’s Health Initiative. It too examined many different health issues. Here’s their publication on multivitamins:
Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts
http://www.ncbi.nlm.nih.gov/pubmed/19204221Their conclusion:
Quote:After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women’s Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD (cardio-vascular desease), or total mortality in postmenopausal women.Dear Marion, please don’t be irked
The study in question was done at Harvard. It’s part of their ongoing research called the Physicians’ Health Study. Yes, it focuses on males.
Harvard runs a similar series of studies that includes only females. It’s called the Nurses’ Health Study.
http://www.channing.harvard.edu/nhs/
I’m guessing Harvard researchers have some very good reasons to run these studies separately. Males and females have distinct health issues!!
Marion,
Most internet discussion forums use “sticky threads” or “sticky topics” to highlight the most important information.
Sticky topics are topics that always show up at the top of their sections. An administrator or a moderator has the ability to stick a topic to keep it at the top.
In this case, we need a sticky topic in the Side Effects section, called something along the lines:
“Major Interactions Between Commonly Prescribed CC Drugs”
All important information should be in the first post of the topic, to make it easy to find. As new information becomes available, it should be added to the first post (by editing it).
Many internet forums close sticky topics to member discussions. In other words, only moderators have the ability to add/edit information in a sticky topic. The goal is to keep the sticky topics concise, clean, and easy to comprehend.
Cathy, I’m sorry to hear that you have these issues.
We had a close call with Reglan and Compazine. My wife got prescription for both from two different doctors. Luckily for us, we fill most prescriptions at the same Costco store. Their computer system caught the conflicting medications. They warned us not to take the two together.
