pcl1029

Hi,CG,
Here are additional info. you may want to know;
Again this is for information purposes only.

1. If you can have resection that will be the first choice if I were you.
2. Orthotopic Liver Transplantation (OLT) based on Mayo clinic data has a five-year survival rate of 82% for selected CC patients who had unresectable CC and a history of primary sclerosing cholangitis.(PSC).And if your tumor can be resected as what is appeared to be the course of treatment at JH now;I will continue the treatment at JH till the next CT scan or MRI result;the reason is that if your liver can be resected you may not be qualified for OLT. and there are lots of test and waiting before the actual transplantation take place.By that time you may miss the opportunity of resection at JH.
” Liver transplantation has a poor outcome for patients with intrahepatic cholangiocarcinoma and is generally not recommended unless in the context of an approved trial protocol.”–Apr.2011 vol.8 Gastroenterology & Hepatology by T. patel.
OLT has a better outcome when it was done on early stage of unresectable hilar CC after neoadjuvant chemo therapy. and recurrence is common in both groups.
God bless.

Hi,Mari,
sorry to hear your brother’s passing.
If you can,please e mail or just answer WEN888 for me.(her’s is a just few entry above this entry that I write to you) .

She wants to know where your brother got help,(names of hospital and the doctors) in Phillipines. And what is your opinions about their care.(Is it up to standard,expensive and effective?).
Her dad has CC,so please give her some pointers and help her out;you know when you first hit with the news that someone had CC in the family you really like a ton of bricks hitting on your head and want any kind of help you can get;
I am in the States and I don’t know that much in that area.
So,if I may request you to see whether you can email Wen888 after you settling down from travelling .I will really appreciated. (I think she is also a Filipino too).
Thanks for your thoughts and prayers for me. As you can see ,it works.
and please keep us informed and come back often,You can be one of us to help other people too. We all are volunteers ,caregivers like you to your brother and patients like me.
God bless.

Hi,
1. I am not a doctor ,I am just a patient .this is for your information only.
I will use your husband’s networking to find a couple good interventional radiologists to look at the CT scans or even better get an up-to date MRI with contrast to determine what are the best options for radiation treatment (PDT,SBRT etc.).to shrink the tumor and then hopefully can have surgery later if they did not take out the 2cmx2cm tumor 2 days ago.
2.Your mom is only 57 years young, when she recovers,it will not be a bad idea to use Gemzar+Xeloda as adjuvant therapy after the radiation treatment; It seems to me that this chemo is as effective as the Gemzae/cis combo if not better for DUCTAL CC and less side effects.Please consult your oncologist colleagues.
3. it will not be a bad idea to ask the head dietician to do a swallow exam to see how well your mom can swallow things;ask him/her to see whether entero feeding is out of the question or which one at this point is better if TPN is needed based on the carloies count and hydration needs,- peripheral TPN or central TPN ,cyclic or continuous?) .One caution,having TPN for a long period may cause ammonia level to rise in the future (because the amino acids content in the TPN)and you may need to watch out for that.Base on what you wrote,it may not be a bad idea to have TPN if the dietitian agree. and I don’t understand why blood transfusion is so difficult especially post-op. For me ,I still feel dizzy and lightheaded now and then even 3 weeks after a liver resection,but my blood loss was only about 300ml and the doctor said drink more fluids and keep on eating and rest.He thinks I look good and the Hgb at discharge was 10.5. so there is no need for blood transfusion.
4.As you may know already antidepressants can increase appetite and gain weight ,it is one of the”side effect” benefit. I notice GP use prozac or Remeron;but again you,as a physician yourself, should weight the benefit against the other side effects of the antidepressants in order to get the maxium benefit from it.
I hope the ino. helps.
and please keep us informed about the progress so we can help other CC patients .
God bless.

Hi,Wen888,
I am not a doctor, I am a patient just had my 2nd resection three weeks ago ,still weak but ok. I mentioned Hong Kong Cancer Centre was that if you want to go Guangzhou for treatment,most likely you will go thru Hong Kong first to get there.

But your sister’s suggestion to go to Singapore (SG)hospitals is even a better choice,The reason why is simple,I have a few of the middle class friends,after hearing I had CC 2 years ago,they started going to SG for ultrasound and blood work physicals and they told me they had good opinions about SG hospitals experience.Since they are private hospitals, they can arrange and diagnose you the day after your landing,they do everything in the same place and they will even book hotels for you and your family to stay nearby,usually 4 days and you will get the result when you fly home.They are not expensive as I was told (ie: the ultrasound of the liver is about SG 150.But you can ask them roughly how much of CTscan or MRI cost and to get an estimate.)

I made a couple calls and found Gleneagle medical centre and Mt. Elburn Hospital,both are private hospitals;you should google them to find out whether they have hepatobiliary or liver surgery specialty , then go from there.
And just in case ,I got a doctor’s name for you to start. Her name is Dr.Susan Lim from Gleneagle medical centre .(I don’t know her, my friend Lydia Mchman recommended her .Lydia’s husband was the 2nd secretary of the Canada counsulate in SG but he retired recently.)

Dr. Lim’s number is 011-65-6475-7133,she is not a liver specialist but she is very good,I was told the queens of the nearby little Asian countries see her for breast cancer,liver and pancreas . I don’t think she is a hepatobiliary or liver surgeon. But it won’t hurt to see her first and she will refer you if she think your case is out of her specialty. Start to do research now and call them asap, you may be lucky if you can see her next week and get to whole thing resolved.
Again remember what I said, “I have no comment for Guangzhou’s treatment” and you should know what I mean. Among the three countries medical centres you mentioned,I will choose Singapore without a 2nd thought if your local Phillipines hospitals cannot satisfied your need,
I hope the info. helps
and remember to share your stories with us so that we can learn from you and help the others in the future.
God bless.

Hi,Wen888,
Normally I will not join in the discussion if you have been taken care already by
our more experience members.But I think I can give you some insights on the treatment of that part of region.
1Type in mares0311 in the Goggle box on the top right hand corner of this CC web site. She is from philippines and her brother has CC and are currently in touch with me via e mails. she may give insights of finding treatment locally or aboard.
2.Hong Kong ,China was a British colony until 1997;and the Hong kong University (a government hospital)is very active in liver cancer research. I saw at least 5 posters while I attended The ASCO,2011 in June; and the filipino population there is large enough that you can ask for more details about anything who speak your language. It may be cheaper for you to get treatment than in Guangzhou ,china as most of the hospital in China are “profit oriented” and I have no comment on their treatment results. Ask the local Filipino what they will do when they get sick in Hong kong? In this way you will get more info. Of other hospitals in treating CC in Hong Kong(there are lots of hospitals there,for the rich as well as for the middle class if you wanted to.( Dr.T.Yau, RC. Leung etc are from Centre for Cancer Research,University of Hong Kong,I don’t know them and you may have to google their phone number or address to start from there.)There are clinical trials for liver and/or cholangiocarcinoma in Hong kong because,as you know,from Japan to Taiwan to Hong Kong to Philippines and Thailand and India,there are lots of CC and liver cancers occur there.( I believe the cause is environmental such as diets,ie: raw seafood, the habit of eating unclean shellfish,and not up to current standard of water hygiene in general).
3.For Stage 2 ductal CC , there are a lot of treatment options even the CC is unresectable;systemic chemo therapy such as 5FU or Gemzar .In Asia they like to ise Gemzar+S1 oral formulations to treat CC ;intrabiliary radiation and therapy such as PDT or brachytherpy;SBRT and clinical trials are the current
approach.
I hope the info. helps
God bless.