pcl1029

Hi,
Second opinion is strongly recommended for a 43 year old like your husband because age advantage is on his side.
If your husband’s CC is intrahepatic(tumor original from the bile ducts in the liver)did they tell you is the tumor resectable or not and why? Is it because of the lymph nodes involvement or the CC is too close to the portal vein or the main artery? or they just first want to shrink the tumor then do resection later?These are the questions you should ask them and Mayo Clinics.

;if you cannot open the above link ;his entry is under the chemotherapy forum on the web site.
These are the current chemo treatment plans available to the physicians apart from the clinical trails that most of them will contain a molecularly targeted agent like Tarceva,Avastin or Nexavir or Erbitux to improve the overall survival rate to a better percentage;but they also come with additional side effects.
God bless.

Hi,Gavin,
thanks for this info.
I do not understand why that hospital just do TACE only ONE time for all the patients population;In the States,usually they will do multiple times of TACE to control the CC to control the recurrence if applicable.
In addition to that the 1,3,5 years OS(overal survival)with TACE once only and without are 69.8%,37,2 and28.3 compare to without TACE,the control group ,are 54% 25 and 20.8% which are not bad at all.Imagine if they repeat TACE like in the States,then the outcome will be much better even on the(RFS) recurrence free survival.
God bless

Hi,Mark,
I have just copied my 14 month experience on Gemzar .
I hope it will give you some ideas on Gemzar as mono therapy.
For the question about the efficacy fo Gemzar alone and how long a patient should be on Gemzar;the reply from the drug manufacturer Eli Lilly of Gemzer is “until disease progress or unacceptable toxicity.”
My personally view about this CC disease is that unless a new drug is found, the use of systemic therapy is to keep the cancer cells at bay ,it will not cure the disease;all it will take is one of them to invade the patient’s immune system successfully and cause us trouble all over again.

As always, please confer with your doctor first before any change of Rx. This is for informational purposes only.
BEFORE Tx
1.Give lorazepam 0.5-1mg or alprazolam,same dose, by mouth 30min. before the start of chemo for anticipatory nausea/vomiting purposes.
DURING Tx
2. As pre-medication prior to gemcitabine to control nausea/vomiting ;Ondansetron(or granisetron or dolasetron)+ dexamethasone(a cortical steroid) as IVPB will be given over 30minx 1dose.(dose determined by body surface area of the patient).
3.Gemcitabine sholud be given just for 30min and no more than that in duration in order to minimize the side effect.;I always make sure the nurse understand this.(this only apply to monotherapy of Gemzar)
AFTER Tx
4. Then when you are home,take 25-50mg of benadryl(diphenhydramine)-an antihistamine and 0.5-2mg alprazolam or lorazepam together with sips of water and go to bed right away, if he needs to vomit,let her do it first,then take the med and go to bed ;he will wake up in about 3-5 hour and will feel better.Encourage her to drink water or juice or soy milk as much as possible especially in the first 8 hour after gemcitabine.(ie;3-4 glass of 240ml size /day or more) to flush out the gemcitabline to minimize its side effects.
5. I do not need any other meds to control the N/V until the next week of chemo;but if you dad needs it,ask to doctor to have some promethazine 25mg on hand for nausea /vomiting and take it by mouth every4-6 hour as needed.
For diarrhea,Imodium or Lomotil are the choices, Take one by mouth every 4-6hrs AS NEEDED for diarrhea and not to use more than 8 tablets/day.

Again, every patient is different in physiology and the state of health at time of diagnosis. You MUST consult your doctor first for his recommendation .
God bless

Online

Hi,Marion,
Are you back from vacation now?
BTW,How can I apply the above interesting in order to help myself and others?
I am still digesting the emails you send to me,will give my thoughts on them later. I am still not 100% before resection but much better by the day.
God bless.

Hi,
I presume the doctor you will consult tomorrow is an oncologist;
Gemzar/cisplatin ;Gemzar/oxaliplatin gemzar/xeloda is the first-line systemic therapy they may offer to your husband. In your case,you can ask the oncologist whether it is beneficial to add a molecularly targeted agent such as erlotinib,sorafenib or bevacizumab.
When you have lymph nodes involvement, it may due to other disease such as infection but most of time,if they confirmed metastasis they will not do surgery but give chemo first to shrink the tumor and the lymph nodes and then perform surgery later if they can in hoping for a better surgical outcome.
Columbus ,Ohio University Clinics and Hospitals may be another place for you to consider since they also provide clinical trail at this moment for unresectable bile duct cancer using Gemzar/xeloda and bevacizumab and their team is familiar with CC.
God bless.

Hi,Katie,
If possible,please quote exactly the part of the CAT SCAN report directly about the”20-30 nodules “so that I will have a better idea about your mom’s condition.
Can your also provide the blood work(inside the BMP report) of ALT,AST and ALK Phos and tol.bilirubin,CEA and CA19-9 and or AFP if you have them?
I am not a doctor,I am just a patient but I think I can help you in understanding your mom’s case a bit more.
Gamzar/cisplatin;Gemazr/Oxaliplatin;Gemzar/Xeloda are systemic therapy to name a few;5FU and bevacizumab or erlotinib are among others.
Depends on your mom’s condition,location of the nodules,other non systemic treatments such as RFA,chemoembo and Sir-spheres are available in the radiology department of hospital.
In the meantime,
God bless.

Hi,
If I may suggest; and if the diagnosis is just “stones in the common bile duct” ,then I will say,your father ,in heaven now,is in deed still looking after his soul mate since 1954.
Stones are not cancer and can be removed easily.And based on the length of time that your mother had the original diagnosis ,no medications taken and so few stents changes and CA19-9 is so low with regard to her ductal CC since Jan.2007.I will say ,if the current diagnosis holds true after other testing, this will be the best gift for your mom and your family .
God bless.