pcl1029

Hi,
On the contrary , I will get a second opinion in China, like the best tumor hospital in Beijing ( I do not know the name), for oncology and interventional radiology consult first before coming to America.
The reason is simple, every year in the most prestige oncologist convention here in Chicago,the ASCO convention, there were a lot Of Chinese md attending and bring home what they learned.
Since most likely, the oncologist in China will start the same protocol they have learned in the States here in Chicago, I do not think the chemotherapy regimen is that much of a difference when it begins.
However ,I will bring my dad here if the 1st line chemotherapy like GEM/CIS or GEMOX do not work after the first CT scan when he has the chemotherapy treatment. In that way you will get more specific info and expertise to treat your father.
As a general rule of thumb, if the surgery went well, patient can start their adjuvant chemo six to eight week after surgery if they have no other medical problem prior to the surgery.
So you still have time to search for the best hospital in Beijing for 2nd opinion.
Mostly likely the best hospital are the one that are affiliate with well known university.
One final note, do not go to the hospital that use Chinese herbal medicine as their main treatment objective. Go to the one that practice western style medicine.But it does not mean you cannot give 八珍湯 or 十全大補湯 those kind of Chinese herbal soup to your father during this no treatment period to boost his energy level to fight the side effects of the chemotherapy. Ask you mom or you to increase his protein intake by drinking soy milk豆湬 or cooking 豆腐 ,fish, walnut , chicken without the fat and skin ,Ensure, Boost are among other protein sources. He can boost his immune system by taking Oncozac , the only yunzhii extract researched in Hong Kong Chinese university that has USP approval for it purity in the States.
After all of that, then prepare to choose which hospital for the next journey if USA is your main wish to come to. MD Anderson is famous in chemotherapy but make sure this is your father’Wish since side effect will decrease the quality of life a lot .he will know after chemotherapy treatment in your hometown or Beijing. if you want to go to HongKong for consult, e mail me at that time and I will help you found the best there.
Can you tell me what are the tumor markers and their lab value before and after result.
God bless,

Hi,
Fever is not common after biliary surgery.Most likely the infection is related to the surgery. In general, it require at least 14 days of antibiotics treatment like ciprofloxacin 400mg twice daily or levofloxacin 500-750mg daily for 14 days to
eradicate the infections; If they put a stent or two in the bile duct to facilitate the bile flow, the infection may be more often. The rule of thumb is if your father has chill and the fever is >39 . Bring him to hospital right way so they can give him antibiotics or ask the doctor to prescribe levofoxacin 500mg daily ,number 14-21 tablets as standby for him to take at home when symptoms occur. In normal situation, the fever will go away in a couple days;keep your father hydrated is also important(6 glasess of 240ml liquid).
Adjuvant therapy ,as far as I am concern , I will do it with no reservation at this time. I do not know what kind of profession you are in, but you may have done research and know that Liver is the only organ that can regenerate itself; that means as few as one cancer cell left inside the biliary system, it will regenerate together with the healthy cells in the liver of the biliary tract ; therefore I believe no matter how well the surgery turn out, due to the fact that 50-75% of cholangiocarcinoma cases may recur for the rest of our life time.( I am a patient of intrahepatic CCA) and adjuvant chemotherapy therefore is warrant to have it done.
Adjuvant may be one of the following.
1. Gemcitabine ,3weks on and one weeks off. (easy to tolerate)
2. Gemcitabine + oxaliplatin. (better tolerate than gemcitabine + cisplatin.)
3. Gemcitabine + cisplatin ( widely used as a reference standard for CC)
4. 5FU infusional pump+ Leucovorin +oxaliplatin (good alternative to # 3)
5. and of course gemcitabine follow by chemoradiation with capecitabine.

For systemic chemotherapy for treatment of advance cholangiocarcinoma
below is the link.

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=57198#p57198

By the way, may I ask where you get your treatment,in the capital of local hospital;Can you give us any names of the hospitals and doctors that help treating your father . We are an international community and some one in China,like you, may want to know that information too to help their parents or relatives. As you know liver disease is much higher than in China than in the States. your info. will help others in China as well.

God bless

Hi,
In general, most people can tolerate the folfox quite well without problems; the pre-medications such as dexamethasone,zofran or other anti-emetic will help the nausea and vomiting. Of course, he will feel tired and have” hand and foot syndrome ” and difficulty to handle cool objects such as a glass of cold water. For specific adverse drug reaction please check the link below .

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=57198#p57198

God bless.

Hi,
the one you take home should be the 5FU pump infusion for 46hours.
but what is the name of the drug that your husband had while in the cancer center .Was it oxaliplatin or irinotecan?
God bless.

Hi,

“I have not stopped researching this disease but in every situation there were symptoms on the onset..
For intrahepatic cholangiocarcinoma, there are no symptoms even in the final stages of the game. The reason, the liver a very large organ, and if the tumors do not block the bile flow, your will not see any symptoms until the bile ducts are blocked or the liver no longer can function under the minimal capacity because of the tumor load is too heavy .
BTW, since I have this disease, I did not hide my situation when asked ; I told my classmates and my coworkers; I join this message board and contribute my share of what I think is my responsibility to find the cure of this disease. Actually I am more active than I had my disease before.
One thing I am sure, I did help a few of my classmates and coworkers who develop cancer later , in understanding that the ” positive attitude “that I demonstrated at work and thru communications give them courage to fight against their own battle of cancer.and I thank God for using me to help others thinks differently and positively about treating the disease called cancer.
God bless.