pcl1029
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Hi,
I do not know the answer;normally CT scan every 3 months will tell the progress of the treatment;that means around the time of the cycle 6.
If they will do the radiation+Xeloda, please ask whether you need a chemo free period before the new treatment starts.
God bless.Hi,
I am so sorry for the loss of your child. It is very difficult for the parent to watch her child goes before them. God took him so he will be in a better place than suffering down here;
Sincerely,I thank you for still have the kindness and gentleness to pray for a cure for patients like me in this extraordinary circumstance. Take good care of yourself and may the Love and Grace of God be always be with you no matter where your are.
God bless.Hi,Tiffany,
This a a good report,like Jim said, you should send this to Dr. Keto or Dr. Chapman for the possibility of surgery as you had mention before that D r. Jalve you may be a candidate for surgery if the tumors shrunk.
Eli’s comment explains very well about your PET scan report.
If base on the SUVmax value in general for the liver, you are in very good shape especially the right lobe. Please also consult an interventional radiologist for the possibility of radioembolization .you may be a good candidate for it.
Please ask dr. Jalve FIRST about his assessment of the possibility of surgery and radioembolization to show your respect about his opinion ,then do the above 2nd and 3rd surgical consultation. You do want to keep a good rapport with him ; for me a good rapport with other medical professionals can sometimes save your life. Good luck
God bless.Hi,
Sorry, I don’t know about the answer. The only thing I know is the CA 19-9 will be much much higher in the pancreatic cancer population.
Your Dad is very lucky to have such quick responses to the chemotherapy ;but as a patient, like myself,even if the CA19-9 is within the normal range,I will not let my guard down.They can come back quickly and the only way to prepare for that is to eat well,exercise ,having yourself in a healthy condition to fight again.
God bless.Hi Helen,
The insight from a specialist through your interviewed about surgery,radiation and chemotherapy are valuable and educational. I learned a lot in the way that how the specialist is thinking about this disease.
A BIG THANKYOU to you,Helen. And please thanks the Professsor for me.
The BILCAP trial, if the patient is in the control arm , the idea that you only receive placebo is tough to take. But the BILCAP study is important in a way that if it works, it will provide a relatively inexpensive treatment,even is not a cure ,to a much larger international patient population.
The thinking of CC as systemic will make me refocusing of my research reading.
PDT may not be the best palliative radiation treatment for CC,but I think the cyberknife(one form of IBRT) is still in the card as hospitals continue to advertise this relative new technique. Proton and ion beams therapy are not far behind.Thanks Helen and
God bless.Hi,
Yes, I was told that 10-14days is enough to stop Xeloda before radioembolization .
Do you think the article you read about sirpheres and the phase one trial in cases with ICC contradicts to each other in the use of Xeloda.?
I do know that radioembolization can be combined with chemotherapy such as 5FU+OXALIPLATIN,5FU+irinotecan or 5fu alone for HCC,liver mets from colon.BTW, how is your mom doing with regard to the side effects of radioembolization ?. Is fatigue the major problem ,nausea or abdominal pain.keep in touch and
God bless.Hi,
If possible,can you directly quote the ” impression or summary” section from the CT scan report. You can email me from this web site if privacy is your concern.
I would like to know is it extrahepatic CCA or Intrahepatic CCA first ,major or partial PVT for the blockage . Lovenox injection or the similar low molecular weight heparin given twice daily is what I believe your husband is on for treatment of PVT. Any bleeding on the various parts of the digestive tract (GI ) system;and any increase in portal vein hypertension(blood pressure). Besides chemotherapy,surgery and radiation oncology are the rest 2 sides of the treatment triangle for treating cancer,therefore options are still available ,
depending on your husband’s current medical situation and health. I am not a doctor,I am just a patient like your husband.Good luck and
God bless.Hi,
2-4weeks depends on the chemotherapy. Like if patient on capecitabine it can be 10-14 days; if on GEM/CIS or TAXOL/carboplatin then I would say 4 weeks to 2 months. That is the suggestion by one of my radiologist who will do the radioembo for me if I will need that done in the future and she had performed the chemoembolization for me last May. So far I cannot find out any info to sustain the idea of ” not to use Xeloda” after radioembolization . but I will try to find it out.
God bless.Hi,
I do not think either chemoembolization and radioembolization can be performed un less the Serum bilirubin is below 2.
Relative contraindications are Serum bilirubin>2;AST>100;ascites;cardiac or kidney problems;tumor burden>50% of the liver etc–from uptodate.com.For Sorafenib, dose reduction is recommended for patients with bilirubin1.5-3 times the upper limit of the normal(roughly equal 2.5-5.6); Sorafenib cannot be tolerated with more severe hyperbilirubinemia. —clinical pharmacology.com
Please remember all the above are for palliative purposes only. Drug resistance is common. The above radiations treatments may cause temporally increase of liver enzymes for a period of time.
Your gut instinct may serve well to make this difficult decision.
God bless.Hi,
Fever of unknown origins is not a risk factor for cholangiocarcinoma as far as I can understand about this CCA.
God bless.Hi,
Sorry to answer so late, I have just come home from my part time job tonite.
In general ,for an adult,the dose for ibuprofen is 600 mg( 3x200mg or 3 of the Advil) every six hours as needed for fever or pain. If she cannot take ibuprofen because of stomachache, she can take Tylenol 500mg or 650mg every 6 hours as needed up to daily dose of 4gm maximum.
I do not understand the lab result you were referring to,Is it WBC ? or respiratory related like the rate of breathing?
Since you will see the nurse for port placement tomorrow, and as you know, I am only a patient and not a doctor, I will wait till what the nurse said but make sure you mentioned to them your mom has been taking ibuprofen or Tylenol for fever. Ibuprofen is stronger in controlling fever than Tylenol, I took them with no problem while on Gemzar. Though the RN or the doctor may want your mom be on Tylenol when the platelet is low once the chemotherapy starts.
I cannot speak for your oncologist,why? But most people when they hear the word cancer,most likely they will see or refer to oncologist first,from then on,it is mostly up to them to refer you to the surgeon if they thought resection is the possibility or if not, they will start to treat the patient unless multidisciplinary protocol is established like the big hospital Mayo,MD Anderson or John Hopkins.then The patient will be evaluated by all sides of the treatment triangle,that included surgery,medical oncology and radiation oncology specialists.
God bless.Hi,
Myelosuppression is my only intended word to use, depression was a typing error.sorry, It means the chemo will depress or decrease the production of RBC,WBC Platelet by the bone marrow,especially from irinotecan .Apart from that, I show the pathology report (biopsy) to my pathologist who had come from John Hopkins ,his overall impression is this; he was not sure if that biopsy description is from you or you directly quoted from the summary.
Any way just based on your message alone, Cholangio CCA is likely he also mentioned your mom’s lung looks ok too since the ttf-1 is negative.he thought that the CDC-2 should be CDX-2 instead,and that is why he doubted that the biopsy report you put on the message is the original description quoted from it.
They are very picky when they want to give out their opinions,but don’t worry ,he is my friend. Next time just make sure you quote from the report directly.I don’t really know any place in India that is the top medical institution for the radiology oncology. My guess is the hospitals that are affiliated with the top universities . Since you are in Brussels ,Europe. Can your mom get treatment from there. Interventional radiologist is the one you should talk to before the tumor metastasis. The lymph node mentioned may not be anything at this point but I am not sure it will affected the decision of the radiologist who you will consult later.
May I ask what is your profession and do you know anyone in the medical field in Brussels.? I know one of our member call Lud had the radioembolization Done in France,it is close to Bressels,right?
All the moderators on this board are volunteers and at this point we may not have enough knowledge to know about the best medical institutions outside the States or Canada for CCA.
I AM NOT A DOCTOR,but I still do not understand about your mom’s chemotherapy,it seems to me that the oncologists are trying the available regimens until the one that works but in the meantime the tumor is still growingCompare to the regimen before the change on December,2011.
I just do not feel comfortable about the situation , I will seek other option if she is my mother.
God bless.Hi,Eli,
Last scan was Demceber,so can your wife have another one in March ,then you can decide together with your wife to have chemo or not.
My personal gut feeling is that it doesn’t matter you have 4 or 6 cycles but the chance forCCA to recur is very high even if you wife agree to have the chemo for a year or more. And when it comes back then you and your wife will fight again.But in the meantime, take a chemo vacation if the March cat scan is stable or show tumor shrinkage..
I took 14 month of gemcitabine, 8 month more than usual with a clean margin of 1.5cm. But the CCA still came back after 6 month of stopping the chemo. I will avoid any chemo if I could if it recur again, Chemo is no picnic even just for gemcitabine only, not to mention if ,like your wife,had the CISPLATIN ,a much tough chemo agent to take and the side effects are tough to swallow.
God bless.Hi,
The PDT message that both Gavin and I written was the response to your question this morning at 08:24 ; and nothing related to your sister’s intrahepatic CCA.“I wonder if this treatment is possible for CC. I have browsed in the forum and I have not seen this topic. If anyone knows about this I would appreciate any reply.
Thank you
http://www.nextgenerationpdt.com/ “
and your are right ,PDT is not for your sister;radioembo or chemoembo are the radiation treatment choices if so you choose after consultation with an interventional radiologist. good luck and
God bless.
