pcl1029

Hi,
In the hospital, they will use heparin for the blood clot for a few days to 2weeks, then after a few days when condition allows they will start either Coumadin or Lovenox and this will be used too when your father discharged home to prevent further development of the same.
The most important thing was your father had the chance of a possible cure for this disease. What a Christmas gift , you cannot ask for more than this . Enjoy while it last.

God bless.

That means both opinions from your Holland doctor as well as the Germany one are correct.

The choice is difficult between “quality or quantity of life.|

God bless.

Hi, Jules,
Since I am only a patient,before I render my opinions,
the link below may help.and if you have further questions after reading the links below. I am happy to answer them.

With regard to the adrenal mass,it can be benign or malignant. the best way is to compare old scans even dating back the first Ct scan a few years ago to see whether the size of the adrenal mass is there or enlarged. Adrenal mass is not always adrenocarcinoma; and that is why you had different opinions from doctors.PET scan is a good choice if you do not need to pay for it in order to establish a baseline SUVmax value to compare with future PET scans.

the message was from Dannyk86

http://www.cholangiocarcinoma.org/punbb/search.php?search_id=1210026648

DR. Khan and Prof. Cummingham are the doctors with a lot of experience of CCA in England.

Gavin just put out messages about SIRT in Scotland and
the link below

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?id=10921

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=80626#p80626

Now the question is to try to find out where you can get SIRT outside Scotland,
if surgery is not and option from The imperial college of London and prof. Cummingham.
2nd opinion for SIRT treatment is appropriate at this point due to the large size of the main tumor as well as the other small ones; but be sure the patient is physically up to it, and try to do it as segmental rather than for the whole liver to minimize the toxicity.

In short, do surgery first if offer; chemotherapy or targeted therapy such as erlotinib (Tarceva) second and segmental SIRT (NOT the whole liver if possible)as the last option.

Happy Thanksgiving and

God bless.

Hi, Faisal,

First of all ,I am not a doctor,I am just a patient.
I presume the surgeons that told you your father CCA was unresectable after they opening him up are GI surgeons; did the surgeon told you the REASON why the tumor cannot be resected at that time. Are they LIVER surgeon and not just general GI surgeons. If not ,seek a 2nd opinion by a liver surgeon is my suggestion especially your message above stated that “liver:shows evidence of pneumobilia(free air,may be due to the procedure of insertion of the stents) and stent seen in site..No definite FOCAL lesion seen in liver parenchyma…
No obvious extraneous mass lesion seen in the region of porta hepatis … unless what it means is EXCEPT the original tumor,the new finding on this scan is irrelevant or unrelated to the subject being dealt with(ie: the original findings of the tumor.) and if otherwise, this is a very good news.
btw, THE SCAN NEVER REPORTED ANYTHING ABOUT THE COMMON BILE DUCT AND ANYTHING INVOLVED THE LEFT AND RIGHT HEPATIC DUCTS, PORTAL VEIN AND HEPATIC ARTERY JUST BELOW THE PORTA HEPATIS.

I know you may intent to just put out the most important part of the scan and may not the completed (full) report as you use the …. at the end of some sentences and i understand;but if your father did not have any other health related problems, then the following suggestion and the above ones may be of help to you.

“Previous CT Scan shows tumour at the level of porta….! But now the report said:”No obvious extraneous mass lesion seen in the region of porta hepatis …”
What is your opinion in this regard???” .
This is rather surprising to me too. I guess the GEM/CIS works and shrinks the tumor completely (complete response?)or the stent works .(some stents are coating with chemotherapy agent to block further growth of the tumor at site of insertion. You need to bring this finding up and ask the oncologist why he/she want to stop the GEM/CIS chemotherapy since according to the recent scan, the tumor is no longer there and it seems the chemotherpy is working, ask for the specific reason not to continue the GEM/CIS.
How about getting another MRCP to confirm the CT scan findings for further treatment plans.
I am not in India, and not familiar how the medical systems work. But I know ,if financial matters is no concern, There are excellent private hospitals as well as specialty surgeon and doctors in most of the Asia countries that can provide the same if not better care for their patient than the States here.

God bless.

Hi,
I know at least Jason,Pamela and Holly have given their opinions and experiences to you based on the messages you had with them on this board.
I think they have given you the best of their experiences and knowledge .
I know Jason wrote to you in one of the message that about what he thinks about the radioembo but he also mentioned” it is not the time for his wife for having this procedure.” He did not say it without studying and asking questions. I know he did a lot of researching on this and you can do the same by reading the past members’ experiences,case by case, on this board,under section of Radiation Treatment.
God bless.

Hi, Jz,

Thanks for your compliment.
As you know, there are our moderators ,nurses,cytologist,and sometimes doctors and other medical professionals will response to our members discussion board message and I am only part of the team.

Interventional radiologists(IR) and the medical articles that I read mostly agree that for intrahepatic tumors ,if the LOCATION of the tumor is not a problem, the SIZE of each tumor is <3cm and/or no more than 3-4 tumor IN NUMBERS; chemoembolization followed by RFA or microwave ablation or IRE will have the same effectiveness of resection.
For lymph nodes nearby the liver ,depends on the location and size, cryoablation or IRE can be of use to ablate the tumor without using HEAT.
BTW,I am actually testing out the above procedures for my third recurrence.
and I will let the members know exactly what I think the result is actually match what the books and experience said or not.

For lungs, RFA,IRE or microwave ablation can be used to burn off the leison ; follow up with adjuvant chemotherapy or targeted therapy and with PET scan every 3 months for confirmation of the effectiveness of the IR treatment.
Stanford is one of the best IR for 2nd opinion in the west. and I see why not to give them a try for a 2nd opinion.
Your dad is 63,the same age as me,unless he had other co-exist diseases at the same time that will affect his overall risk of having IR treatment. I do not see any problem for IR procedures;

Most of the IR procedures are outpatient procedure and can go home the same day. The only problem IR procedures are palliative in nature and not for cure.( but I have 2 successful resections and still have 3 recurrence,so resection is ONLY a POSSIBLE cure ; the recurrence rate for ICCA is 50-80%)

If they(Standford) offer your father radioembolization ; and If I were your father, I will only choose it as my last IR option.

God bless.

Hi,

First find out why your father cannot have further treatment.(very important)

Second, get a current CT scan to compare to the last one to check out the current tumor situation to determine the next best treatment plan.

Third if there are no contradiction to continue treatment based on the above information, if your father ‘s bilirubin level is acceptable by the doctor, and the liver enzymes is normal, especially the ALK phosphate ;and your father’s lab work of platelets etc.are ok, and if the CT scan done or will be done after the 6th dose GEM/Cis and show tumor shrinkage or no further growth of the tumor(stable); and your father is relatively heathly with no other disease like kidney problems; then ask your doctor to continue the GEM/CIS till your father cannot tolerate the GEM/CIS.
or ask your oncologist to consider whether targeted agents such as Tarceva® (erlotinib) is proper for your dad.
Systemic treatment in your father’s case is one of the beast opinionat this point.
Get a second opinion by an other oncologist or GI oncologist to confirm treatment is highly advised.

God bless.

God bless.