Hello and thank you for submitting your question.

Your question is a very good one and I will work on providing you with some information and recommendations regarding your specific question.

Urobilinogen is a urine marker for the breakdown of the bilirubin. Bilirubin is a substance which is mainly generated by bacteria in the intestines as well as by the breakdown of red blood cells. Red blood cells breakdown naturally on ideally basis.

Regarding your test results this result by itself does not indicate anything worrisome in my opinion. I would be more interested to learn any additional test results which you may have had performed recently.

I would not focus on this individual result by it's self. If for some reason your bilirubin level was elevated This would be more of a concern.

If you have additional test results related to this concern I would be happy to review those as well. You could scan them and attach them to an email and send them to my attention at the following email address: YYYY@YYYY .

I will await your response and possibly the additional test results related to this individual question. I hope this will be a very informative experience for you. If you have additional concerns I would be happy to address those as well.

Sincerely,

Dr. Robert

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Hello and thank you for the follow-up question.

Eight bilirubin of 2.3 is not worrisome in my opinion. This does not reveal any evidence of obstruction of the flow of file through your liver. It really is something that can be followed conservatively at this point. I don't think there needs to be any type of intervention performed.

Regarding your kidney function your nephrologist should be paying close attention to this. In addition a careful review of your medications should be taking place on a regular basis. It is certainly extremely important that your blood pressure is maintained under a optimal control as well. I'm sure you are aware of all this I just want to remind you at this point.

I'm not concerned regarding the bilirubin or the urobilinogen at this point. I think a repeat blood test in about six months would be reasonable just to document stability. Otherwise I think your kidney function should be followed very closely with your Nephrologist.

I'd like to thank you again for submitting your question. I will be happy to address any additional concerns if you have them as well.

Sincerely,

Dr. Robert

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Hello and thank you for your follow-up.

Your concern is absolutely understandable and completely warranted. You are correct that this type of histology can behave very aggressively. I am glad to hear that you have upcoming appointments and radio logical studies planned.

it appears to me that so far your cancer has been managed quite well. This will overall provide you with the greatest chance at remaining in remission. I realize you do have this discomfort which you have been experiencing and while it is possible that this could be related to your previous history of cancer we cannot assume anything. This is the way I am sure your doctors are approaching things as they see you in clinic.

As oncologists these days we really do not put life expectancy or numbers in conversation with patients. The reason for this is that every patient is going to experience cancer in a different and unique way. To apply averages to a single person is simply not fair and it is certainly not accurate. In your case as long as you continue to have scheduled interval follow-up visits to document maintenance of remission I am confident that you will achieve the greatest overall survival.

Sarcomatoid tumors do have an aggressive nature but this does not mean that this type of tumor cannot be controlled or defeated.

I thank you again for submitting your question. I hope you have found our discussion to be helpful and informative. If you have any additional concerns I would be happy to address them.

Sincerely,

Dr. Robert

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