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Suggest Alternatives To Chemotherapy For Gall Bladder Cancer?
Question: Hi Doctor,
My mother, aged 59years, has been diagnosed with gallbladder cancer on 10 Aug 2014. We are apprehensive of the chemotherapy because of the adverse affects that the treatment has on the patient. I want to understand the possibility of the treatment in this case. Doctor has suggested Stage-IV GB cancer.
Is it still curable ?
If not, what alternative treatments are available other than chemotherapy?
How effective is ayurvedic treatment?
Please find below the details:
CT Scan Upper abdomen with contrast - Liver shows multiple hypodense lesions in both lobes. On post contrast sequence, they show peripheral enhancement. Intra heptic biliary radicals are not dilated.
GallBladder - There is evidence of focul thickening noted in fundus region along both wall approx. 16mm.CBD is not dilated. No CBD stone seen.
Few heterogenously enhancing lymph nodes seen at portal and porto-caval region and left para-aortic region.
Pancreas, both kidneys, and spleen appear normal.
CA 19.9 - 1010 U/ml
Liver Function Test -
Bilirubin (Total) - 0.88
Bilirubin (Direct) - 0.46
Bilirubin (Indirect) - 0.42
FNAC - USG FNAC done on gallbladder mass. Positive for malignant cells. Cytomorphology consistent with adenocarcenoma.
Please advise soonest.
Thanks, XXXXXXX
My mother, aged 59years, has been diagnosed with gallbladder cancer on 10 Aug 2014. We are apprehensive of the chemotherapy because of the adverse affects that the treatment has on the patient. I want to understand the possibility of the treatment in this case. Doctor has suggested Stage-IV GB cancer.
Is it still curable ?
If not, what alternative treatments are available other than chemotherapy?
How effective is ayurvedic treatment?
Please find below the details:
CT Scan Upper abdomen with contrast - Liver shows multiple hypodense lesions in both lobes. On post contrast sequence, they show peripheral enhancement. Intra heptic biliary radicals are not dilated.
GallBladder - There is evidence of focul thickening noted in fundus region along both wall approx. 16mm.CBD is not dilated. No CBD stone seen.
Few heterogenously enhancing lymph nodes seen at portal and porto-caval region and left para-aortic region.
Pancreas, both kidneys, and spleen appear normal.
CA 19.9 - 1010 U/ml
Liver Function Test -
Bilirubin (Total) - 0.88
Bilirubin (Direct) - 0.46
Bilirubin (Indirect) - 0.42
FNAC - USG FNAC done on gallbladder mass. Positive for malignant cells. Cytomorphology consistent with adenocarcenoma.
Please advise soonest.
Thanks, XXXXXXX
Brief Answer:
palliative chemotherapy
Detailed Answer:
Hi
As per the CT scan upper abdoem report as there are multiple hypodense lesions in both lobes of liver your mother is suffering from stage 4 gall bladder cancer.
As this stage the disease is not curable.
Aim of treatment at this stage is palliative chemotherapy to palliative symptoms and improve quality of life and improve overall survival.
Palliative chemotherapy with combination drugs gemcitabine and oxaliplatin in patients with good general condition have a response rate of 21% to 53% with median overall survival of 5 to 15 months.
Alernative treatment other than chemotherapy is only basic supportive care which is medications to reduce symptoms like pain abdomen, jaundice and tapping of abdominal fluid in case of swelling of abdomen which can occur as the disease progresses.
Ayurvedic treatment is not scientifically proven.
Hope i have answered your query.
Regards
DR De
palliative chemotherapy
Detailed Answer:
Hi
As per the CT scan upper abdoem report as there are multiple hypodense lesions in both lobes of liver your mother is suffering from stage 4 gall bladder cancer.
As this stage the disease is not curable.
Aim of treatment at this stage is palliative chemotherapy to palliative symptoms and improve quality of life and improve overall survival.
Palliative chemotherapy with combination drugs gemcitabine and oxaliplatin in patients with good general condition have a response rate of 21% to 53% with median overall survival of 5 to 15 months.
Alernative treatment other than chemotherapy is only basic supportive care which is medications to reduce symptoms like pain abdomen, jaundice and tapping of abdominal fluid in case of swelling of abdomen which can occur as the disease progresses.
Ayurvedic treatment is not scientifically proven.
Hope i have answered your query.
Regards
DR De
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thanks Doctor for your response.
I wanted to know if there is any possibility of tumor shrinking after chemotherapy and leading to chances of resection by surgery later. Basically, I want to be clear of the approach. I will go for chemotherapy for my mother ONLY IF there is any chance/hope to shrink the tumor in gall bladder and recover the liver from lesions, so that gall bladder can be extracted. Otherwise, I don't see any reason for my mother to suffer the daunting side effects of chemotherapy.
If you confirm that chemotherapy will ONLY be palliative to improve the quality of life, then I will rather chose to NOT have her suffer in her last days and instead enjoy them healthily to whatever extent she could.
I hope you understand where I am coming from.
Appreciate your sincerest and bold response.
Thanks, XXXXXXX
I wanted to know if there is any possibility of tumor shrinking after chemotherapy and leading to chances of resection by surgery later. Basically, I want to be clear of the approach. I will go for chemotherapy for my mother ONLY IF there is any chance/hope to shrink the tumor in gall bladder and recover the liver from lesions, so that gall bladder can be extracted. Otherwise, I don't see any reason for my mother to suffer the daunting side effects of chemotherapy.
If you confirm that chemotherapy will ONLY be palliative to improve the quality of life, then I will rather chose to NOT have her suffer in her last days and instead enjoy them healthily to whatever extent she could.
I hope you understand where I am coming from.
Appreciate your sincerest and bold response.
Thanks, XXXXXXX
Brief Answer:
Unresectable tumour
Detailed Answer:
Hi
Since the tumour has already spread to her liver and there are multiple hypodense lesions in both lobes of liver chemotherapy will only help palliate her symptoms.
The tumor size may shrink somewhat but as their are multiple lesions resection may not be possible.
Chemotherapy will only palliative her symptoms and improve her quality of life.
Regards
DR De
Unresectable tumour
Detailed Answer:
Hi
Since the tumour has already spread to her liver and there are multiple hypodense lesions in both lobes of liver chemotherapy will only help palliate her symptoms.
The tumor size may shrink somewhat but as their are multiple lesions resection may not be possible.
Chemotherapy will only palliative her symptoms and improve her quality of life.
Regards
DR De
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thanks Doctor.
Can you please list down the potential side-effects of the palliative chemotherapy (gemcitabine and oxaliplatin) in my mother's case? She is presently quiet weak, but improving day by day. I want to understand how badly she may get hit by the chemo.
In addition,
How long and how many cycles of chemotherapy will it take before we know its working?
Will she live longer?
Can you please list down the potential side-effects of the palliative chemotherapy (gemcitabine and oxaliplatin) in my mother's case? She is presently quiet weak, but improving day by day. I want to understand how badly she may get hit by the chemo.
In addition,
How long and how many cycles of chemotherapy will it take before we know its working?
Will she live longer?
Brief Answer:
3 cycles
Detailed Answer:
Hi
Side effects of gemcitabine and oxaliplatin combination chemotherapy are diarrhea, fever, anorexia, vomiting, pain abdomen and tingling sensation in hands and feet.
She will need atleast 3 cycles of chemotherapy followed by CT scan of whole abdomen.
If radiologically her disease remains stable meaning the size of lesions remain same or if there is partial response meaning size of lesions reduce in size then she will need further 3 more cycles of chemotherapy.
She will live longer and average overall survival varies from 5 to 15 months.
If you have no more clarifications then please rate the answer and close the thread.
Regards
Dr De
3 cycles
Detailed Answer:
Hi
Side effects of gemcitabine and oxaliplatin combination chemotherapy are diarrhea, fever, anorexia, vomiting, pain abdomen and tingling sensation in hands and feet.
She will need atleast 3 cycles of chemotherapy followed by CT scan of whole abdomen.
If radiologically her disease remains stable meaning the size of lesions remain same or if there is partial response meaning size of lesions reduce in size then she will need further 3 more cycles of chemotherapy.
She will live longer and average overall survival varies from 5 to 15 months.
If you have no more clarifications then please rate the answer and close the thread.
Regards
Dr De
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thanks Doctor for answering my queries.
But I still fail to understand how does the palliative chemotherapy improve "quality of life" when it afflicts so many side effects and leaves the patient confined to bed ?
We recently tried 'immunotherapy' and my mother suffered fever, anorexia, vomiting, and pain abdomen after just 2 days of starting the treatment. And I can tell that her health and quality of life "degraded" significantly in only 3 days, which took these effects to wear off by giving her other medications. We have not stopped immunotherapy as she could not manage that.
If it's just the pain, then that can be handled by other medications as well.
Please advise.
A correction -
We have NOW STOPPED immunotherapy as she could not manage that.
But I still fail to understand how does the palliative chemotherapy improve "quality of life" when it afflicts so many side effects and leaves the patient confined to bed ?
We recently tried 'immunotherapy' and my mother suffered fever, anorexia, vomiting, and pain abdomen after just 2 days of starting the treatment. And I can tell that her health and quality of life "degraded" significantly in only 3 days, which took these effects to wear off by giving her other medications. We have not stopped immunotherapy as she could not manage that.
If it's just the pain, then that can be handled by other medications as well.
Please advise.
A correction -
We have NOW STOPPED immunotherapy as she could not manage that.
Brief Answer:
Increase in life span
Detailed Answer:
Hi
If she is weak and about 50 % of her waking hers she is confined to bed then she will not tolerate injectable chemotherapy.
But if she is not confined to bed 50 % of waking hours then she will be able to tolerate chemotherapy .
Side effects of chemotherapy will occur only for about 3 to 4 days after which she will slowly improve with supportive medications and after 2 to 3 cycles if the chemotherapy works then her symptoms will improve and she will also be able to live 5 to 6 months longer.
Regards
DR De
Increase in life span
Detailed Answer:
Hi
If she is weak and about 50 % of her waking hers she is confined to bed then she will not tolerate injectable chemotherapy.
But if she is not confined to bed 50 % of waking hours then she will be able to tolerate chemotherapy .
Side effects of chemotherapy will occur only for about 3 to 4 days after which she will slowly improve with supportive medications and after 2 to 3 cycles if the chemotherapy works then her symptoms will improve and she will also be able to live 5 to 6 months longer.
Regards
DR De
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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