This is Dr. David
the biopsies could still have missed the cancer area if not done properly.
how has she had the biopsies performed.
the best way to do these sorts of biopsies is with endoscopic ultrasound guidance during an ERCP procedure.
which is very difficult procedure and I'm not sure if it is available in Pakistan.
removing the gall bladder most likely will not help much
so what should we do dr
did the MRCP show the area of abnormality around the bile stent area where the potential cancer is.
sometimes after a metal stent is placed in, this can cause a lot of artifact on an MRCP procedure
which can make it hard to see around where the stent was placed.
the doctor in hospital says that they will do an open surgery to see inside and if anything serious found the doctor will remove gallbladder along with cancer area
I hope they can do this.
it can be tough to do surgery around the liver and bile ducts.
the doctor said that there was infection in stent area but later he said it has been cured by antibiotics
I would get a copy of the MRCP procedure.
I would be happy to help you interpret it.
but she cannot eat anything
she is loosing weight
yes, I understand.
and vomiting is there as well
this is most likely due to a cholangiocarcinoma or a tumor in the liver pressing on the bile ducts.
this is a tough cancer, even to treat in the USA.
and will be difficult also in Pakistan as well.
she is very weak
and i think if the doctor do another surgery she wont survive it
you are right.
there is a chance she might not survive a surgery.
operation for gallbladder is not necessary
removing the gall bladder is not the problem.
the problem is the tumor mass which is pressing on the bile duct.
possibly in the liver.
it seems like her doctors are having a hard time seeing the area.
yes that is true
in the USA we would use MRI scans of the liver and PET scans to try to see the area
to target for biopsy
and the possibly target the area with radiation and chemotherapy.
as to not use surgery in a very frail patient.
does this help?
do you have other questions?
yes Dr you are very right
Does radiation and chemotherapy have any success rates
can it cure the problem
they took biopsy samples twice from all possible areas and nothing cancerous was found
it depends on the cancer.
but the cure rates are still very very poor.
with radiation and chemotherapy .
but it spares the patient of having to do another surgery.
do you have any other questions?
My question is how to reduce her pain thats what what i want to do for my mother.
Should we ultimately do a open surgery
to remove the cancer area
or just stay with the radiation and chemotherapy
should she be at home or hospital?
she can have morphine for pain
I would lean away from doing surgery.
but it seems like the surgeons are pushing to do this to get a biopsy.
I have a feeling that they will be able to get a biopsy of the area with surgery, but most likely will not be able to resect all of the area
chemo radiation is fine, but that will be done without a biopsy to show the cancer.
it seems that with all of her pain and inability to eat, she most likely needs to be in the hospital receiving pain medications and IV fluids
if she does not wish to keep fighting this cancer, she can be comfortable with only hospice care and pain medication as an option as well
I know these options are not very good, but this is a very difficult cancer in an elderly patient who is suffering substantially from most likely an aggressive liver biliary cancer which seems to be very difficult to diagnose.
so this is not a good situation overall.
I wish I could give you better news.
You have been very helpful Dr
I thank you so much
you are welcome
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Thank you Dr
Yes I will Dr
Please attached find further reports for your expert advise.Many thanks
Attachments are only available to registered users.
Dr. Abid Ali Qureshi
Associated Professor of Radiology
The Children’s Hospital and
Institute of Child Health, Lhr
Patient Name : M/o Aftab
Patient Age : 65 Years / Female
Patient R. Date : 03.05. 2014
Patient Referred : Dr. Shah Muhammad
History: Status post surgery, no details available.
Discussion: MR Cholangio-pancreatography was performed and images are displayed after Maximum Intensity Projection (MIP).
Gall appears distended showing thick sludge and a few stones.
Intra-hepatic biliary channels appear normal with no abnormal dilatation. Pancreatic duct show mild prominence. There is no evidence of any collection in the sub-hepatic space. There is subtle heterogeneous intensity abnormal area in the left lobe of liver.
There is no appreciable peri-ampullary mass on these available images. Spleen, pancreas and both kidneys are unremarkable.
Dr. Abid Ali Qureshi
Assistant Professor Radiology
CH & ICH, Lahore.
Thank you for referral. This is a comp
Dear Dr David,
Many thanks for this.
BLOOD CULTURE REPORT-ESCHERICHIA COLI
AMOXICILLIN/CLAVULAN, AMPICILLIN, AMIKACIN, AZTREONAM, IMIPENEM, PIPERACILLIN/TAZOBAC, GENTAMICIN, CEFTRIXONE, CEFUROXIME, COTRIMOXAZOLE, CEFIXIME, CIPROFLOXACIN.
she is currently taking piperacillin/tazobac.
please advise me what is the actual problem with my mother and how it could be treated. i ll very much appreciate your expertise for the poor sole
Thanks Dr David. We have been very grateful for your timely advise and help. Now she has been on ZOSYN, RISEK and GRAVINATE. She is feeling better now and she has started eating and her vomiting and fever has stopped with ZOSYN. Would you suggest any other drug to increase her appetite? But so far the the tumour is shown to be non-malignant. But i know 90% of the cases it is cancerous. Now she has ascending cholangitis as well. Once she is a bit healthier and her RBC counts are better she is welling to carry on with the surgery. Now the doctors said that they can remove the tumour and gallbladder and clean the biliary ducts from e-coli bacteria during surgery. The patient and doctors are not inclined towards radiation and chemo. Please advise us the best way forward to treatment. Many thanks in advance