Topic: unable to place stents and no biopsy to start chemo

Hello everyone.. my mom was diagnosed with cc 3 months back, resection wasn't possible, so a bypass was done. She held on well till about 10 days back, when her itching came back, though she isn't jaundiced at all. We did a blood test (liver function text) and the liver enzymes were high but the billirubin was normal, and the doctor told us that only the left lobe of the liver was drained during surgery and the right lobe wasn't, so the itching and the enzymes being high maybe because the right lobe isn't drained.

He suggested metal stents, and today they tried to insert the stents but couldn't since the blockage was too 'tight', they are presently draining the liver and they are going to try to insert it again on saturday The doc said 9 out of 10 times it is possible to insert a stent, but there is that one chance that it might not be possible. Also he said, they've noticed irregularities on the left lobe of the liver and the tumor might be progressing to the left side, and hence the bypass is in danger of being blocked so they are gonna place a stent in the bypass as well. What do we do if they are not able to place the stent?

Also, another problem is a biopsy wasn't done since the tumor is embedded quite deep and the doc said he didnt wanna create a bigger mess there and its just 2 cms X 2 cms (it isn't an obvious mass)! All the oncologists say Chemo isn't advisable when there is no biopsy, and also since there is no obvious mass, it's difficult to find out if chemo is even working in the first place, so the docs say it isn't worth doing the chemo.

Should we start chemo ( if at all we do, it'll be gemcitabine because its got the least side effects) in this situation? We are very confused about what to do next? i dont think we have too much time to decide, because if the disease progresses, it would be difficult to start chemo. Also, what do we do if they are not able to place the stent?

Would really appreciate any suggestions.


2 (edited by JeffG Thu, 10 Jan 2008 12:51:06)

Re: unable to place stents and no biopsy to start chemo

Varun....  Sorry to hear about your Mom.  It sounds like a very complicated case.  I don't know anything about the medical system in India so I don't think I can be of much help.  I would try to get a second opinion if possible to maybe see if another specialist can recommend something different.  The stents can always be a problem with blockage and infections.  Would keep close eye for chills and fever and not hesitate to get checked out.  Some people have had external drains in place of stents. It's an individual choice of how far your Mom wants to go. Sometimes chemo and or radiation will cause tumor shrinkage enough for stents to be tried.  You said your Mom has a2x2 CM I really wonder why it is not resectable, again I guess that depends on the location.  I would highly recommend another opinion.  Has she had the whipple procedure yet?  Varun, I wish you and your Mom the best. Chemo is not advisable if no biopsy confuses me; as she was already diagnosed.  How did they determine that?
God Bless,
Jeff G.   Talk with Oncologist, Radio Oncologist, and Gastrointestnal Surgeon not just one.

Take it to the Limit,One More Time! (Eagles)

Re: unable to place stents and no biopsy to start chemo

Thanks for replying Jeff, mom was diagnosed with cc based on the CT, MRCP and PET scans, and also when she was taken in for surgery (resection) the doc said it can't be anything else except cc, and they've ruled out everything else.

Resection wasn't possible because it had already infiltrated the blood vessels (portal vein, hepatic artery). The doc says it's more like a fibrous kind of growth and not a real big mass kind of growth, and that the disease has already advanced. The doc also said the location of the tumor was very bad.

We also pressed the doc about the biopsy a lot, and he said it was just impossible to get a biopsy with a fibrous kind of growth like that and even if we did get a biopsy, there's every chance that it might turn out negative even if the cancer exists.

As soon as mom was diagnosed, we consulted more than 3 docs (oncologists, surgeons, etc) and they more or less said the same as to how to go about it.

What is the whipple procedure? she's not got that done. They are gonna try to place the stents again tomorow, I just hope and pray to god that it happens this time.

Re: unable to place stents and no biopsy to start chemo

Varun,  I'm sorry the whipple procedure deals with the pancreas not the liver and upper ducts.  It sounds as you have really advocated for your mom and treatment and got plenty of opinions.  I'm sending you a prayer of support my friend ! I'll or I should say we here on this site will be wishing for a positive outcome.
God Bless,
Jeff G.

Take it to the Limit,One More Time! (Eagles)