Topic: Biliruben count and Chemo

My mom-in-law is suffering with CC. Here is a quick summary:
- Diagnosed late March,
- Underwent a failed surgical attempt in May, said tumor was unresectable and chemo/radiation are the way to go. Doc supposedly put in a bile duct bypass to connect duct from liver to the intestine
- Recovery in June
- One external drain put in through her rib-cage to drain out the absyss that was collecting post surgery (was in hospital for 9 days)
- That drain eventually dried up and she started getting jaundiced again
- They put a second external drain (one end on the outside, the other end gping through the liver to the BD to the intestine) about 15 days back
- Last week they closed both drains and removed the external bags

So far chemo or any treatment has not started since the oncologist says she is waiting for a green signal from the surgeon as to when he thinks bile management is under control. Last we checked, her biliruben was 116.

Question I have is what is the target bili level before which they can start chemo safely?

We are concerned that the cancer may be spreading but we have not even started any treatment after almost 4 months after it was originally diagnosed.

(Treatment is being done in Toronto General Hospotal and oncologist in in Princess Margeret Hospital)

Re: Biliruben count and Chemo

I completely understand your concern. My mom's chemo was also delayed until 3 months after her surgery because the oncologist said she could not do anything with her, she was so weak, and I wonder if it made a difference. I did not know at the time about photodynamic therapy (PDT) and wish I had, the side effects are minimal so maybe my Mom could have tolerated it. There is an article in the Medical Therapy section, here is the outside link: … 041508.php


Re: Biliruben count and Chemo

vk933, you are in Canada. You have the benefit of universal health care but its deficiencies as well. If the drs. feel (are you with Dr. Moore??) that there's only a bit of benefit in treatment, they'll delay you with a runaround and all that stuff. You have to be quite agressive in advocating for yourself. My sister is being cared for (palliative care from princess margaret and mount sinai--they're great and you shouldn't need them at all) in toronto so I'm a bit familiar with the set up there.