1 (edited by PCL1029 Mon, 05 Mar 2012 18:23:57)

Topic: General Information about CC- a reprint from previous message

Hi,
Side effects of blood transfusions are fever and transfusion allergic reactions such as itching ,rash and shortness of breath ,which if occur, will be in the begining of the transfusion and generally will be managed by premedicated with Tylenol 605mg  and Benadryl(antihistamine. 50mg) before transfusion.
CEA and CA19-9 are tumor markers ,along with ALK phosphatase,  to MONITOR the progress of the chemo treatment. Doctors are looking for a TREND rather than single value ,together with the Cat Scan result to determine the course of treatment.
If you have advance  cancer or cancer metastasized ,CEA is more likely to have higher value;a steadyily rising CEA value often is the first sign of tumor recurrence.
If you have CC in your liver(intrahaptic),you will most likely to have a much lower CA19-9 value than if you have the  ductal CC in  or near the main bile ducts .
CA19-9 is ordered for checking bile duct blockage and that is why after putting in a new stent the CA19-9 will be lower.
ALK phos is indicated for bile duct's health;ALT and AST are related to the liver's health.AFP is biomarker for liver cancer.
Cat Scan is for diagnosis purpose.(including initial diagnosis and follow up after resection or chemo treatment for CC.  Both MRI and Cat Scan are used to look for structural changes(ie:the size ).PET scan is used to look for functional  changes (activity)of  the CC.
According to one study compared  20 intrahepatic patients images ,the extent of the  tumor enhancement was similar with both MRI and CT methods,however  the relationship of the tumor to the vessels and surrounding organs was more easily evaluated on CT scan as opposed to MRI.But for perihilar tumors CT also has limited sensitivity for extra regional nodal disease(ie metastases to the periaortic,pericaval or celiac artery lymph nodes.)---from uptodate .com.
I myself think that MRI with contrast is  a good choice after initial CT with contrast when inconclusive reported in the early stages of CC development(ie: size of the cc<2cm.) to rule out recurrence.
PET Scan allows visualization of CC because of the high glucose uptake of the bile duct epithelium(the lining )-- the "Hot spots" will light up on the PET scan.
A PET scan  therefore can  help to tell if the bile duct obstruction is caused by a cancer or not.PET scan can also be useful in determining the cancer may have  spread or return after treatment.
Some hospitals equipe with machine that  is able to perform both A PET and CT scan at the same time(PET/CT scan) ;this allows the radiologist to compare areas of higher  radioactivity(SUVmax) on the PET with the appearance of that area(the location) on the Cat scan. But  according to the radiologist I talk to , A (PET/CT scan ) is not the SAME as if you take them SEPARATELY;(PET/CT scan is PET plus CT scan WITHOUT contrast). Remember Ct scan is for structural and PET is for functional( activity) visualization. That is why sometimes doctors order a PET scan on this 3 month checkup and on the next checkup, he/she orders a CAT Scan with contrast or MRI instead.
Additional info. from uptodate.com
MRI and CAT SCAN (CT)  have similar resolution for liver lesions.
CT has been considered to be superior to MRI for evaluating extrahepatic organs and calcifications. MRI is more specific than CT for differentiating cavernous hemangiomas,diffuse hepatic steatosis and focal fatty infiltration.Also MRI should be reserved for the evaluation of lesions less than 2 cm,or lesions located adjacent to the heart or to major intrahepatic vessels.If you are allergic to the IV  iodinated contrast agent used for CT,then MRI is the alternative because the contrast agent used is different than CT. and MRI is not involved  radiation .
Having SUVmax value show up on the PET scan does not automatically means you will have cancer activity on that "hot spot" location. It is highly depending on the location such as the liver,the lung or the prostate; and the condition of your health(ie: infection or inflammation on that part of the body).
I hope the above info. helps.
God bless;.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: General Information about CC- a reprint from previous message

Percy....thank you for compiling this informative posting.  It will be of great benefit to everyone.
Best wishes,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: General Information about CC- a reprint from previous message

Thanks very much for this Percy, great stuff.

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

Re: General Information about CC- a reprint from previous message

Dear Percy,
Have you read if unresectable ICC always metastasizes? I have had 3 doctors tell me "no"and 2 doctors tell me "yes".  Thanks, Johanna

Re: General Information about CC- a reprint from previous message

Hi,Johanna,
After I read your case from all the info you posted.(because each patient case is different,I have  to do research on your CC first);59 years is young enough to hang in there until a new drug will be found more effectively to treat CC.
In the meantime, as far as your case is concern,I will keep on using  the chemoembo treatment to continue shrink the original 10cm tumor.and get a Cat SCAN or MRI  with contrast EVERY 3 MONTH to monitor the progress of the chemoembo treatment(TACE); that is the only way to tell whether you get any result from the TACE.
Since you did not have metastasis when your  CC first diagnosed and you did gem/cis systemic treatment a while ago; and you use MRI to monitor your case;I do not believe you need to worry about metastasis now but may be down the road; if you want to know for sure;ask your doctor to order a PET/CT with contrast and it will tell you the answer.
I did read articles about CC metastazied to the liver,lymph nodes ,omentum and to the lungs at the time of the first diagnosis but not new locations once they are on treatments if they are  effective;mostly the metastasis will be benefited too once treatment is  provided.Systemic treatments provide the greatest coverage when CC involved with metastasis,since the chemo goes thru the entire body whether than locally as TACE that now your are receiving.
For your case,other options included SBRT,TARE,chemoradiation, and clinical trial. Remember, it only take one cancer cell to invade the patient's immune system successfully to cause recurrence.
"Local disease control with TACE is possible in up to 76% of patients,and the outcomes might be improved with systemic chemotherapy.
Although small,localized lesions are seldomly encountered,local ablation might be considered if complete tumor necrosis can be achieved and there is no evidence that the tumor has spread.Ablation might be considered in patient with local recurrence"-from Tushar Patel vol.8 April,2011 Gastroenterology & hepatology.
I hope the info. helps.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: General Information about CC- a reprint from previous message

Hello Percy,
You trully are a wealth of information! I thank you for your research. Sincerely, Johanna

Re: General Information about CC- a reprint from previous message

Thanks so much for this info! It's great!