Topic: My personal case study & history of cholangiocarcinoma treatment
Let me share my up dated story as of 3/17/2014 and hopefully of benefit as an ongoing case study in intrahepatic cholangiocarcinoma.
At age of 57, I had acid reflux off an on for a couple years taking Pepcid ,the H2 blocker Night sweat may be once every several months ; Lost weight for about 5 lbs over several months during 2009. ,drink 3-5 cups of coffee daily. I am also a chronic hepatitis B carrier since birth.) other than that, no specific symptoms, may be at time feel a bit tired .
Mr. Leung is a 63-year-old male with recurrent cholangiocarcinoma and a history of chronic hepatitis B. His oncologic history is well documented by Jessica Mitchell, CNP, as follows:
1. May 2009, diagnosed intrahepatic cholangiocarcinoma, stage IIB.
2. June 2, 2009, left lobe resection with clear margin and RFA to two metastases in the right lobe. No known residual disease.
3. August 2009, started gemcitabine three out of four weeks and had treatment for 14 months.
4. October 2010, stopped gemcitabine and was followed with scans.
5. April 2011, CT scan showed a new lesion followed by an MRI which showed two lesions.
6. May 10, 2011, chemoembolization with mitomycin C and Adriamycin. This was followed by May 23, 2011, RFA to one of the lesions. The second lesion could not be treated as it was too close to the hepatic vein.
7. October 24, 2011, resection performed of the lesion, but a positive margin because it was touching the hepatic vein.
8. November 24, 2011, through November 2012, given Xeloda over 12 months with overall good tolerance.
9. June 2013, scanning showing recurrence of disease.
10. July 2013 underwent PEI (percutaneous ethanol infusion) to liver metastasis times two.
11. August 2013, KRAS testing showing overexpression of EGFR overexpression. Started on Tarceva, overall had good tolerance, although did experience slight weight loss, thinning of hair, and mild diarrhea.
12. August 2013, underwent cryotherapy to a nodal mass in the right crux of the diaphragm and IVC extending around the celiac trunk.
13. January 2014, increasing CA 19-9. Re-evaluated at Mayo Clinic for possible treatment options including SBRT, TheraSpheres, or additional radiofrequency ablation and chemotherapy. Evaluated by Dr. Nagorney of General Surgery, who did not recommend surgical resection. An MRI of the abdomen demonstrated right hepatic lobe masses under the diaphragm and along the posterior margin of the liver adjacent to the right hepatic vein which is suspicious for residual cholangiocarcinoma.
So far thru my research,there are no effective chemotherapy for recurrence.
RFA, microwave ablation , IRE (irreversible electroporation),TACE (chemoembolization), PEI (percutaneous Ethanol Injection),cryoablation and radioembolization with y90(glass or resin) are non-systemic interventional radiation treatments that can extend my survival time as an intrahepatic cholangiocarcinoma patient and the PDT and IMRT (ie: Cyberknife),,nano knife,SBRT are treatments for Extrahepatic cholangiocarcinoma patients.
But none of the above treatment choices is a cure for CCA.
Even Only surgery can provide the only possible cure for CCA and in my case, the CCA COMEs AROUND every 20 month after resection with chemotherapy.this is not a long term cure but a chronic disease that require a lot of decisions to be made after reading and attending a lot of seminars.it is indeed a roll-coaster ride.
the recurrence is high (50-75%) for CCA.But if you can discover the tumor recurrence earlier (ie: sizes of the lesion or tumor</=3cm and not more than 3-4,even with a few lymph nodes involvement; IRE, cryoablation, RFA with chemoembolization can extend the life and qualitity of life for those who is not resectable.
Again ,the KEY is EARLY DETECTION by CT ,MRI (both are for structural change of the tumor and if the scan is positive,then follow up with a PET/CT to find out whether the tumor is active
Finally, as recurrence is very common (50-75%) , try to view CC as a CHRONIC disease like our Marion said may not be a bad idea, like hypertension or diabetes ,then the negative psychological and emotional impact will be much less for the patients as well as for the caregivers when we first heard of this disease and we can devote more positive energy to prepare learning and treating the cholangiocarcinoma at hand.
For understanding about ultrasound ,CT,MRI and PET scan see the link below.
For systemic chemotherapy individual agent and the regimen,the link below May be of help.
For intervention radiology option, check out the link below