Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Marion - OK, I fully understand the need for larger Phase III studies for chemo.  But then, let me pose the question, "Where is the Phase III study that proves resection is better than no resection?"  I think it is almost universally accepted that resection is better.  What is that based on?

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Bruce....you are addressing the law of medicine, so to say.   Surgery removes an abnormal growth of tissue (in our case malignant and life threating) interfering with the pathological function of the patient. Results can be curatative or life extending. 
Hugs,
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: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Between 1987 and 1995, a phase III trial of the EORTC (European Organization for Research and Treatment of Cancer) Gastrointestinal Tract Cancer Cooperative Group to determine the effectiveness of adjuvant radiotherapy and 5-Fluorouracil after curative resection of cancer of the pancreas and periampullary region.  The results are presented at the following link:

http://www.ncbi.nlm.nih.gov/pmc/article … 06p776.pdf

The author state that the cancer in the periampullary region is periampullary carcinoma and it occurs in the ampulla of Vater, duodenum, and the distal common bile duct.  The authors also state that in periampullary cancer, the 2-year survival rate was 63% in the observation group and 67% in the group that had adjuvant therapy, however p=0.737 for their analysis which means that the results were not statistically significant.

I became interested in this because it was a phase III test involving adjuvant therapy and the distal common bile duct was mentioned.  My problem was that I couldn't find if periampullary carcinoma was cholangiocarcinoma.  The paper "Adjuvant treatment in biliary tract cancer: To treat or not to treat?" has 11 references to periampullary cancer including adenocarcinoma of ampulla of Vater (4), periampullary cancer (2) ampulla of Vater cancer (1) ampullary carcinoma (2), and ampullary adenocarcinoma (2), the second most references for a paper on biliary tract cancer, the first being gallbladder.  I could not find mention of periampullary, ampulla or Vater in ICD-O-3 (International Classification of Diseases for Oncology, 3rd edition) although I did find it as Code 156.2 in the 1st edition, and C24.1 in the 2nd edition.  In the 1st edition, it was coded with the "gallbladder and extrahepatic bile ducts" and in the 2nd edition, it was coded with "other and unspecified parts of biliary tract."

Page 74 of the paper,

http://www.ncbi.nlm.nih.gov/pmc/article … 02-070.pdf

states, "However, only 75% of periampullary tumours are truly of pancreatic origin . . . " but doesn't mention what the other 25% are.

Does anyone have more information about periampullary tumours and could they be cholangioncarnoma?

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Bruce,

Take a look at this article.

http://www.ncbi.nlm.nih.gov/books/NBK6924/

Definition section says:

Periampullary carcinoma is a widely used term to define a heterogeneous group of neoplasms arising from the head of the pancreas, the distal common bile duct and the duodenum. This term should be distinguished from ampullary carcinoma as a tumor topographically centered in the region of the ampulla of Vater...

The next section ("Epidemiology, clinical characteristics and diagnosis") enumerates cancers included in the periampullary carcinoma group:

Ampullary cancer
Adenocarcinoma of the duodenum
Carcinoma of the distal bile duct (extrahepatic CC)
Carcinoma of the pancreas

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Thanks Eli for the distinction between ampullary and periampullary.  I missed that completely.

There appears to be something left out of the following sentence in the paper.  Are they trying to say something like distal cholangiocarcinoma account for 27% of the extrahepatic cholangiocarcinomas and perihilar cholangiocarcinoma accounts for 60-80%, or maybe 73% if the 27% is correct.

"Carcinoma of the distal bile duct: Cholangiocarcinoma is a rare malignancy of the biliary tract occurring in 27% in the distal bile duct, however the hepatic bifurcation is the most frequent involved site (60–80% of the cases)."

I'm still trying to find out where the 1973-2009 distal bile duct cancer is located in the SEER.  I figure it must be there, but just coded unusually.  I thought this may have something to do with it.

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

2000miler wrote:

Are they trying to say something like distal cholangiocarcinoma account for 27% of the extrahepatic cholangiocarcinomas and perihilar cholangiocarcinoma accounts for 60-80%, or maybe 73% if the 27% is correct.

Bruce, I read it the same way you did.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

I just noticed that the clinical trial, NCT00123825, "A Phase II Trial of Gemcitabine and Cisplatin in Unresectable Or Metastatic Biliary Tract and Gallbladder Cancers," sponsor Dana-Farber Cancer Institute, was completed on 10/01/2007, but there was no published paper on its results.

Is this common practice?

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Bruce...it is a common problem in that these studies are completed and yet findings are not published.  In fact, clinical trial participants are entitled to receive that also.
You may want to reach out to the Clinical Investigator. 
Hugs,
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

84 (edited by 2000miler Thu, 13 Jun 2013 22:00:51)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Eli, here's another. 

The AJCC Staging Manual, 7th edition describes the three geographical regions for cholangiocarcinoma as intrahepatic, perihilar, and extrahepatic.  Others have referred to perihilar as Klatskin and extrahepatic as distal.  Perihilar (Klatskin) and extrahepatic (distal) together have been referred to as extrahepatic, which is very confusing since the same name is used to describe two different locations.

Now, some authors refer to intrahepatic cc as consisting of peripheral cc and hilar cc, with hilar cc originating from a main hepatic duct or from the bifurcation of the common hepatic duct.

Is there any difference between the hilar cc that is referred to as being intrahepatic cc and the perihilar cc that is referred to as being extrahepatic cc?

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi Bruce,

You wrote:

Is there any difference between the hilar cc that is referred to as being intrahepatic cc and the perihilar cc that is referred to as being extrahepatic cc?

I don't think so. As far as I know, hilar cc and perihilar cc is the same thing. Hilar CC was misclassified as intrahepatic at some point. The classification was later corrected, but much confusion remains.

See if you can access Patel's paper, Cholangiocarcinoma - Controversies and Challenges. He discusses classification challenges in section 2. You might need to register for a free Medscape account to see the paper.

http://www.medscape.org/viewarticle/739598

86 (edited by marions Fri, 14 Jun 2013 11:48:44)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Bruce, Eli ..I have contacted a librarian, who might be able to retrieve the above mentioned study.  I will keep you posted.  Here is the abstract.
http://www.ncbi.nlm.nih.gov/pubmed/21460876
Hugs,
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: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Thanks Marion. I was able to download Patel's paper off the Medscape site.  I set up my account with them months ago.  The paper was proceeded by almost 3 pages of Medscape stuff, but it was there.  Altogether, there were 24 pages.

Also, thanks for the advice on the unpublished phase II clinical trial results.  I haven't written the clinical investigator about the results, but I intend to.

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Our Patty, the librarian, came through for us.  Eli, I have no idea how to post it hence, I am mailing it to you via your personal e-mail with the hope that you can attach the link. 
Thanks and hugs,
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: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

I previously thought that the Roux-en-Y procedure was just done for extrahepatic cholangiocarcinoma.  However, while reviewing the article "Treatment outcomes and prognostic factors of intrahepatic cholangiocarcinoma," by R. Dhanasekaran, et al,

http://www.spandidos-publications.com/or/29/4/1259

I found the statement, "Extrahepatic bile duct resection with Roux-en-Y reconstruction was carried out in patients (ie IHCC patients) with bile duct invasion or lymph node metastases." My wife had IHCC with a single positive LN and I remember the surgeon telling us that he was going to do something beyond a simple resection, and it would be more like surgery for extrahepatic cholangiocarcinoma.  I checked the pathology report and the extrahepatic bile duct was listed as a specimen.  I'll ask the surgeon about it at our next meeting.

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi, Bruce,
In your data collection of our members; do you keep track of patients who have lymph node involvement ,the regions(mediastinal ,hilar or mesenteric),number of the lymph nodes and the next organ that  will be affected based on the regions( the direction of metastasis based on the lymph node first metastized from the liver.) .
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: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi Percy,

I keep track of the number of positive lymph nodes and their regions.  I don't think anyone has ever reported the next organ that will be affected based on the region, but if someone did, I would add a column and record that also.

Of the 498 cc patients for which I have recorded data, 117 have reported their lymph node status, and 12 reported the location of the affected LNs.  The 117 was divided into 45 with 0 positive LNs, 44 with an exact count of the positive LNs, and 28 with more than 1 positive LNs.

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi, Bruce.

That is about 23% of the member population had reported lymph node involvement  and there is at least one positive LN involvement  of the 61.6% of the 117 reported cases which include LNs.

Can you tell me the 12 reported locations  or areas of the affected LNs, I would like to use them to compare the one LN that I had  been treated yesterday.
again , thanks for your  professional help.
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.

93 (edited by 2000miler Wed, 03 Jul 2013 21:17:41)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Percy, the 12 locations for the positive nodes are:

Abdomen
Abdomen
Celiac
Diaphragm
Gall Bladder
Gall Bladder
Hilar
Liver
Liver
Near liver
Pancreas
Pericardial, etc.

I believe that most of those patients who did not report lymph node status did not have positive LNs.  Assuming that this was the case for all who did not report LN status, the percentage of all patients with positive LN status would be 14.5%.  I'll have to check other sources to see if this is about what should be expected.

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi, Bruce
Thanks for the data.
Mine Ln is located between the liver and the Morsion's Pouch near the top of the kidney. it is less 1 cm in size, PEI for treatment.
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: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Bruce, you do know that the SEER data is flawed because the Veterans Administration stopped reporting cholangiocarcinoma cases back in 2004???  In the 10 years prior to that they had reported over 800 cases.  Given the long latency period from exposure to onset of symptoms, I would imagine that there are many more than 800 cases involving vets over the last 10 years that are missing from the data repositories.

96 (edited by 2000miler Sun, 07 Jul 2013 06:48:34)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Thanks maryvz, I didn't know that.  I've downloaded all 15,229 of the cholangiocarcinoma cases in the SEER.  I checked the SEER registry for those cases and none of them are from the Veterans Administration, so perhaps they just don't include them in their public database anymore.

I wouldn't say this is a flaw in their data since many cancer facilities in the United States don't report their cases to the SEER.  The cancer facilities in your state of Virginia don't report.  SEER estimates they cover about 28% of the US population, but when they started in 1973, they didn't have anywhere near that percentage.  The cancer facilities in my state of Louisiana started in 2000.

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.