Topic: Is it necessary to have a chemo/radio therapy right after the surgery?

Hi all, my Mom got a bile duct cancer, which was found out 2 weeks ago, and we immedialty went to the hospital. There, the doctors said that a surgery was possible and promptly conducted it. The result was quite good: the tumor was completely removed including the right lobe of the liver and the gallbladder. It also shows that the lymph nodes nearby was not affected. And the doctor said it is the best result we could achieve, chemo/radio therapy is not neccesary at the moment. In case the tumor comes back, we will use radiotherapy.
So, I would like to seek your advice on whether we should take a chemo for prudent purpose? I'm afraid that the tumor may come back after a short time.
BTW, after the surgery, she felt full in her abdomen, and vomit blood for 2 days, now she still vomits fluid like coffee ground. they had to insert a tube into her stomach to suck the fluid out, then she felt normal. Is there any problem?? Thank you so much for your advice.

2 (edited by tiapatty Thu, 31 Jul 2008 15:46:27)

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

I can't answer this question but there is a discussion about this in an earlier post in the Chemotherapy section of the board, see:

http://www.cholangiocarcinoma.org/punbb … .php?id=71

and here:

http://www.cholangiocarcinoma.org/punbb … php?id=948

Patty

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

haiminh......the vomiting you are describing; have the physicians given you an explaination?  Also, has it stopped?

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: Is it necessary to have a chemo/radio therapy right after the surgery?

Thank you so much, Patty. Hi Marions, the vomiting lasted 2 days, until they insert a tube into her stomach through her nose, to suck the fluid out. Now, she feels better and does not vomit, however, the fluid is still flowing out so much (color like coffee ground - the tube is still there, they have not yet taken it out). The Dr said that it is due to her stomach, it did not work well so the gastric juice flow up and caused vomitting.
In addition, she is still bleeding, from the wound where they insert a tube to drain out the fluid from the liver after the surgery.
Has anyone had experience on this? Please give us your advice so we can talk with the Dr. Thank you so much.
Hai Minh

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

haiminh..so glad they used the tube to empty the stomach and am glad to hear that your Mom's nausea and vomiting has stopped.  There was quite a bit of bleeding (about one week) post surgery for my husband however, it diminished slightly, every day.  Others may be able to share with you their personal experiences, also. 
Sending good wishes your way,
-M-

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: Is it necessary to have a chemo/radio therapy right after the surgery?

Thank you so much! The Dr just came and told us that the liver function for coagulation was decreased according to the blood test (actually, I saw it is still at normal threshold, however quite low). the blood is coming from the cut on the furface of the liver. the immediate action is to give her an injection for blood cloting (coagulation), then  one more after 8 hours. If the bleeding slow down, then it is ok. However, if it is still bleeding, they may have to insert a tube to check if the vessels inside is ok, then they shall suture it. So far, she is still fine & strong, look good, however I'm so worried on her bleeding and stomach problem. Because, there is a worse case of dealth, which makes up a certain percentage of surgeries.

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

the bleeding has not been stopped since the day before yesterday (2 days), although they have given my Mum NovoSeven (for stopping bleeding) and Platelet (for increasing coagulation). They may have an Angiogram for my Mum today, however I doubt the doctor's capabilities. Does anyone know that the cause of bleeding is due to the operation or the condition of each patient??? Please advise me, I dont know anything to do now.

8 (edited by JeffG Fri, 01 Aug 2008 17:17:53)

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

Haiminh... Sorry to hear the troubles your Mom is going through.  I've read your posts and going to be quite frank with you.  If your mom is still bleeding I would go with your gut feeling and get a patient advocate or head of hospital involved.  In my opinion this is not normal.  Some bleeding yes ,but vomiting No. A surgery of this type can have complications.  Do they know for sure were the bleeding is coming from?  Is her blood pressure being monitored closely? Have they provided her with a transfusion?  Transfusion may be needed. Normally a drain tube is automatically put in during surgery. Could there possibility be a bowel perforation?  I would be watching closely and speaking your mind.  Where did she have her operation?  Is there other doctors available to check her out? Sorry for being so blunt, but if your uncomfortable and feel things are not adding up, play it safe my friend.  As far as chemo that is an individual choice we all have to make.  Some choose to do few rounds, other choose not.  Their is no evidence either way in my opinion. Best wishes and good outcome for your Mom real soon.  P.S.  With all that going on keep close watch for any signs of infection.  One last thing is she on any antibiotics?  If she was actually vomiting alot of bile, a high possibility of infection.  I'm no doctor Haiminh, I'm just thinking out loud as if it were my mom going through this. Is her health considered normal otherwise?

God Bless,
Jeff G.

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

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

Dear Hai Minh....Jeff said it so right.  This is a very complex operation and bleeding can be a major problem.  My concern is the color of the vomit...does is resemble coffee grounds in it's consistency or, is it a liquid fluid,  dark brown in color?  I am not a physician, but there are physicians around you.  Please, have them explain to you exactly what it is they think is happening.  You need some emotional support.  Who is there for you?  As Jeff had suggested, talk to the social worker at the hospital or, talk to the nurses and have them arrange a meeting with someone who can give you some explainations for what is happening to your Mom. 
Thinking of you and sending all my love.

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: Is it necessary to have a chemo/radio therapy right after the surgery?

Thank you so much for your helpful advices. She has just had the angiography --> they found nothing; then gone for a CT scan --> no problem. The Dr explain for the bleeding that there maybe a small bleeding on the cut surface of the liver, however because the drain tube is touching that bleeding source, the blood comes out alot (the wound on that surface cannot be healed). He will draw the tube a bit out, so the head of the tube will not touch the surface, and already given her 2 doses of Novoseven (double). All the explanation is just "maybe" and he could not ensure anything.
So far, the condition of my Mum is quite good, except that bleeding (Blood presure is ok, no fever, not tired). Regarding the vomitting, she vomitted blood in 2 first days, then the color turned more yellow and pure. However, the tube is still there to drain out the fluid in the stomach. She is also on antibiotic through pills and drip; and blood transfusion as well.
For sure, I somtimes suspected the capability of the Dr, because some other patients here having the same operation (removing half liver, bile duct and gallbladder) are in good conditions and stay in hospital for some days. Cannot understand what the Dr is doing...

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

Haiminh.... Good to hear. Sounds logical that tube could be rubbing on liver aggravating things . Pulling the tube away from liver abit will allow healing properly.  Glad to hear she is on antibiotics.  Only one last thing is be careful when she gets up to walk if she hasn't already , as if she has lost a considerable amount of blood she could pass out upon standing.  However blood will replenish on it's own to normal level if not to much was lost.  Yellowand pure sounds better than dark and coffee ground looking.  Make sure her potassium level is normal as well. Loosing alot of fluid /dehyration can cause potassium depletion belownormal levels.  Hopefully in the next 3-4 days she will be doing alot better.
God Bless,
Jeff G.

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

12 (edited by marions Sat, 02 Aug 2008 13:56:26)

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

Hai Minh...great news about your Mom.  Everyone's response is different when recuperating from a surgery especially, one as invasive as this one.   Once I had been told by a surgeon:  "I did my job now, it is up to the body to do what it needs to do."  Stay strong...sending tons of good wishes your way.

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: Is it necessary to have a chemo/radio therapy right after the surgery?

Haiminh,
    Stay strong - my husband is in UPMC - just had 3/4 of his liver out on the 16th of July. We have had MANY complications - including sepemia (a bacteria infection that got into the blood), and heart complications stemming form that - temporary, we hope. He is doing better , however, and I am hoping the worst is over. It is hard to trust the doctors, so I rely on the Great Physician! Hopefully, your Mom will continue to improve.

Joyce

Re: Is it necessary to have a chemo/radio therapy right after the surgery?

Thank you all for your supports. After having a double doses of NovoSeven for bleeding stop and the drain tube a bit out, she has been better. The bleeding was just a little, and it was not fresh blood like 2 days ago, its color turned into pink color. However, last night it suddenly turned dark (like fresh blood, although the volume coming out is also little). The Dr said they need to observe some more days.
Yesterday they took the tube to her stomach out, and they suck the fluid out of her stomach once per 4 hours. She vomited 2 times yesterday. They still gave her the injection for anti-vomiting.
Joyce, so your husband is now taking the medicine from an internal medicince doctor? is he ok? is it necesary to have another surgery? Hope that they can treat him with medicine only. Re-operation is a terible thing, and they are considering doing that to my mum

Best wishes,
Hai Minh