Hello there - my mom have a cholangiocarcinoma cancer I wonder if you Can you help me .

My mom is a 60 year old , general health good.

On 2016 she underwent extensive liver amputation due to cholangiocarcinoma and in 2018 during hernia repair surgery recurrence of the disease was diagnosed.

She has been under chemotherapy treatments since 2018 (Cisplatin / Gemzar), last dose.

Increase in markers.

She completed 4 courses of FOLFIRI treatment with an addition of Neulastim.

Increase in markers – and imaging deterioration.

She has been put on weekly Taxol treatment.

This is the full summery: :|

On 4.5.2016 a right portal vein obstruction was performed, PVE with good angiographic results.

On 14/6/2016 she underwent extensive right liver amputation, including the liver tail lobe and the extrahepatic bile ducts and lymphadactomy, initial resection and anastomosis of left portal vein, bile duct anastomosis to small intestine RNY, suspected of liver cholangiocarcinoma.

In pathology results – adenocarcinoma with immunohistochemical features of intrahepatic cholangiocarcinoma, moderate degree of differentiation.

Perineural invasion, no lymphovascular invasion, [tumor] free resection margins, without involvement of lymph nodes.

She first came to Oncology 4.5 months after surgery.  

4.1.17 MRI 16mm finding in upper pole of right kidney – in follow-up done at Urology in our institution.

Small subdiaphragmatic collection, slight improvement from the recent US but with a deline compared to the MRI prior to the US with the small bilobular collection in the right abdomen with no change.

Slight- medium dilation of the intrahepatic bile ducts in segment 2 without a change, that is probably caused by postoperative stenosis in the biliary tract, or in the  intra- parenchymatous section closeset to the anastomosis or in the anastomosis (that is not optimally recognized). Additional findings without a change.

Physical test

Tested: yes

General state of health  Abnormal   Findings on right abdominal wall up to 3 cm.

2.4.17 CT   No findings suspicious of recurrence. Renal findings unchanged.

7.6.17 Abdominal MRI – Restriction center 8 mm

23.10.17 Right partial nephrectomy in pathology – clear cell type RCC 1.2cm

30.10.2017 Abdominal MRI – known lesion suspected of RCC – in the right kidney, stable.

Findings in the liver as described, no change.

At present she is in pain. Weight loss. New subcutaneous findings on lower right abdomen. Strong pain in lower abdomen – treated with Percocet as needed and cannabis in oil at night. Genetic counselling. Regular treatment with Targin- will try 20 mg twice daily and Abstral 400 as needed. She refuses Neemol.

Tests –

Hemoglobin CEA 24 CA 19-9 593 CA125 42 ALKP 205 9.5

9.3.18 during hernia repair – two subcutaneous lesions were found and findings in the hernia sac.

29.3.18  PET CT  Tumor invovlement of the ovaries and fallopian tubes, wide secondary spreading in the abdomen and pelvis and the abdominal wall.

In pathology – two nodules of metastatic adenocarcinoma, the largest nodule measureing 0.8 cm in diameter – were found in the subcutis. Compatible with metastatic cholangiocarcinoma.

11.4.18  She began Cisplatin / Gemzar treatment – last dose 13.8.18  Pancytopenia  - receives Neupogen PD.

MSS in foundation – PIK3CA APC PBRM1 ARID1A TMB-low

25.6.18  PET CT  The findings of the examination demonstrate a certain response in the secondary spreading in the abdominal cavity and the pelvis with the involvment of the abdominal wall, but the disease is still active.

29.6.18 PET CT     The test results demonstrate a certain response to the secondary spreading in the abdominal cavity and the pelvis with the involvement of the right abdominal wall but the disease is still active.

The ovaries and fallopian tubes, as in the past, are large with over absorption in the thick tissue areas and there is suspicion of Krukenberg tumor disease.

The right ovary and fallopian tubes looks hypodense maybe bleeding – in a sonar gynecological test – the right ovary is enlarged 6.5 cm, findings of many cysts without active blood.

28.8.18 CT   Peritoneal implants in the abdomen and pelvis and on the abdominal wall are known, no significant change.

Small retrocrural lymph nodes and in the gastrohepatic ligament a few grew to 0.6 cm a short axis compared to 0.4 cm in the gastrohepatic ligament lymph nodes also grew a little along the retroperitoneum. Enlarged hypodense left frontal area, no change about 1 cm, short axis. A known hypodense center on the spleen grew a little 1.7*2.1 cm compared to 1.5*1.8 cm. The spleen is normal in size. Enlarged, its capacity is about 18 cm, its texture is somewhat uneven. Grew slightly, it amassed the pelvic masses, involvingב the two ovaries and fallopian tubes with the areas with thicker tissue and the areas with more cysts. There is a decrease in the proximity of some of the lesions at the front of the spleen, no significant change in dimensions in the hypodense process that was observed during the previous test, although there is a certain decrease in its absorption intensity.

17.9.18    Started second line of FOLFIRI with last Neulastim 31.10.18 PD

3.12.18 PET CT   Progress of secondary spreading in abdomen and pelvis.

Tumor implants some across the colon serosa. Involvement in the progress in the right abdominal wall. Tumor involvement of the ovaries and fallopian tubes with increasing dimensions. Over absorption in new hypodense processes in the left liver Over-absorption in new hypodermic processes in the left lobe of the liver are suspected of secondary distribution in the parenchyma itself. A known secondary process in the spleen. Suspected new tumor involvement of the right adrenal gland.

Any recomendations ? :|:|