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Oncology (General Cancer)/Way forward advice - GA Cancer


My 67 year old mother, with past history of several episodes of pain abdomen (?Acute cholecystitis/ Cholelithiasis) underwent  Laparoscopic cholecystectomy+ Lap Adhesiolysis under GA on 4/7/2013. Histopathology revealed moderately differentiated adenocarcinoma, state 2 (pT2, Nx, Mx). Perineural spread was seen; Proximal margin could not be commented upon; Cholelithiasis). Whole body PET with triphasic CECT  done on 17/7/2013 did not reveal  any evidence of metabolically active disease anywhere in whole body. She underwent complete radical cholecystectomy ( Lymphnode+Liver Bed+Port site excision) on 22/7/2013. Histopathology revealed
  Tumour invasion in 1 out of 6 lymph nodes dissected in Lt peridochal region
  Tumour invasion in one lymph node dissected in Posterior pancreaticodudenal region
   Fibrocollagenous tissue/ foreign body  Giant Cell reaction/ granulation tissue in pericholedochal region
  Cystic duct margin had fibrocollagenous tissue; tissue free of tumour
  In Liver wedge, few neoplastic glands lined by cells  showing moderate plemorphism; body giant cell reaction was also seen in parenchyma
  Port site: all 4 sites lined by stratified squamous epithelium; subepithelial tissue shows foreign body  Giant Cell reaction and fibrosis; Free of any tumour invasion.

As advised, she has been given 12 cycles of chemotherapy (Cytogem 1600: Gemcitabine) over 4 months (September-December 2013). [CECT Abdomen conducted after 3 chemo cycles indicating marked postoperative changes in the GB Fossa in form of surgical clips but no obvious mass lesion in gall bladder fossa. No significant lymphadenpapthy]
Now, radiotherapy has been advised (5 days a week; total 25 sessions).  I  wanted a second opinion, since she has already undergone radical surgery followed by chemotherapy : Whether radiotherapy is really required.

Sorry for the delay but I am ill. Cancer of the gall bladder is rare (even if my mother died of it but it was caught late since she refused all gall bladder surgery). So there is not much experience of the curative effect of radiation therapy. However this is already (after the second surgery) a stage 3 cancer (it has spread at least to lymph nodes) so I therefore think her treatment should be as aggressive as possible. I am older than your mother and I have undergone extensive radiation therapy for a prostate cancer (my own decision). That treatment was with 35 treatments similar to those of your mother after 2 intensive treatments - 2 weeks apart - with the radiation sources right in the tumour. It seems to have worked. Now 5 years later I am still free of cancer and my PSA which at the time of my biopsy diagnosis was 8.8 is now below 0.05 so it is not even measurable.  Her treatments will probably not cause much problems. Mine did not even with my urine bladder, my urethra and my rectum in the radiation field. So I support the view of her doctors. Good luck!

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Oncology (General Cancer)

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Claes-Gustaf Nordquist, M.D.


Questions concerning Cancer, Oncology, radiation Therapy, Tumours, Chemotherapy, Cytotoxic Drugs, Hormonal Therapy, Radiation Protection.


I'm a Doctor of Medicine and specialist in Medical Oncology and Radiation Therapy educated & trained in Sweden. Now retired. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps. You can also reach me on: I have no restrictions in the number of questions there. I also answer questions in these other categories: General History, Military History, Brain Tumors, Breast Cancer, Colon Cancer

I'm a medical doctor and specialist in medical oncology and radiation therapy

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