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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