Carol's story so far
September 9, 2017 at 10:33 pm #11231
I was diagnosed with primary Cholangiocarcinoma on 31st July but it has been a long journey to get here since March this year.
I had a secondary cancer successfully removed on 12th May but did not know then that I had this ‘silent’ cancer. I did not have any of the classic symptoms for Bile Duct Cancer besides a dull aching pain under my right shoulder blade which I put down to sitting at a PC all day and just a bit of itching. I first visited my GP in March and was referred to a Gynaecologist and Urologist to investigate bleeding. I ignored a consultants advise that I could delay or not even bother to have a polyp on my Uterus and a 9cm ‘benign slow growing’ Ovarian cyst removed. I had both Ovaries removed on 12th May.
On 1st June the biopsy shocked everyone and muscinous adenocarcinoma in Krukenberg deposits on both Ovaries that had metastasised from a primary in the Upper GI area. I was referred to my Oncologist and then began the journey of tests and scans to locate and then successfully remove a 4cm tumour from my Liver that was eventually identified to be the primary tumour. ( A long story….. including ruling out a suspected recurrence of a perhaps undiagnosed Gallbladder cancer 4 years ago when an inflamed Gallbladder and Gallstones were removed and entertaining the notion of a primary cancer of unknown origin, hidden cancer which I had never heard of before. It perplexed me and also the consultants and MDT or so I believe.)
After the tumour on the Liver was removed on 14th July it was discovered to be attached to the Intrahepatic Bilary Tract – so I have Bile Duct Cancer, stage 4. The disease had spread to 2 local lymph nodes which were removed but no other Peritoneum disease was found. Part of the Liver and the Appendix was removed as a precaution. A 17mm Ommntal nodule of ‘indeterminate’ origin has increased in size over the last few months and systemic chemotherapy of Cisplatin and Gemcitabine is due to start next week. So mine is not your standard progression of an unusual type of cancer so I am not sure this experience would help those asking about successful operations on secondary cancers? I was so very fortunate that the primary cancer was found asymptomatically while it was still operable.
I spent August recovering from open surgery and visited Penny Brohn in Bristol mentioned on AMMF and took part in a 2 day ‘ Living Well with Cancer’ course as an introduction to the Holistic approach and gained excellent advice on nutrition and how to cope with stress and relax and help my immune system. I would really recommend this to anyone considering it. Everyone there is so kind and supportive and extremely professional. The setting is peaceful and restorative. It gave me the tools to help me try to cope.
Also, I have greatly appreciated reading about everyone on the forums’s experience with chemotherapy and being allowed to read about some of their journeys.
I understand that Cisplatin and Gemcitabine is the chemotherapy that is standard treatment for this type of cancer that has spread. While I am fortunate that the primary and one secondary have been removed, this does mean I will be having chemotherapy with no way of measuring any success of the treatment until it reappears? Which is perplexing. Will stay positive and not entertain that prospect. However, I have read about some others on the site having genetic testing to try to find treatments and suitable clinical trials. Molecular screening is mentioned on AMMF for immunotherapy which I am particularly interested to learn more about and wonder if it would be suitable for my type of cancer at this stage of treatment in addition to chemotherapy or in the future?
Any advice and experiences would be appreciated.September 11, 2017 at 4:25 pm #12394
What a convoluted and stressful pathway you have been through to arrive at your diagnosis of cholangiocarcinoma. Many thanks for sharing this with all of us on the forum – although your experiences are unusual, I’m sure many will certainly relate to quite a few of them.
Thank you for letting us know that you followed up AMMF’s link and spent some time on Penny Brohn’s ‘Living Well with Cancer’ course*. They are very helpful, compassionate and empathetic, as you have found out.
Assuming the metastatic disease you now have is not operable (and worth asking about if you haven’t already) then yes, the Gemcitabine and Cisplatin combination is the usual treatment for inoperable cholangiocarcinoma. In answer to how you will know how things are, you should be scanned at the half way point through the Gem/Cis course to see what effect the treatment is having – providing your cancer is stable or getting smaller, then treatment will continue. Then you should be scanned again at the end of the course, and then at set intervals to check how things are.
In the meantime there are a couple of things you could consider, one of which is to ask for a second opinion from a named cholangiocarcinoma ‘expert’ to double check that the treatment pathway you are on is correct for you, and also you could consider molecular screening. This would show which gene mutations are ‘driving’ your cancer, important information if you wanted to pursue any of the trials looking at inhibiting those specific mutations at some future point. The Sarah Cannon Institute has some clear information on molecular profiling: http://sarahcannonresearch.co.uk/
I hope some of this is helpful for you, and that others will come in and share their experiences with you. And please post again if there’s anything else you think we can help with, and to let us know how you get on.
With best wishes
*The link for others who might be interested: https://www.pennybrohn.org.uk/
Please note it is not appropriate for AMMF to give specific medical advice or recommendations, but we do have a wealth of experience and information which we are always willing to share, whenever possible.
October 22, 2017 at 2:08 pm #12558
Your advice has been very helpful for me. Many thanks. The site has been such a source of reliable information.
I have been reassured by the second opinion checking my current treatment pathway which I followed up on at your suggestion.
With regards Molecular screening, I am being treated at the LOC who as it turns out have a partnership with Sarah Cannon Institute and I was eventually signed up for this on the day that you replied to my original post….the day that I started Chemotherapy. I am 2 cycles into Gemcitabine and Cisplatin chemotherapy and seem to be tolerating it OK with few noticeable side effects at the moment. Despite having the primary cancer operated on, I have this type of Chemotherapy as I had a metastasised cancer on my Ovaries – also removed. I have been told to forget about the Omental nodule of ‘indeterminate’ origin for the time being – Easier said than done? There is only one nodule and if it were metastatic disease there would be more? Besides, I have been told that it would be difficult to locate and to operate. But if it doesn’t ‘disappear’, it will be possible to look at operating after chemotherapy which is a priority given the mucinous nature of my cancer. Mucin producing types of cancer are also not usual and normally aggressive. Perhaps someone else might have experience of this type of cancer?
As you say, I will have a scan after 3 months. This will be open to interpretation……if the nodule reduces in size does that mean the Chemo is working as it is ‘indeterminate in origin? Only if there is a reoccurrence then we know it is NOT working. Without a primary or a determinate secondary, I have no way of measuring effectiveness and this was why it was difficult to sell the idea of Chemotherapy to me. My reward for tolerating the first course will be another 4 cycles of 3 weeks……
All this may not resonate with others but it might help others considering Chemotherapy to know that I personally seem to be coping with it. I am a not especially fit 61 year old and thankfully do not have any other symptoms of the disease to contend with, apart from the surgery. I follow the Rainbow diet as best I can and eat lots of small meals as I have a steroid induced appetite. I had 2 days feeling unwell after dining out at a Chinese restaurant and so will not be doing that again and this reinforces for me the benefits of a healthy diet?
I use Fishermen’s friends lozenges to mask the constant metallic taste in my mouth or foods with strong flavours. I eat and drink lots of ginger to help with any feelings of sickness and indigestion that I had also prior to treatment. I do try to motivate myself to do at least 30 minutes of exercise a day and wish I could do more. I find mindful meditation helps a lot especially during chemotherapy. I do have plenty of examples of what I have come to identify as ‘Chemo Brain’ but have to learn to laugh about these and try to appreciate life.
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