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peritoneal carcinomatosis from cholangiocarcinoma

cancer_sux
Posts: 1
Joined: Oct 2011

My brother was diagnosed with cholangiocarcinoma in July 2010. He has been participating in a clinical trial at UPenn where he was being treated with 3 different types of chemotherapy drugs. His tumors responded very well to the chemotherapy and he became a candidate for a liver resection and radiofrequency ablation. When his surgeon opened, he discovered that his cancer had spread within the abdominal cavity-peritoneal carcinomatosis, they immediately closed and now the question is what to do next. Any suggestions or anyone with previous experiences of peritoneal carcinomatosis with origin of bile duct cancer?? The only options we have been informed of are 1. to continue IV chemotherapy or 2. hyperthermic intraperitoneal chemotherapy (HIPEC)...

Best Friend
Posts: 222
Joined: May 2011

My mom was treated at UPenn. She had alot of chemo before she has the surgery. For peritoneal cancers the tissue is like ovarian.....epithelial or something like that. Most people i talk to on here are on the carbo/taxol cocktail. My mother had rounds of that and than the surgery. She was debulked. Your brother obviously doesn't have ovaries but PPC can originate from there. They removed alot and than shaved alot of the organs. She had hers on the liver also and with the chemo alone before surgery the spots disappeared. Only spot its on now is the spleen but her ca125 number is only a 3 so one more chemo and hopefully she will be safe awhile. This cancer is more like a maintenance thing. I mean some people can go yrs, but it most liekely comes back and than u maintain it with chemo. Chances are u will keep up chemo! I have heard of HIPEC but they didn't even offer it to my mom. Dr. Chu did her surgery. They had closed up my mom to at Phoenixville when they first saw the cancer cause it was just a general surgeon. He basically told us she was gonna die and he never saw my moms type of cancer in his 37 yrs as a surgeon. It's rare but today there is alot more to do for it. GOOD LUCK! Keep us posted.

wanttogetwellsoon
Posts: 147
Joined: Apr 2011

Welcome to the board. Primary peritoneal cancer is a rare cancer. Normally, peritoneal cancer comes from somewhere else which seems to be what has happened in your brother's case. The surface cells of the peritoneum are very like the cells which cover the ovaries. I have been diagnosed with primary peritoneal cancer but am on carboplatin which is used to treat ovarian cancer. However, I'm not sure if your brother will have the same type of cancer or if it's cholangiocarcinoma which has meta'd from the gallbladder. (I presume it's the gallbladder - is that right?) However, men can have primary peritoneal cancer too. HIPEC is a technique where the chemo solution is warmed slightly and put directly into the peritoneum cavity. It is seen as being more effective as the drugs get right to the site of the problem. Not every centre offers HIPEC as it is a relatively new technique and nor is everyone deemed a suitable candidate for treatment. So far, I haven't been offered HIPEC as my surgeons say that the abdominal cavity is much too damaged by adhesions although they did say that, depending on my scan results, they may offer peritoneal stripping. This is where the peritoneum is taken away. Apparently, it regrows. There are lots of posts on HIPEC here but if you look up Sugarbaker (who is the guy who developed the technique) online, you'll find lots of useful information. Good wishes are sent your way. :)

westie66's picture
westie66
Posts: 642
Joined: Jun 2010

Hi: Just to correct some information here. I have secondary peritoneal cancer that originated from my gallbladder tumour (removed with surgery April 2010 plus part of the liver). Although most peritoneal cancers seem to be ovarian in origin and the treatment is usually carbo/taxol and possibly debulking, this is not the treatment being given for secondary peritoneal cancer originating from the gastro-intestinal system. The tumours on the peritoneum in this case are like their origin and not therefore ovarian. In addition, the peritoneum on men is different from that in women - women's are closed "sacks" if you will, while men's are open at one end.

There are several options for secondary peritoneal cancer. The peritoneum can be removed completely in a long and potentially risky surgery called peritoneal stripping. This is followed by the HIPEC procedure. Recovery time is quite long - 3 wks in hospital and a further 3 wks convalescence (at least in Canada). This is usually preceded by chemo. In these cases, the chemo is usually the kind used for other gastro-intestinal cancers: cisplatin/gemcitibine or oxaliplatin-maybe irenotecan-5FU pump for 42 hrs. The interesting thing is that while nodules of cancer may be visible on the peritoneum and omentum, the surgeons worry about the invisible nodules (micro seeds) which do not respond well to chemotherapy as they are not well connected to the blood system. Hence the HIPEC type of internal chemo.

In my case, I have had 6 nodules identified since my surgery in April 2010, all less than 2 cm in size. With both of the above-described chemo regimes, the nodules have not spread or grown, some have shrunk. My oncologist feels I could beat this with the peritoneum stripping surgery or be stable with mainenance chemotherapy.

My advice - get the best information you can from a gastro-intestinal expert. These cancers are rare (even gallbladder cancer is rare). The danger with spread to the bile duct is blockage by a peritoneum cancer nodule. You want to get that checked out quickly.

Hope this helps. Hope my info is right - there is so little known, even my oncologist shakes his head.

Cheryl

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