Immediate Opinion Reqd

Two weeks back my mother ( 54 years ) had pain in the abdomen and at back, we thought of it as gastric and treated it so. The pain got relieved and she caught fever. Then we took a tablet for fever and she got well.

Last week again the pain started and this time we consulted a Gastroentrologist and he suggested Ultrasound. Ultra sound report showed swelled CBD (Combined Bile ducts) and swelled PD (pancreatic duct ) and mass lesion. She was admitted and further tests like CECT and MRCP confirmed the mass lesion and its size (aprrox 11*23*40 mm). CA 19.9 shows 34.9. She is having mild jaundice ( billirubin = 2.54).Also liver size is increased i.e. 15.4cm. Now ERCP is being done and by biopsy the piece is being sent for analysis. All other reports are OK.

What type of problem it is ?? And what is the remedy ?? Which type of doctor should operate her ?? ( Surgon or Oncologist ).

[Dr. Kokil Mathur]

Hi!
I am sorry to hear about your mother. I think you probably mean CA125 has increased from 19.4 to 34.9. Actually all values below 35 U/ml are considered normal, but yes a rising level does increase the suspicion of cancer. Usually a high level is associated with ovarian cancer. However, a mass in liver can either be original cancer of liver or a metastasis. If there was a pelvic mass as well on CT abdomen (I assume your mother underwent this and not a simple ultrasound—if not CT whole abdomen and pelvis should be done) then chances of ovarian cancer are high.
If surgery is required, it is performed by an onco-surgeon or by a specialist surgeon of that field, and later chemotherapy etc is given by an oncologist.
Hope this helps. Take care!

[ip16]

Thanx for your spending your time.

Now i have all info.....

After doing MRCP, CECT and ERCP (also doing biopsy),it was confirmed that she was suffering from PERI AMPULLARY CARCINOMA(cancer of Ampulla of vater ).


Suggested option was WHIPPLES. And it was performed successfully on 26 Dec,2011.Now she has been discharged from the hospital and is on liquid diet. The stage is pT3N1Mx with one main lymph node effected.

Now My QUERY is What should be our next step ??.....Consulting an Oncologist and Chemotherapy or any other option ( I have reffered a few cases which differ in opinion and restricts the use of Chemo). Plz guide..

[Dr. Kokil Mathur]

Hi again!
Normally we do not reply to the second query with the same post, but am making an exception since you have provided new information.  Yes, surgery is the treatment of choice, and chemotherapy has limited affect. Only Fluorouracil as a radiosensitizer has shown some affect, and is tried in high risk cases with metastasis. You should consult an oncologist and also follow up with the surgeon regarding the need for this treatment. Otherwise only diet, proper nutrition, and antibiotics is the main stay of treatment post operation. Take care!