Stomach Cancer and Jaundice need Medicine

[SriPrabu]

My mother had cancer in prolific antrum and under went surgey on december 2007 and found that extended stage to gall blader, pancreas and limb node.She had under gone chemotherapy of 3 months course.Now she suffered with jaundice, and the report says biliary duct block and bilurubin level is 10.8.

She is 58 years old and Diabetic patient.

What will be the next level of treatment? Kindly advised us for next process.

Suggest Any Medicine to cure my mother's pain.

Awaiting for reply.

Prabakar S

[Fernando Roque, MD]

Hi. Your mother may benefit from intermittent administration of Demerol (meperidine).  Aside from providing pain relief, this drug relaxes the sphincter at the end of the bile duct and might improve the flow of bile (provided that the bile duct is not totally obstructed by the tumor).  She may also need a long-acting opioid-based analgesic (e.g. sustained release morphine or oxycodone preparations) as maintenance pain medication.  I think it would be best to consult with your oncologist or preferably a pain specialist so that your mother's condition can be treated appropriately.

[SriPrabu]

Thanks Doctor,

Right now  my mother's sugar level and BP is random. She is afraid and hesitate to go for   PTBD. So my doctor suggest for pain relieving medication only and ask us leave her as it is and full fill her wishes. Please suggest some alternate pain relief medicines.Its great help for us in this situation.

Thanks for your valuable suggestions.
Prabakar S

[Fernando Roque, MD]

Hi.  Part of the pain your mother is experiencing may be due to distention of the biliary tract because of the accumulation of bile.  So doing the PTBD may help relieve some of the pain by relieving the pressure from the accumulated bile.  If she's still experiencing pain in spite of the morphine, then additional doses should be given or a new drug should be added to control the pain more effectively.  There's no reason why cancer patients should remain in pain when there are sufficient pain medications available.  If your doctors are having a hard time treating her pain, you should probably ask them to refer your mother to a pain specialist for co-management.

[SriPrabu]

Thanks Doctor,
Thanks for suggestion. We have clearly understand the problem and found that its a extra hepatic bile duct cancer (Adenocarcinoma) spreads to lymph node and mild intrusion to pancreas and liver. My doctor says that my mothers physic is not support to go for next surgery or ERCP stent procedures. If she is willing(physical & phsychlogical improvement), he will do PTBD.

So he advised us keep her as it is and medication for pain and sugar(Diabetic).

But we are not able to console ourself, when she is in pain. The doctors giving morphine still sometimes she underwent more painful state.

If there is any medicine, please suggest to recover or prolong her life.

Thanks

PrabakarS

[Fernando Roque, MD]

Hi.  The next step in the treatment would be to perform surgery to remove the blockage on the bile duct and relieve your mother's jaundice.  This can be done either by placing a stent on the bile duct to prevent it from collapsing, or to insert a tube through the abdominal wall, directly into the bile duct to drain the accumulated bile (this procedure is called percutaneous transhepatic biliary drainage or PTBD).

Your mother may need to take stronger pain medication (e.g. demerol, morphine or some other opioid-based pain medication) if she has not done so already.

Just to put things in perspective: your mother's cancer is at a very advanced stage, having spread from the stomach to the gall bladder and pancreas.  All the treatments being given to your mother right now are palliative in nature - they are meant to relieve the pain, jaundice and prevent other complications brought about by the cancer.  However, a cure for her cancer may not be possible at this point.