Gallbladder Cancer - What Other Options May be Available

[Korrin]

My mom was diagnosed with gallbladder cancer in early September of 2006.  She had been having alot of lower back pain, which was thought to have been caused by bladder infections.  She started getting jaundice and itchy skin.  Soon after that the doctor had an ultrasound done, which led to a cat scan, which led to a biopsy of the liver.  They found a tumor in the common bile duct which was blocking both the left and right side of the liver.  This was causing the jaundice and itching.  After further investigation it was determined she had Gallbladder cancer that had spread to the common bile duct.  This blockage was causing her bilirubin to be around 17, which is very high.  She was sent to Dartmouth to have a bili tube put in the left side of the liver.  They were able to put an internal stent in, she also has an external tube.  This took alot out of her.  She had blood work done every week to check the bilirubin.  It did not go down.  She went back to Dartmouth to have a bili tube put in the right side of the liver.  They were not able to internalize this one.  She has an external drain only on this side.  She ended up with bacteria in the blood.  She was hospitalized for seven days for intervenus antibiotics, which we were told was a very powerful one.  She was on this for a total of ten days.  This seemed to have cleared the bacteria.  Her bilirubin came down to 6 through this process.  We were hopeful she would be able to start some sort of chemo when the bilirubin went down to below 5.  Shortly after this the biliruben started going back up.  It is currently at 11.4.  She is being seen by an Oncology unit within a small community hospital.  We are unable to get answers as to why the bilirubin is not coming down.  No treatment is being done for the cancer because of the elevated bilirubin.  I am hoping you have some suggestions for what our next steps may be.  She is not able to travel any distance.  She has become very weak and has lost about 22 pounds.  She has continued to have extreme back pain.  Are there clinical trials that may be available?  What do you suggest our next steps should be?
I look forward to hearing from you.

Thank you,

[Kevin Pho, MD]

The rise in bilirubin persists due to a continuing blockage of the biliary ducts.  The stents that have been placed are the appropriate treatment for this.  However, there are cases where the blockages may persist.  Surgical therapy can be considered in these cases.

Another option would be radiation therapy to possibly shrink the cancer.  

If the bilirubin continues to be elevated, you can consider other causes outside of the gallbladder cancer.  Elevated bilirubin can also be caused by an abnormal breakdown of red cells (hemolysis).  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[Korrin]

Is radiation therapy safe with elevated bilirubin?