On Tuesday, September 28, 2010, a consultation was scheduled with the Intermountain Medical Center’s Cancer Center. Mom, with dad, her children and in-laws, and sister Jean met with a series of doctors concerning her test results and condition. Prior to meeting with the doctors, we were informed that a medical oncologist (Dr. William Nibley), a radiation oncologist (Dr. Jeffrey Lee), and two surgical oncologists (Dr. Ott and Dr. Tanya Bowles) met to review mom’s case, to diagnose her condition, and to determine the best course of action.
We first met with Dr. Nibley, the medical oncologist. He informed us that mom likely suffers from a condition called sclerosing cholangitis. Sclerosing cholangitis refers to swelling (inflammation), scarring and destruction of the bile ducts inside and outside the liver. The doctor explained that sclerosing cholangitis is a condition that is common in individuals who have had crohn’s disease and/or ulcerative colitis, which mom has.
He then explained that sclerosing cholangitis can lead to the development of cancerous cells and a condition known as cholangiocarcinoma. This is what the doctors believe mom has. Specifically, mom has masses in her gall bladder and a mass in the liver. There is also substantially disruption of the bile ducts.
The doctors then explained that the biopsy tests to date have proved inconclusive, meaning additional biopsies still need to be taken before we can confirm that this is, in fact, cholangiocarcinoma. However, we were told that additional biopsies would likely confirm that it is cancer and that the chances of it being something else are very rare.
Dr. Nibley explained that because of the location of the masses in the gall bladder, surgery was not an option at this time due to the high probability of cancer spreading in other parts of the body as a result of the surgery. He has therefore, recommended a course of chemotherapy (assuming the biopsy proves this is cholangiocarcinoma).
Dr. Nibley said the course of chemotherapy he is recommending is based on recent studies that have shown the following course of drugs to be effective. Mom’s chemotherapy will consist of the drug’s cisplaten and gemcitabine. These drugs will be given to mom by IV once a week for two out of every three weeks. The cisplaten will take approximately 2 hours to be given and the gemcitabine will take another hour. Dr. Nibley explained that this course of chemotherapy will not result in mom losing her hair. It will make her tired, but hopefully will not make her too nauseous.
The chemotherapy will, however, result in a decrease in her immune system. Therefore, if people are sick, they should avoid mom, but normal personal interaction does not need to be avoided. However, anyone who meets with mom should wash their hands before doing so.
The hope is that the chemotherapy will reduce the size of the masses and help mom avoid the negative side effects of the cancer. After mom is on the chemotherapy for two months, there will be a check to see how the cancer is reacting to the chemotherapy. And, it should take four months before the doctors can give us an idea of how successful the chemotherapy has been.
For those who do not know, as many of us did not, cancer can spread microscopically throughout a person’s body. The benefit of the chemotherapy is that it will hopefully get to cancer wherever it is in the body.
After meeting with Dr. Nibley, we met with Dr. Lee, the radiation oncologist. He informed us that he agrees with Dr. Nibley’s assessment that we should begin treating this cancer with chemotherapy. He explained how radiation may be used in the future, but agreed that it would not be beneficial at this time.
We then met with Dr. Bowles. She discussed the biopsy, which will be conducted by needle to confirm this is cancer. She also discussed a more invasive procedure in the event this needle biopsy was not successful. Finally, she explained that surgery in the future has not been ruled out. However, this will largely depend on the effect the chemotherapy has on my mom’s cancer.
We finally met with a social worker who discussed with the family some of the emotions we may experience in the upcoming months. We also met with a dietician who explained how diet can help mom.
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