Month: May 2016

Bile Duct Cancer

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From UCSF Medical Center, Department of Surgery

Different types of treatment are available for patients with extrahepatic bile duct cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Two types of standard treatment are used:

The following types of surgery are used to treat extrahepatic bile duct cancer:

Removal of the bile duct: If the tumor is small and only in the bile duct, the entire bile duct may be removed. A new duct is made by connecting the duct openings in the liver to the intestine. Lymph nodes are removed and viewed under a microscope to see if they contain cancer.
Partial hepatectomy: Removal of the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with some normal tissue around it.
Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to make digestive juices and insulin.
Surgical biliary bypass: If the tumor cannot be removed but is blocking the small intestine and causing bile to build up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area. This procedure helps to relieve jaundice caused by the build-up of bile.
Stent placement: If the tumor is blocking the bile duct, a stent (a thin tube) may be placed in the duct to drain bile that has built up in the area. The stent may drain to the outside of the body or it may go around the blocked area and drain the bile into the small intestine. The doctor may place the stent during surgery or PTC, or with an endoscope.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Radiation sensitizers
Clinical trials are studying ways to improve the effect of radiation therapy on tumor cells, including the following:

Hyperthermia therapy: A treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs.
Radiosensitizers: Drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas ( regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Treatment Options by Extent of Disease

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Localized Extrahepatic Bile Duct Cancer
Treatment of localized extrahepatic bile duct cancer may include the following:

Stent placement or biliary bypass to relieve blockage of the bile duct may be done before surgery to relieve jaundice.
Surgery, with or without external-beam radiation therapy.
Check for U.S. clinical trials from NCI’s PDQ Cancer Clinical Trials Registry that are now accepting patients with localized extrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Unresectable Extrahepatic Bile Duct Cancer
Treatment of unresectable extrahepatic bile duct cancer may include the following:

Stent placement or biliary bypass with or without internal or external radiation therapy, as palliative treatment to relieve symptoms and improve the quality of life.
A clinical trial of hyperthermia therapy, radiosensitizers, chemotherapy, or biologic therapy.
Check for U.S. clinical trials from NCI’s PDQ Cancer Clinical Trials Registry that are now accepting patients with unresectable extrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Recurrent Extrahepatic Bile Duct Cancer

Treatment of recurrent extrahepatic bile duct cancer may include the following:

Palliative treatment to relieve symptoms and improve quality of life.
A clinical trial.
Check for U.S. clinical trials from NCI’s PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent extrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Recurrent Bile Duct Cancer

Recurrent extrahepatic bile duct cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bile duct or in other parts of the body.

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Alcohol and Liver Disease

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The liver is our largest internal organ and it has 500 different roles. One of the liver’s most important functions is to break down food and convert it into energy when you need it. Your liver also helps the body to get rid of waste products and plays a vital role in fighting infections, particularly in the bowel

And yet, when your liver is damaged, you generally won’t know about it – until things get serious. Drinking alcohol can increase your risk of developing liver disease and cause irreparable damage to this very important part of your body.

In fact, drinking is a major cause of the 25% increase in deaths from liver disease in over the last decade. Overall, alcohol-related liver disease accounts for well over a third (37%) of liver disease deaths. And figures show victims are getting younger – more than one in 10 of deaths of people in their 40s are from liver disease, most of them from alcoholic liver disease.

Gallstones

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Gallstones
Gallstones are hard deposits that form in your gallbladder — a small, pear-shaped sack that stores and secretes bile for digestion. Twenty million Americans are affected by gallstones. Gallstones can form when there’s too much cholesterol or waste in your bile or if your gallbladder doesn’t empty properly.

When gallstones block the ducts leading from your gallbladder to your intestines, they can cause sharp pain in your upper-right abdomen. Medications sometimes dissolve gallstones, but if that doesn’t work, the next step is surgery to remove the gallbladder.

Tips to Prevent GERD

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Here are 10 tips you can try to prevent GERD.
  1. Lose weight. Obesity is the leading cause of GERD, Dr. Vaezi says. …
  2. Avoid foods known to cause reflux. If you’re at risk for GERD, avoid: …
  3. Eat smaller meals. …
  4. Don’t lie down after eating. …
  5. Elevate your bed. …
  6. Review your medications. …
  7. Quit smoking. …
  8. Cut back on alcohol.
  9. Wear loose-fitting clothes
  10. Try a gluten free diet.

If none of these tips seem to work, see your doctor. Medications or surgery for GERD may be recommended.

What is ERCP

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What is ERCP (Endoscopic Retrograde Cholangio-Pancreatography)?

ERCP is a procedure that enables your physician to examine the pancreatic and bile ducts. A bendable, lighted tube (endoscope) about the thickness of your index finger is placed through your mouth and into your stomach and first part of the small intestine (duodenum). In the duodenum a small opening is identified (ampulla) and a small plastic tube (cannula) is passed through the endoscope and into this opening. Dye (contrast material) is injected and X-rays are taken to study the ducts of the pancreas and liver.

Why is an ERCP Performed?

ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts, and is also used to treat those conditions. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice (yellowing of the skin), or an ultrasound or CT scan that shows stones or a mass in these organs.

ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP. Tumors, both cancerous and noncancerous, can be diagnosed and then treated with indwelling plastic tubes that are used to bypass a blockage of the bile duct. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.

In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by ERCP.