What Does This MRCP Report Indicate?

Posted on Tue, 28 Jul 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 28 Jul 2015 Answered on

Wed, 19 Aug 2015 Last reviewed on

Question : Hi
Can you please advice best treatment for my mother . She is suffering from cholangio-carcinoma . I am attaching the MRCP report . Let me know if more tests are required for further diagnosis or for deciding the correct treatment .

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer:
Surgery should be considered

Detailed Answer:
Hi
Thanks for your query.

Surgery is the only curative treatment for hilar cholangiocarcinoma. Since it is type IV, surgery will be bit difficult but not impossible in good hands. However, we should rule out distant spread of cancer by doing CECT chest+abdomen before going in for this surgery.

If surgery is deemed not suitable by the surgical team then we are left with chemoradiation but for that bilirubin needs to be normal.

Hope this helps. I will be available for followup.
Regards

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Indranil Ghosh (1 hour later)

Hi
I am attaching the few more reports . Initially , Dr. Dey from this forum suggested that it is stage 2 cancer . However the first report says that it is stage 4 ?? ? Can you confirm that .

The doctor is saying that after putting stent they will do liver operation as well then followed by Chemo .

I am clueless / confused about what to do , as I don't think my mother's health can withstand these oprations .

What about alternative treatment like IPT ?? Any suggesstion on that

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer:
surgery should be considered first

Detailed Answer:
It is type 4, not stage 4. Type means the location. Here it involves both right and left hepatic ducts, so type 4 hence surgery bit tricky. Also this is node positive disease proven by FNAC, hence at least stage III disease.

Still, if her general health permits, surgery should be considered. Then we can consider chemo and/or radio depending on final biopsy report.

IPT is an unproven therapy and has been refuted by scientific community.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (2 hours later)

Thanks Dr. XXXXXXX .

One question does she need the liver operation as well before chemo ?? If yes what it is for ??

I thought that the only operation she need is for putting stent so that her jaundice can be cured . Can you give me more details on liver operation and why it is required ??

Answered by Dr. Indranil Ghosh (7 hours later)

Brief Answer:
that is the main surgery

Detailed Answer:
Stent putting is not a surgery. It is an endoscopic procedure to reduce jaundice. The main surgery is opening the abdomen and removing the tumor and surrounding liver and lymph nodes. This is the only hope for cure.

Chemo is given after that to prevent relapse. If above surgery not feasible then chemo plus radio to control the cancer for as long as possible. But it will not cure.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar