-  prevention and early detection of cancer
–  cancer screenings
–  diagnosing cancer
–  psychological and psychiatric support services
–  nursing and patient care
–  management of side effects
–  community resources and services
–  education programs/speakers bureau
–  cancer treatments
–  referrals

When you call, you will speak to an oncology clinical
specialist.

We also have an e-mail address you can direct your questions to
and a web page that has all Western Pennsylvania community
resources and information on the topics listed above.  We also
have booklets on all cancer topics.  This is a free service so
feel free to call or e-mail.

**********************************************
Phone:  1-800-237-4724 (4PCI)
e-mail: pci-i…@pcicirs.pci.pitt.edu
WWW:    WWW.PCI.PITT.EDU
**********************************************

- Hide quoted text — Show quoted text -

>My father, 65 yrs old, was recently (2 months ago) diagnosed
>with adenocarcinoma of unknown primary. He presented with a
>right side pleural effusion and the pleural biopsy (not the fluid
cytology)
>showed moderately differentiated adenocarcinoma suspected primaries
>being Lung, Prostate, and Breast. His PSA level was normal, so prostate
>was eliminated. Breast is uncommon amongst men and was eliminated.
>So, the docs have focused on the lung as the likely primary source.

>A CT scan showed that he has multiple mets in the right side of
>the liver, but no primary has shown up in the lung. The docs
>said that this often happens with NSCLC, and that the primary
>may be small and/or on the lining of the lung.

>After undergoing 2 cycles of chemo (carboplatin/taxol), he
>developed severe diarrhea and subsequently a paralytic ileus.
>The docs suspected an obstruction, but a colonoscopy has ruled
>that out, showing just a small amount of diverticulitis.

>A surgeon, looking at the CT scan of the paralytic ileus was
>surprised by the fact that the transverse colon was paralyzed
>(also?). He also said that the CT showed that the gallbladder
>was thickened, and he suspected that the gallbladder might be
>the primary. The paralytic ileus has resolved itself (he was
>zapped with broad spectrum antibiotics for 10 days though its
>not clear whether that did anything as all cultures were negative
>and he had no fever).

>My father has gallstones that were detected in an ultrasound last
>June (6 months before the cancer was).

>The oncologist says that the liver mets look like they have
>shrunk by 10% (I wonder if they can really tell to that fine
>a detail since the CT scans he’s comparing were done at different
>hospitals).

>His other symptoms are hyponaetremia (not clear that it really is
>SIADH), and anemia. He also had a stroke back in October – 2 months
>before the cancer was diagnosed. Some have suggested Trousseau’s
>syndrome (though it is most common amongst pancreatic cancer).
>He also had a clot in the femoral artery while in the hospital
>for the paralytic ileus – again of unknown origin.

>The questions are as follows:
>1. How does gallbladder cancer present itself – is my Dad’s
>symptoms likely/possible? Right side pleural effusion,
>hyponaetremia, right side liver mets, paralytic ileus of
>unkown origin, anemia.

>2. How can one diagnose gallbladder cancer? Blood tests?

>3. Is the 10% tumor reduction in the liver good/poor? The
>2 CT scans which were compared were:
>  - done 1 week prior to the first cycle and
>  - done 1 week after the 2nd cycle
>Is this enough time to see the efficacy of the chemo?

>4. Does it matter whether the primary is gallbladder or
>lung?

>5. What does his stroke (multiple clots in the Right rear side which
>looked like an embolic phenomenon, but no clear diagnosis) have
>to do with this cancer and are there chances for reccurrance?

>Thanks for any help,
>Ron Hira
>rh…@ecrc.gmu.edu

In response to your questions:

GB cancer usually presents as a locally expanding mass and jaundice. It is
unusual to present as metastatic adenoCA of unknown primary.

There are no blood tests to make the dx. It can usually be determined
with a fair degree of certainty by CT scan and cholangiography (dye study
of bile ducts).

Tumor shrinkage during chemo is always a favorable sign. A complete
shrinkage however is MUCH better than a partial one.

There is no effective chemotherapy for gallbladder cancer, so if the
physicians think it might be lung it is worth treating.

Many cancers increase the risk of spontaneous blood clots. The risk
persists if there is remaining tumor.

Good luck.

J.M. Estes, M.D.
jmes…@shore.net

- Hide quoted text — Show quoted text -

>My father, 65 yrs old, was recently (2 months ago) diagnosed
>with adenocarcinoma of unknown primary. He presented with a
>right side pleural effusion and the pleural biopsy (not the fluid cytology)
>showed moderately differentiated adenocarcinoma suspected primaries
>being Lung, Prostate, and Breast. His PSA level was normal, so prostate
>was eliminated. Breast is uncommon amongst men and was eliminated.
>So, the docs have focused on the lung as the likely primary source.

>A CT scan showed that he has multiple mets in the right side of
>the liver, but no primary has shown up in the lung. The docs
>said that this often happens with NSCLC, and that the primary
>may be small and/or on the lining of the lung.

>After undergoing 2 cycles of chemo (carboplatin/taxol), he
>developed severe diarrhea and subsequently a paralytic ileus.
>The docs suspected an obstruction, but a colonoscopy has ruled
>that out, showing just a small amount of diverticulitis.

>A surgeon, looking at the CT scan of the paralytic ileus was
>surprised by the fact that the transverse colon was paralyzed
>(also?). He also said that the CT showed that the gallbladder
>was thickened, and he suspected that the gallbladder might be
>the primary. The paralytic ileus has resolved itself (he was
>zapped with broad spectrum antibiotics for 10 days though its
>not clear whether that did anything as all cultures were negative
>and he had no fever).

>My father has gallstones that were detected in an ultrasound last
>June (6 months before the cancer was).

>The oncologist says that the liver mets look like they have
>shrunk by 10% (I wonder if they can really tell to that fine
>a detail since the CT scans he’s comparing were done at different
>hospitals).

>His other symptoms are hyponaetremia (not clear that it really is
>SIADH), and anemia. He also had a stroke back in October – 2 months
>before the cancer was diagnosed. Some have suggested Trousseau’s
>syndrome (though it is most common amongst pancreatic cancer).
>He also had a clot in the femoral artery while in the hospital
>for the paralytic ileus – again of unknown origin.

>The questions are as follows:
>1. How does gallbladder cancer present itself – is my Dad’s
>symptoms likely/possible? Right side pleural effusion,
>hyponaetremia, right side liver mets, paralytic ileus of
>unkown origin, anemia.

>2. How can one diagnose gallbladder cancer? Blood tests?

>3. Is the 10% tumor reduction in the liver good/poor? The
>2 CT scans which were compared were:
>  - done 1 week prior to the first cycle and
>  - done 1 week after the 2nd cycle
>Is this enough time to see the efficacy of the chemo?

>4. Does it matter whether the primary is gallbladder or
>lung?

>5. What does his stroke (multiple clots in the Right rear side which
>looked like an embolic phenomenon, but no clear diagnosis) have
>to do with this cancer and are there chances for reccurrance?

>Thanks for any help,
>Ron Hira
>rh…@ecrc.gmu.edu