Bile duct Cancer: To live or to die is your choice!

LY is a 68-year-old lady from Indonesia. In late 2015, she had fevers on and off. This had been going on for some six months. At the end of February 2016, LY went to a private hospital in Johor for check up.

Blood test on 29 February 2016 showed elevated liver function enzymes:

Alk. phosphatase 302
ALT / SGPT 66
GGT 603
AST / SGOT 59

The tumour makers were normal: Alpha-fetoprotein = 1.9, CEA = 1.6 and CA 19.9 less than 2.0.

MRI done on the next day showed dilatation of the CBD (common bile duct). There is a round mass lesion in the lower end of the CBD protruding into the duodenum. Impression: biliary obstruction due to a polypoid mass arising from the lower end of CBD — ampullary tumour ?

LY was asked to do a scope but she refused. She decided to come and seek our help. After going through her medical reports, I advised LY to see a “liver” specialist in one private hospital in Penang. I advised LY that she might need to install a stent and clear off the blockage in the bile duct. After this is done, she can come back to see me again if she wants to take herbs.

Blood test done on 14 March 2016, showed LY’s liver function had deteriorated.

Alk. phosphatase 1,094
ALT / SGPT 121
GGT 1,239
AST / SGOT 134

CT showed a soft tissue mass at the ampulla of vater measuring 2.1 cm x 2.2 cm. The common bile duct is also dilated with greatest diameter measuring 2.3 cm. LY’s problem was diagnosed as cancer of the ampulla with biliary obstruction. There is no evidence of liver metastasis.

LY underwent an Endoscopic Mucosal  Resection (EMR) and pathology report confirmed a Grade 2 adenocarcinoma of the periampullary region.

An expandable metal biliary stent (8 cm x 10 mm) was inserted at the common bile duct.

Blood test two days after the stenting showed improvements of her liver function enzymes.

20 Mar 16
Alk. phosphatase 752
ALT / SGPT 67
GGT 785
AST / SGOT 26

LY was asked to undergo follow-up chemotherapy. She refused to see an oncologist and came back to seek our help again. LY was prescribed Capsule A, C, D and M, in addition to Liver-1 tea.

For the rest of 2016 and until August 2017, LY was doing fine. Her blood test results are as follows:

22 May 16 26 Sept 16 19 Mar 17
Alk. phosphatase 183 125 100
ALT / SGPT 43 41 26
GGT 124 74 29
AST / SGOT 38 41 27

Ultrasound on 19 March 2017 showed a large stone or sludge, 3.8 cm, in the gall bladder. There is a 3.1 x 3.7 cm septated cyst in the spleen.

Ultrasound of the pelvis and X-ray of the chest showed no abnormality.

In July 2017, LY felt discomfort in the liver region. She came to see her surgeon again in Penang. CT scan on 22 August 2017, showed the common bile duct and intrahepatic ducts are dilated with greatest diameter of CBD measuring 2.3 cm. Intraluminal soft tissue tumour thrombus nearly completely filled up the biliary stent in keeping with biliary obstruction and could represent cholangiocarcinoma.

The doctor flushed off the obstruction. LY felt better. This procedure cost RM 2,800.

LY came to our centre and told us what had happened. She looked good.

 

Comments 

For the past fifteen months, LY was doing fine and led a normal life. Only the past 2 months did she feel discomfort. Did you take care of your diet? Not exactly! She said at times she took fried food! I told LY, If you want to live longer, take care of your diet. 

LY installed a metal stent in her bile duct and refused chemotherapy. So far she had lived a normal life! So patients, to live or to die is your choice! Know that you have a choice. Know also that what you choose to do will determine how you live and die later. Let me reproduce the emails I received from Canada. 

14 November 2016: Dear Dr. Teo: I am hoping that you will be able to help us.  My mother has cholangiocarcinoma with metastasis to the liver.  Her primary tumour is just outside the liver in the common bile duct.  I have attached her recent MRI and blood work.   

We are heading to the hospital right now because she has had a fever around 100-101 degrees F for several hours.  She has two plastic stents in the bile duct which are situated side by side.  In the last couple of days she is having some sharp pain over the spleen area.  She is on a mainly vegetarian diet since she was diagnosed June 29, 2016.  Her plastic stent is likely infected and her surgeon will change it this Tuesday.  I hope it doesn’t get worse by then. 

As you can see, she is in no shape to travel.  She is dependent on me to take care of her. I know that you do not believe in treating patients at a distance without meeting the patient or a knowledgeable family member in person.  However, we are praying that God will send someone like you who can help us.  We put all of this in God’s hands and are praying you will be able to help us. I would greatly appreciate hearing back from you. My mother has not had any chemo, radiation or surgery.  She is still eating and can walk for 25 minutes without stopping. 

16 May 12017:  She’s still in the hospital in palliative care.  We are trying our best to see if we can get her home.  Has been here 3 weeks … she is on: 

morphine, buscopan, ursadiol, acid reducer ( pantalog), unfortunately salt tablet because sodium and albumin is very low, dexamethasone, blood thinner – ?daltoperrin – a small clot was found in her lung.

She has a paracentesis stent draining her abdomen and she has leg edema. 

She is no longer on meropenum for a possible infection even though blood cultures came back negative.  Could localized in bile duct.

22 May 2017:  If I knew in December 2016 she would have made it this far before the Dec 2016 stent got blocked,  we would have taken a plane to come to see you. 

It may be too far gone, but I know with God anything is possible. She is very weak and cannot walk anymore and hardly eating.  The hospital staff keep trying to  give her morphine around the clock even when she doesn’t want it.   

The morphine and buscopan had her so constipated for 4 days that she could not have a bowel movement even after using the hospital protocols and my coffee enema.

My mother is still hanging on and has not been in hospital since Dec 22, 2016 when she got the two plastic stents in addition to the metal stent she previously had.  We have taken the kid and liv teas and the one for constipation. She has some leg pains at night and I am contemplating giving  the pain tea for it . Bilirubin is 14, but ALT is about 499 and GGT about 440. 

I think she could benefit from the capsules but cannot do so without your guidance and feedback about healing reactions to expect . 

23 May 2017: Dr. Chris, …. everything went downhill when the stent procedure didn’t work and the rest of the family who know nothing about health and who don’t want to learn anything new insisted she stay in the hospital for the past month in palliative care with no fresh air, sunshine or healthful food and supplements/herbs etc and was just fed painkillers etc. 

The doctors say it may happen anytime and she is so weak that it could be days. Her albumin is only 14 or 15 and her sodium was 116. She has been taking 4 g of NaCl capsules each day and the sodium is up temporarily to 121-125. Sometimes she has problems swallowing when she is sedated. However, she had begged me to take her home which I intend to do tomorrow. 

5 August 2017: Sadly my Mom passed away May 29th.  My siblings argued with me and kept her in the hospital and it broke my heart to see them kill her with drugs. So we were never able to use your herbs. 

 My 65 year old brother just got diagnosed with small cell ca of the lung – 7 cm which they told him that surgery is not an option. Chemo or radiation. Could these herbs help him?

Reply: Like your mom too, no, I cannot help patients from faraway places! Let the doctors help him.

 The above story happened in Canada. Here are stories which happened in Malaysia. 

  1. My dad (aged 75) has been diagnosed with bile duct cancer – advanced stage.

Dear Dr. Teo: I hope this finds you well. I got in touch with you earlier about my dad. Sadly he lost the battle with cancer. He went down the chemo route and we lost him pretty soon after. https://cancercaremalaysia.com/2017/08/31/they-went-for-chemo-and-they-died/

  1. Bile Duct Cancer: When MORE = WORSE https://cancercaremalaysia.com/2017/01/02/bile-duct-cancer-when-more-worse/

Here are some stories of hope and success!

Had Three Cancers! Three To 12 Months To Live. Three years on CA Care Therapy still okay!

https://cancercaremalaysia.com/2015/07/23/had-three-cancers-three-to-12-months-to-live-three-years-on-ca-care-therapy-still-okay/

Liver-Bile Duct Cancer: Herbs Kept Him In Excellent Health

https://cancercaremalaysia.com/2010/12/09/liver-bile-duct-cancer-herbs-kept-him-in-excellent-health/

Advanced Bile Duct-Liver Cancer: Doctor’s prognosis three months — Now one and half years, still alive!

https://cancercaremalaysia.com/2015/03/03/advanced-bile-duct-liver-cancer-doctors-prognosis-three-months-now-one-and-half-years-still-alive/

Pancreatic Cancer: No chemo, only on herbs. Still fine after 4 years

https://cancercaremalaysia.com/2015/02/05/pancreatic-cancer-no-chemo-only-on-herbs-still-fine-after-4-years/

 Let me end by asking you to reflect on the quotations below:

 

 

 

 

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He Prayed, God Answered

Part 2: Desperate Search for Alternative Therapy

Desperate, Mei decided to go to the Philippines for immunotherapy-herbal treatment. A one-month stay and treatment in a “private hospital” cost AUD 4,500. Unfortunately, the treatment did not make Mei any better.

After Mei returned to Australia she did an ultrasound which showed the tumour had increased in size.

A CT scan in July showed the nodule in her lung had also increased in size from 5 mm to 8.5 mm. The “multiple hepatic lesions appear somewhat numerous and slightly larger than before.”

Mei and her husband was in a desperate situation having to face the possibility that Mei may die anytime soon.

Mei did not want to give up hope.

She started to surf the net and found a hospital in China which offers a special treatment. She wrote to the hospital and was told that she would need to undergo 3 to 4 treatments and each treatment cost AUD 20,000.

Mei’s husband said they do not have the money to pay for such an expensive treatment but he was ready to go to the bank and ask for a loan to finance his wife’s treatment.

Mei’s husband said that his wife did not know that all day and night and where ever has was — driving or in the toilet — he kept praying and praying, asking God for a sign of what to do to help his wife.

Then, something wonderful happened! While he and Mei were reading the website of this Chinese hospital, CA Care’s website suddenly popped up. It was a video of a man with black hair (not white like now!) and he was talking. Mei and her husband read more about us, and according to Mei’s husband he was certain that God had answered his prayer. He told his wife, we must go and meet this man!

He prayed, God answered.

 

CA Care: God’s answer to my prayer

For more go to Part 3

 

They went for chemo and they died

  1. Bile duct cancer

Dear Dr. Teo,

My dad (aged 75) has been diagnosed with bile duct cancer – advanced stage. He has Hepatitis B, so the liver is functioning at only 20% of normal capacity. The oncologist has suggested chemo as the only option and it is scheduled on the 14th of June. My family and I are trying to explore other options, or at the very least, want him to be nourished and protect the body from the ill-effects of chemo.

Would you be able to help? I am based in London, but I am heading back to Kuching early next week. Looking forward to hearing from you. Best regards.

( No news after this!)

Dear Dr. Teo,

I hope this finds you well. I got in touch with you earlier about my dad. Sadly he lost the battle with cancer. He went down the chemo route and we lost him pretty soon after.

A friend of mine who is based in America (HK Chinese born in the UK) is wondering if you are able to help her friend who has just been diagnosed with stomach cancer stage 1b. This will be reconfirmed soon after a laparoscopy surgery which is scheduled to take place soon. My friend is now in HK to sort out a few personal thing and is wondering she could visit you in Penang in the next week or so to get some help for her friend (based in the US). She has all the relevant information with her including medical records. Please could you assist? Blessings.

  1. Sarcoma

Hi, think you should know this. My cousin sister’s husband just passed away two days ago. His condition deteriorated after chemo, How I wish he didn’t undergo any chemo…..Thanks

More details …..

Aug 23, 2017 Dear Dr Chris,

Good day! My cousin sister’s husband who is only 32 years old is suffering from sarcoma, final stage. He was diagnosed with it in late March (due to coughing non-stop) and is now in final stage. They just got married last year and my cousin sister just gave born to a baby boy (one month old).

He has undergone treatment (previously surgery done in China) and chemotherapy (for 1 time) only in GMC. His condition deteriorate after the chemo while my cousin was in confinement. He couldn’t walk now due to edema.

I came across your blog and I am impressed with your ideology, probably we can alleviate the condition by using herbs. I myself believe herbs can create miracles. There must be something which can help to suppress the development of sarcoma or even reduce the extension of it.

It’s sad to see a good family in bad shape. Hope to receive your feedback. Thanks.

Dear Dr Chris,

I myself believe in herbs. I would like to ask can he take both, meaning undergoes chemo and take herbs at the same time?

Reply: Go and do all the chemos first …. no need to take my herbs

Which means you only help those who don’t do or has stopped chemo?

Reply: Better… anything wrong they all blame me not the chemo.

Hmmm…… Understood

Comment

Many people write to ask me if they should undergo chemotherapy or not. No, I cannot and would not answer such question.

Read what chemo is all about and you make your decision. In this way, if there is something wrong, you or others around you, cannot blame me.

Read this ….

 

 

Bile Duct Cancer: Go find a good surgeon to help you!

lion-2

Kat (not real name) is a 64-year-old Indonesian lady from Aceh. Her problems started about three weeks ago when she felt dizzy and had abdominal pain. A doctor in Aceh did an USG and said there was something in her gallbladder.

Kat and her family came to a private hospital in Penang for further management. MRI of her abdomen showed:

  • a lesion in the region of bifurcation of the common bile duct. It measures 42.4 x 50.0 x 24.5 mm.
  • gallbladder was grossly distended.
  • Para-aortic lymph node was enlarged, measuring 52.7 x 49.0 mm.

Diagnosis: Klatskin tumour with biliary obstruction and para-aortic lymphadenopathy.

Her blood test results are as below.

Total bilirubin 286.8 H
Direct bilirubin 210.4 H
Indirect bilirubin 76.4 H
Alkaline phosphatase 505 H
ALT 108 H
AST 54 H
GGT 461 H
C Reactive protein 15.6 H
Alpha-fetoprotein 3.1
CA 15.3 14.0
CA 125 22.4
CA 19.9 786.89

The attending surgeon, Dr. B suggested that Kat undergo a procedure to install a metal stent to relieve the blockage. This procedure would cost about  RM6,000.

Kat and her family came to seek our advice first before undergoing the procedure. This is rather surprising! Generally patients come to us after all medical procedures failed them. So this morning, we gave them the following advice:

  1. Yes, should go ahead with the stenting procedure. It is better not to wait for too long because your bilirubin level is already too high (see above).
  2. The problem associated with stenting is that blockage can occur again after a few months (and for the unlucky ones even within a few weeks).
  3. Because of this it is wiser to use a plastic stent first instead of a metal one.
  4. I cautioned Kat and her family that it is important that they go to a “reputable” doctor who is known to be able to do a good job. Not long ago, I had a case where the patient’s gallbladder was removed only to be told later that she had Stage 4 liver cancer! You don’t want to go to such doctor. So we have to be careful.
  5. From the feed-back from patients, I know that Dr. A could do a good job! Kat should see him first before agreeing to let Dr. B do the procedure.
  6. A had done an excellent job for Bak, a patient who is also from Aceh. A stent was installed for his blocked bile duct. Every 5 to 6 months, Bak had to come back to the hospital to change the plastic stent. After 4 or 5 changes, everything was okay. And the good part of this story is that this surgeon did NOT object or did not get angry when Bak refused to undergo chemotherapy. Bak told the surgeon he wanted to take herbs instead. And most important of all, today, Bak has no more problem with his cancer!  Bak’s wife came back to our centre one day and told us that her husband can now live a normal, healthy life.

A few days later Kat and her family came to see us again. The stenting procedure was done by Dr. A as suggested. Kat went into the operation room at 6 pm and was out by 7 pm. The procedure cost RM 3,890. She was discharged the next day.

Note: Let me be clear that we did not receive any monetary reward for referring Kat to Dr. A or any doctor for that matter.

After all done is done, Kat and her family wanted to pay us our consultation fee! Our answer: Free-of-Charge!

Our reward this morning was to be able to see Kat to being treated well. From the facial expressions of those who came, we knew that they were very pleased. Our little advice had helped them a lot! Praise be to God! 

Understanding Klatskin Tumour and It’s Treatment

Klatskin tumour is a type of cholangiocarcinoma or a tumour of the bile duct system. It occurs at the confluence of the right and left hepatic bile duct. It is named after Dr. Gerald Klatskin. See illustration below.

bile-duct-cancer

The tumour blocks the drainage of the bile duct giving rise to symptoms such as jaundice (yellowing of the skin), bilirubinaria (dark urine), pruritus (itchy skin) and abdominal pain besides weight loss.

What is the cause? Don’t know.

How to treat? Placement of stent to open the duct and relieve jaundice. ” Cholangiocarcinoma represents a rare malignancy. Without intervention, death due to progressive jaundice is inevitable. The goals of therapy, therefore, are resection of all disease and relief of biliary obstruction.”

Prognosis: Intrahepatic bile duct cancer: 5-year survival — Localized 15% Regional 6% Distant 2%

Extrahepatic bile duct cancer: 5-year survival — Localized 30% Regional 24% Distant 2%

 

 

Bile Duct Cancer: When MORE = WORSE

AM is a 48-year-old lady. About nine months ago she passed out tea-coloured urine. Her body was itchy. A blood test was done and her doctor said it was not good. She was referred to a private hospital near her hometown. From there she was referred to another private hospital in Kuala Lumpur.

A CT scan on 11 March 2016, showed:

  • A gross intra hepatic biliary tree dilation secondary to obstruction at the proximal common bile duct due to suspected cholagiocarcinoma.
  • No focal liver lesion.

AM had a blood clot in her neck. was treated with Clexane (an blood thinning injection to stop blood clots forming within the blood vessels). A biliary stent was inserted to help relieve the blockage.

A scan  on her brain and head showed no evidence of abnormality.

Her problem was diagnosed as inoperable cholangiocarcinoma and right IJV (internal jugular vein) thrombosis. That is to say AM had a bile duct cancer that should not be operated on.

A follow-up CT scan done about a month later, 25 April 2016 showed:

  • An increase in size of known cholangioncarcinoma.
  • Enlarged spleen.
  • Uterine fibroids.
  • Multiple tiny pulmonary nodules, bilaterally.

A CT scan done on 27 July 2016 showed the following:

  • Biliary stent in situ … stable in appearance.
  • Main and right hepatic arteries demonstrate normal enhancement.
  • Spleen is enlarged.
  • Uterine fibroids.
  • No focal bony lesion.
  • Multiple pulmonary nodules stable in numbers and sizes.

From this follow-up scans, it appeared that AM condition was stable — did not deteriorate. However, after 3 months, the stent was clogged. Although AM’s cancer was initially regarded as inoperable, in August 2016, the doctor decided to operate on AM.

Pathology report indicated that many lymph nodes were infected with cancer.

Two months after surgery, AM had fluid in the abdomen. She did not feel good and had to undergo another surgery to “clean” up her abdomen.

AM was referred to a government hospital for chemotherapy. Her 6 cycles of chemo was due to start in mid-December 2016. A week before commencing her chemo, AM and her family came to seek our advice.

My advice then was to go ahead with her chemo. But AM was reluctant to undergo chemotherapy. I told her to go back and think about it properly and come back to see me again if she needed our help.

AM came back a few days later and said she decided to try our therapy first and would not go for chemotherapy for the moment.

Her blood test results done on 14 December 2016 are as follows:

 

ESR 50  H
RBC 3.6  L
Haemoglobin 10.7  L
Platelet count 122  L
WBC 3.8  L
Alkaline phosphatase 403  H
SGOT/AST 67  H
SGPT/ALT 57  H
GGT 198  H
Alpha fetoprotein Less than 1.3
CA 19.9 11,500.5  H
CEA 2.2

 

During our conversation, I asked AM a few important questions.

  1. In all, for the stenting and 2 follow up surgeries, how much did you have to pay? According to her husband, the total medical cost in this private hospital came to about RM 120,000.
  2. Did you ask if the surgery was going to cure you? No, there would be no cure.
  3. Were you okay before the bile duct surgery when you only had the stent? Yes, okay except that the stent was clogged after 3 months.
  4. What was your condition like after the surgery? My condition deteriorated. I was better off before the surgery.

 

 

Comments

What can we learn from this case?

  1. Why do you think an initially inoperable cancer suddenly was operated on? Was it because the stent was clogged after 3 months?
  2. If clogging of the stent was the main reason, would a change of a new stent not help solve the problem? I recalled a case of a patient who had to change his “plastic” stent every 6 months (and he did it for about 6 times). He underwent our therapy and refused chemotherapy. Eventually the cancer disappeared and he is well up to this day. Read more here: https://cancercaremalaysia.com/2011/11/04/pancreatic-cancer-severe-itch-disappeared-and-health-improved-after-herbs-and-the-e-therapy/
  3. AM started off with a normal liver. After the surgery, she was worse off. Her CA 19.9 was 11,000 plus and her liver function parameters were all high. Before the operation, her condition was not like that. What if she were to just change her clogged stent again and again and not do the surgery? Did surgery spread her cancer?
  4. There is another story which was posted in this blog not too long ago, Gallbladder Stone to Stage 4 Liver Cancer: How is that possible? Would you like this to happen to your mother? This patient had surgery to remove her “so called gallbladder stone.” Surgery did not solve her problem. Later it turned out to be a stage 4 liver cancer. The patient died. How could it be?
  5. However, many of us have the impression that the more we do, the greater are the chances that we get a cure! Doing less or nothing is never an option! But often, with cancer, it is the other way round, the more we do may mean the worse we become, as in this case.

 

Had Three Cancers! Three To 12 Months To Live. Three years on CA Care Therapy still okay!

Sixty-six year-old Ray (not real name) was a smoker since age 17. He stopped smoking when he was 58.

  • In 2004 (61 years old), Ray was diagnosed with stomach cancer and underwent a subtotal gastrectomy followed by 6 cycles of chemotherapy. This was followed by radiotherapy.
  • In 2007, his PSA was at 7.29. TRUS guided biopsy was done which revealed prostate cancer, Gleason 3+3. Ray underwent prostrate surgery.
  • In 2011, Ray underwent another surgery to remove his gallbladder. Biopsy indicated no malignancy. However, in early 2012, Ray had high grade fevers and was jaundiced. His liver function enzymes were elevated — Alkaline phosphatase = 433, AST = 87 and ALT = 161.
  • Ray underwent an ERCP with SEMs placement. Later, a tumour was found in the lower bile duct.

Ray was in a dilemma. The doctors told the family:

  1. There is no medication for him.
  2. Chemotherapy would only provide a 20 percent chance of success.
  3. Cyberknife procedure may be a consideration.

They consulted three doctors. One doctor said Ray have only a few months to live, maximum 7 months. An oncology surgeon said if it is a bile duct cancer, maximum 30 months but if the tumour grows and blocks the duct then he would not last long. The third doctor gave him a year at most.

Ray’s son found CA Care in the internet and wrote us. Later, his son-in-law came to seek our help. Watch this video.

This is the story written by Ray’s son.

My father’s journey with alternative treatments http://www.cancercompass.com/message-board/message/all,71199,0.htm?mid=550843

Hi,

I just wanted to narrate my father’s journey with cancer and our personal experience with alternative treatments.   

Background

My father was first diagnosed with Stomach cancer in 2004 and whilst it was a tremendous shock to us we were a bit ignorant about the cancer (which probably helped us at that time). Anyway, he underwent surgery followed by chemotherapy and radiation treatments.  He was lucky to be a stomach cancer survivor and made changes to his diet and lifestyle (gave up smoking).  He was then diagnosed with prostate cancer in 2007 and again underwent surgery and recovered from that successfully.

Bile Duct Cancer

To our horror he was diagnosed with Bile Duct cancer in March 2012 (albeit he did revert back to a more unhealthy lifestyle in 2011, which included alcohol, meat and fried foods).

In April 2012 the doctors put a self expanding metal stent to alleviate issues of bile flow and subsequently when his condition improved a bit they looked at the possibility of surgery. However, once on the table the surgeon decided that surgery was not possible.  The doctors attending to him had mentioned a prognosis of 3 to 6 months to me.

Without surgery my understanding is that conventional medicine does not offer many solutions and quality of life was a key consideration in our decision. Therefore, as a last resort we turned to alternative medicines.

Our Journey with Alternative Medicines

I spend my time between Australia and India. My focus last year in April was entirely on finding him the best alternative medicines that are available (and with some body of knowledge behind them).

I narrowed down my options to the following

1) Professor Chris Teo from Malaysia who runs CA CARE

2) Natural Supplements

3) Ayurveda treatment from DS Cancer research in India.  Albeit I started Dad on the Ayurveda in Sep 2012 more as an insurance policy.  He was already feeling better before then.

CA CARE

This is run by a botanist in Malaysia called Chris Teo and he has had great success in healing people (he doesn’t believe in a cure) with cancer and Dad has his herbal teas on a daily basis. Protocol is provided by Chris.  Also, he is very focused on diet and red meat, fried food, dairy, alcohol and processed sugar are definitely not allowed.

Dads current situation

My father has a good quality of life (90% of any one of us) and apart from the occasional infection due to the stent, his blood reports (tumor markers have remained down and Liver Function test is mostly in normal range) and scan on his 1 year anniversary has also provided a clean bill of health (i.e. scan said stable disease).

The future is always uncertain but I really wanted to share my personal experience with everyone who might be struggling with this disease and wish you all the best.

Latest update 2015: It has been 3 years plus and this patient is still doing okay. This is an e-mail Ray wrote in June 2015.

Over last three years have lost over 22 kg, current weight 54 kg. I am 5feet 11 and normal weight was in 70s. Doctors looking after my day to day issues including  Bile Duct stents, have been strongly advocating putting on some weight to counter disease plus new developments. My diet is mainly vegy, little fish sometimes, no sugar, salads and fruits of all types. Cooking media is olive oil mainly and sometime a coffee or tea to feel normal.

 UPDATE: 25 December 2015 

Chris,

My father passed away yesterday night as a result of his cancer. He was bed ridden towards the end, however, he did not suffer pain which is associated with the disease and was able to eat and drink small amounts to his last day (including some of your tea).

I wanted to give you a heartfelt thank you as your medicines have certainly provided us with much cherished time with our father. He was diagnosed in March/April 2012 and the time we have had with him has been very precious. Regards, Rahul.

Please take note: Patient was given 3 to 6 months to live but he managed to live a happy life for more than 3 years. This is what we mean by we cannot cure any cancer — neither can anyone on earth!

 

 

Advanced Bile Duct-Liver Cancer: Doctor’s prognosis three months — Now one and half years, still alive!

Joe is a 75-year-old Indonesian from Medan. Sometime in 2010 he suffered from heart problems and was on a blood-thinner drug. Then in September 2013 he was severely jaundiced. The doctor in Medan inserted a biliary (plastic) stent into the left hepatic duct and CBD. Two weeks after this procedure his blood pressured dropped drastically. Both his arms and legs and abdomen were swollen. He was semi-unconcious and was unable to walk.

Laid on a stretcher, his family flew him to Penang. This medical emergency trip on Sriwijaya Air cost he family RM 8,000 (the normal flight ticket is about RM 150 to RM 200).

In a private hospital in Penang, Joe had MRI on 9 September 2013. The results:

  1. Lesions scattered in the liver ranging from 0.5 to 1.8 cm in size, suspicious of metastatic deposits.
  2. There was a lobulated irregular mass at the portal of the liver measuring 3.5 x 3.9 x 5.6 cm. It has infiltrated the portal of the liver.
  3. Enhancing soft tissue lesions in the right subdiphragmatic, right subhepatic, around the right kidney, crus of both diaphragms with encasement of the vessels anterior to the aorta.
  4. Right kidney was displaced anteriorly.
  5. Mild ascites.

Impression: Features are suggestive of advanced cholagiocarcinoma with local infiltration and liver metastasis.

Joe underwent an endoscopic retrograde cholangio-pancreaticogram (ERCP). The plastic stent, previously installed in Medan, was removed and an self expandible metallic biliary stent was inserted into the left intrahepatic ducts.

Joe remained in the hospital for 2 weeks and his conditions improved. All swellings and jaundice were gone. The treatment in the hospital cost him about RM 16,000.

Joseph-M441-ercp

Joseph-s-441-liver-met

Joe was asked to undergo chemotherapy. With chemo his life would be prolonged (no months mentioned) but without chemo the doctor said he would not last more than 3 months. The family refused chemotherapy and his two sons (without the patient) came to seek out help on 20 September 2013. Joe was started on herbs.

After 2 months on the herbs, we were told that Joe was doing very well, in spite of not undergoing  chemotherapy! His appetite had improved and he was more energetic. The family did not tell Joe that he had cancer!

One Year Five Months Later

In February 2015, one of Joe’s son came to our centre. Listen to our conversation.

The following are the results of Joe’s blood test

Date CA 19.9
6 Aug 2013 1,000
8 Sept 2013 More than 12,000
Installation of stent in bilary duct and started on CA Care herbs on 20 Sept 2013. No chemo.
11 Dec 2013 11,335
4 Feb 2015 454
5 Feb 2015 Blood test: Low in Sodium, Albumin and Haemoglobin. Ask to go for transfusion.

 

 

Liver-Bile Duct Cancer: Herbs Kept Him In Excellent Health

The son of Henry (not real name) came from Jakarta, Indonesia. He told us an interesting story about his father. His father is 70 years old. He was diagnosed with bile duct cancer that had spread to his liver.

He declined further medical treatment and immediately took our herbs – Capsule A and B, Liver 1 and 2 teas, and LL-Tea. His health improved – his appetite improved and he regained his strength and energy.

Since he felt well, he stopped taking the herbs after five months. His health deteriorated. He was back in the hospital again. A scope done showed a bile duct blockage. The doctor suggested surgery but he refused. Henry again took our herbs. His health was again restored. After four months on the herbs, he again stopped taking the herbs. Within three weeks he started to vomit and he had fevers. Henry again went back to the herbs and he was well again until now. His son said: “I am afraid to stop the herbs again.”

Henry first started taking the herbs about two years ago. The herbs made him well up to this day. He has no complaints. He is healthy – can eat, can sleep and can move around. His son said: “Oh, he is very strong.  When you see him you would not think that he has cancer – he can even climb the tree. He is very, very okay.”

Comments: According to medical literature, median survival of liver cancer patients without medical treatment is 1 to 4 months. Prognosis worsens without increased tumour size. Patients with tumours larger than 6 cm have a mean survival of 3.5 weeks. Generally patients who come to us are often told that they only have 6 months to live.

In this case, Henry survived for 2 years without any medical treatment. He only took herbs. He continues to lead a quality life – without any pain, able to eat, sleep and move around like any healthy person. What more can such patient ask for?

 

 

The Doctor Said: “No More Hope” After a 60-Million-Rupiah Operation for Bile Duct Cancer

Hass (not real name, M847) is a 44-year-old male from Indonesia.  In early 2010, he had jaundice. The doctor suspected this was due to Hepatitis. Hass was prescribed medication. After a month, the treatment was not effective. Hass went to a private hospital in Kuching.

A CT scan on 28 January 2010 indicated a 6 mm stone in the gallbladder. There was a 1 cm hypodense lesion in segment 8 of his liver. This could be just a cyst.  The common bile duct was dilated. The maximum diameter was 16 mm. There was a 18 mm mass at the distal common duct. Conclusion: Mass in the lower common duct with biliary obstruction.

Immediately Hass underwent an operation to remove his gallbladder and the bile duct tumour. The histopathology report dated 3 February 2010 indicated: infiltrating moderately differentiated exophytic adenocarcinoma of bile duct, invading through entire thickness of the wall and metastatic to periductal lymph nodes. Margins of excision free of tumour.

An ultrasound of the abdomen on 8 June 2010 showed no evidence of tumour recurrence although his CA19.9 increased from 52.4 (in March 2010) to 1420.0. A CT scan on 9 June 2010 indicated a 15 x 10mm lesion in segment 7 of his liver. The 10 mm cyst in segment 8 of his liver remained the same. In addition there were a few paraaortic lymph nodes noted from the celiac axis down to the liver of the renal hilum. The largest node measured 20.0 mm – the others were subcentimeter.

The doctor told Hass that the cancer had recurred and he was unable to help him anymore. Hass was asked to undergo chemotherapy. But he refused.

Below is a table showing the rise of CA 19.9 markers from March to October 2010.

Date CA 19.9
Before operation 2,000 plus
18 March 2010 – after operation 52.5
8 June 2010 1,420.0
3 August 2010 – last visit to surgeon 5,645.0
1 October 2010 18,746.18

Hass came to see us in Penang on 8 October 2010. Listen to our conversation.

Review of Medical Literature

Understanding the Liver-Gallbladder-Pancreas-Bile Duct Complex

  • Attached to the liver, is a pear-shaped structure called the gallbladder.
  • The liver makes bile and this is transported to the intestine by a long tube-like structure called the bile duct.
  • The gallbladder is attached to the bile duct by a small tube called the cystic duct.
  • The top half of the bile duct is associated with the liver while the bottom half of the bile duct is associated the pancreas through which it passes on its way to the intestine.
  • Blockage of the bile duct by a cancer prevents the bile from being transported to the intestine. When this happens the bile accumulates in the blood giving rise to jaundice. The skin and eyes becomes yellow. This condition may also cause severe itchiness.

(Diagrams are obtained from the internet)

The clinical presentation, prognosis and natural history of bile duct cancer (or cholangiocarcinoma) depend on where the cancer originates. The cancer may occur:

  • In the part of the bile ducts contained within the liver. This is known as intra-hepatic.
  • In the part of the bile ducts outside the liver. This is known as extra-hepatic.
  • In the duct between the left and right portal veins. This is known as hilar bifurcation.

Anderson et al. in Diagnosis and treatment of cholangiocarcinoma, The Oncologist, Vol. 9, No. 1, 43–57, February 2004, noted that approximately:

  • 60%-70% of cholangiocarcinomas occur at the hilar bifurcation.
  • 20%-30% in the distal common bile duct.
  • 5%-15% within the liver (intra-hepatic).

Patients with extrahepatic tumors usually present with painless jaundice due to biliary obstruction, while patients with intrahepatic tumors usually present with pains, pruritus (66%), abdominal pain (30%-50%), weight loss (30%-50%), and fever (up to 20%).

In their review, Anderson et al also noted that:

  • The majority of patients with cholangiocarcinoma presents with unresectable,advanced stage disease and have a survival of less than 12 months. Cure rates are low, even with aggressive therapy. The average 5-year survival rate is 5%-10%.
  • Surgery remains the only intervention offering the possibility of a cure. But the treatment goal should be complete excision with negative margins.
  • All patients should be fully evaluated for resectability before any type of intervention is performed.
  • Neoadjuvant and adjuvant therapies have not improved survival in patients with this tumor.
  • Since the prognosis for unresectable patients is poor, palliative measures should be aimed at increasing quality of life first and increasing survival second.

Results of Surgery

  • Among selected patients who undergo potentially curative resections, 5-year survival rates are generally from 8%-44%.
  • The importance of achieving a margin-negative resection cannot be overemphasized. The 5-year survival rates were greater when a negative margin was obtained, 19%-47% versus 0%-12%.
  • Distal lesions represent approximately 20%-30% of all cholangiocarcinomas and are usually treated with pancreaticoduodenectomy (Whipple procedure). Achieving a margin-negative resection is also important with these tumors. The 5-year survival rates in selected patients who underwent curative resections is 21%-54%.
  • Intrahepatic cholangiocarcinoma is usually treated by hepatic resection. Three-year survival rate of 60% was reported in patients who underwent a margin-negative partial hepatectomy.

Chemotherapy

  • Chemotherapy has not been shown to markedly improve survival in patients with either resected or unresected cholangiocarcinoma. The majority of reports use 5-FU alone or in combination with methotrexate, leucovorin, cisplatin, mitomycin C, or interferon alpha.
  • The 5-year survival rates were not significantly different between patients who received chemotherapy and surgery and those who received surgery alone.

A note in http://emedicine.medscape.com/article/189843-treatment stated  that:  “Chemotherapy has not been proven to be of definite benefit.”

Experience of doctors in Fuda Hospital, China indicated that:

  • Cancer arising in the extrahepatic bile duct is an uncommon disease, curable by surgery in fewer than 10% of all cases.
  • In most patients, the tumor cannot be completely removed by surgery and is incurable.
  • Palliative resections or other palliative measures e.g. stenting procedures may maintain adequate biliary drainage and allow for improved survival.

Experience of doctors in India indicated that:

  • Surgery may be used to remove the cancer if it has not spread beyond the bile duct. It is not always possible to carry out surgery, as the bile duct is in a difficult position and it may be impossible to remove the cancer completely.
  • There are different surgical procedures depending upon how big the cancer is and whether it has begun to spread into nearby tissues.

These surgical procedures are:

  • Removal of the bile ducts. If the cancer is small and contained within the ducts, then just the bile ducts containing the cancer are removed.
  • Partial liver resection. If the cancer has begun to spread into the liver, the affected part of the liver is removed, along with the bile ducts.
  • Whipple’s. If the cancer is larger and has spread into nearby structures, then the bile ducts, part of the stomach, part of the duodenum, the pancreas, gall bladder and the surrounding lymph nodes are all removed.
  • Bypass surgery. Sometimes it is not possible to remove the tumour. Other procedures may be performed to relieve the blockage and allow the bile to go into the intestine. The jaundice will then clear up.
  • Stent insertion. One way to relieve jaundice without a surgical operation is to perform ERCP (Endoscopic Retrograde Cholangiopancreatography). This procedure involves insertion of a tube, called a stent into the blocked bile duct. The stent clears a passage through the bile duct to allow the bile to drain away. The tube usually needs to be replaced every three to four months to prevent it becoming blocked. If the tube does block, recurrent high temperatures and/or return of the jaundice will occur.

In summary, Witzigmann et al. in an article, Guidelines for palliative surgery of cholangiocarcinoma, HPB (Oxford). 2008 June 1; 10(3): 154–160, listed the following guidelines for surgery of bile duct cancer:

  1. Non-surgical stenting is regarded as the first choice of palliation for patients with short life expectancy.
  2. For patients with longer projected survival, surgical bypass should be considered.
  3. Palliative resections may be beneficial to patients with distal and hilar bifurcation.

Questions to Ponder

The fact is very clear. Surgery for bile duct cancer in this case is an absolute failure. Is this failure a rare event? Probably NOT! A surgeon told his liver patient: “For ten liver operations that I performed, nine patients died”. Good information indeed but the problem is that he made this comment some three years too late. This patient had already undergone the operation and had suffered a severe recurrence.

A few more questions come to mind:

  • According to the literature, not all patients with bile duct cancer are suitable condidates for surgery.  “All patients should be fully evaluated for resectability before any type of intervention is performed”. To what extent is this evaluation done?
  • The surgeon recommended chemotherapy after the recurrence. What benefit can the patient expect from this? Medical literature clearly indicates that “Chemotherapy has not been proven to be of definite benefit.”
  • Is the suggestion of chemotherapy after the failure of surgery, a way of “passing the buck” to someone else? “I have done my job to cut it out. My responsibility is over. Now you go to the oncologist and see what he can do for you.”

More related stories:

Liver Cancer: Surgery and Chemo Did Not Cure Him

A Great Failure and Let Down

Surgery for Liver Cancer: Eighty Percent Success?

Liver Cancer: He Died After a RM 10,000 Open-Close Surgery

Healing of Metastatic Liver Cancer