Resolved question:
My mother gall bladder cholecystectomy was done on August 2011. Then the biopsy report said "the gall bladder shows moderately differentiated, mucin secreting, papillary adenocarcinoma. The carcinoma has infiltrated the muscle coat of the gall bladder and has extended to serosa. It has not invaded the adherent liver tissue. The cystic lymph node shows non specific reactive hyperplasia. It does not show metastasis. The surgical cut margin(neck of gall bladder) is free of lesion.
Impression- Moderately differentiated, mucin secreting, infiltrating papillary adenocarcinoma, gall bladder"
That time no further action was taken. Now the problem is that after three yrs of operation in Aug 2014 she is having pain frequently in upper most abdomen or epigastric region. Doctor has prescribed Zintac, Omez type drugs but the pain is not curing completely. Now my questions are- Is it a worrying factor? Is it a case of relapse of carcinoma on any parts of liver, stomach or some where else? What medical advice you suggest? please help.
Submitted:
4 Days
Category:
Gastroenterologist, Surgical
Hello.
Thank you for your query at DoctorSpring.com
Definitely it is a worrying factor according to me, as symptoms may suggest a recurrence, this has to be confirmed with ultrasound scan of abdomen, may also require a CT scanning of abdomen.
Carcinoma gallbladder is a very aggressive cancer, repeat resection should have been done at first place after seeing the initial histopathology report, don't know why it was not done. So chances of recurrence are high.
I advice you to get the ultrasound/CT scanning of abdomen
Regards
Dr. Lokesh
One thing I must share that my mother had open cholecystectomy and after operation around 9 cms Gallbladder along with it a piece of adherent liver tissue and a cystic lymph node were also operated out by surgeon. Then my mother biopsy report which said "the gall bladder shows moderately differentiated, mucin secreting, papillary adenocarcinoma. The carcinoma has infiltrated the muscle coat of the gall bladder and has extended to serosa. It has not invaded the adherent liver tissue. The cystic lymph node shows non specific reactive hyperplasia. It does not show metastasis. The surgical cut margin(neck of gall bladder) is free of lesion. Impression- Moderately differentiated, mucin secreting, infiltrating papillary adenocarcinoma, gall bladder" I had done USG of whole abdoman of my mother around 20 days back on 28.07.14. The report says no obvious lesion or SOL in any region of abdoman. The Impression of USG says: Epigastric region probe SI tender. May I request this report may be shared and opinion may be taken from any Oncologist from your doctor spring board. Please help.
Thank you for the additional information.
A normal USG is a good sign. But even an USG can miss some finding. A normal USG obviously states that there are no major findings (which is a very good thing). This pain could be from acid peptic ulcer disease. However if the pain is not resolving even with drugs , it is safer to go for a CT abdomen. Let her take Omez just before sleep or early morning without any food. Menawhile if the symptoms are persisting (say even after 2 days) consider further testing - a CT scan. A stool occult blood test can also be done. Our Oncologist also agree. If you need a specific reply I think you will need to start a separate consult .
Let me know if you have more queries.
Thank you
Dear Doctor,
We had done my mother's Oesophago-Gastro-Duodenoscopy on 14/10/2014. The report is described below:
Endoscopy findings:
Oesophagus : Normal; GE junction at 35 cm
Stomach ulcer present : Mucosa of the fundus and body normal. Prepyloric
Duodenum : Both D1 and D2 normal.
Boipsy taken : No
Rapid Urease Test : Done; Negative
Impression : Prepyloric ulcer present
After that we consulted one Surgical Gastroentrologist and he adviced one drug namely Rabeloc RD one each at early morning before meal for one month, for eating non spicy/non oily foods, drinking water after boling and repeat Endoscopy after two months.
I request your further advice in this regard.
Hello,
Before I advice on UGI ENDOSCOPY report and prepyloric ulcer, I would like to know about whether the CT Scan of abdomen was done and their results, as I have advised in last consult.
Also what are current symptoms of the patient?
Dr. Lokesh
Dear Doctor,
The CT scan has not yet been done. About the symptoms of my mother, she is having mild abdominal pain in the upper region sometimes in the day and some of the days she is having no problem. This is alos to be mentioned that one day she had continued mild pain for almost the whole day. I must also mention the food habits and timing was affected during the Durga Puja season for last 15 days or so. The endoscopy was done just yesterday.
Now if you please give your valuable suggestions.
Regards
Hi,
I have noted your mothers reports and problems
For now you can continue with tab. Rabeloc RD, but she is required to undergo at least a ultrasound scan and repeat endoscopy after one month to look for the healing of ulcer and if present may require biopsy the ulcer
For now continue tablet and regular diet.
Regards
Dr. Lokesh