Gallbladder and Biliary Cancer

Chemosensitivity and chemoresistance assays – pro

Chemosensitivity assays are controversial but most experts believe that they do not reliably assist in selecting chemotherapy. There is more evidence for chemoresistance assays but this also remains disputed. Chemoresistance assays are a modification that tests resistance to chemo rather than sensitivity. They work on the assumption that if celss show reesistance to very high concentrations of a drug in vitro, they will also be resistant in vivo

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Chemotherapy for biliary (gallbladder) cancer – pro

Lay Summary: Chemotherapy can be tried in glabladder and bibliary cancers but it is not particularly effective. There is no combination that is proven better than another. There is no credible medical literature that second line chemo is beneficial in gallbladder cancer. Chemotherapy has a role in metastatic disease in biliary cancers. In advanced disease, one randomised study of combination chemotherapy versus best supportive care reported a significantly

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Oncotech chemosensitivity and chemoresistance assays – pro

Lay Summary: Chemosensitivity assays are controversial but most experts believe that they do not reliably assist in selecting chemotherapy. There is more evidence for chemoresistance assays but this also remains disputed. Oncotech ER is a form of chemosensitivity testing, or rather, a modification that tests resistance to chemo rather than sensitivity. The article by Schrag et al1 criticized the field of chemosensitivity and drug resistance, concluding

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Avastin for gallbladder and cholangiocarcinoma – pro

There is not much experience with the use of Avastin in cholangiocarcinoma or gallbladder cancer and medical necessity has not been established.  A Taiwanese report used it in a single patient in 2006. Holen and colleagues also investigated this combination in previously untreated advanced gallbladder cancer or cholangiocarcinoma. The data were presented at the 2008 ASCO annual meeting. Twenty-nine patients were eligible for enrollment; 3 out of

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PET for cholangiocarcinoma – pro

Cholangiocarcinomas are not simple to image because they are located in an area of multiple other organs and there is often associated inflammation and anatomic variation. There are also only a few studies of PET for cholangiocarcinomas and conclusions vary. In a study by Kim et al, FDG PET was not found to be specific enough in detecting hilar cholangiocarcinomas, an observation ascribed to small tumor size or to fibrous or mucinous components of

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Adjuvant chemotherapy and radiation for ampullary cancer – pro

Carcinoma of the ampulla of Vater is defined as a malignant tumor arising in the last centimeter of the common bile duct where it passes through the wall of the duodenum and ampullary papilla. The pancreatic duct (of Wirsung) and common bile duct merge and exit by way of the ampulla into the duodenum. The ductal epithelium in these areas is columnar and resembles that of the lower common bile duct. Adenocarcinoma of the ampulla of Vater is a relatively

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Intrahepatic therapies ablative therapies – pro

Percutaneous ablation is a commonly used modality of treatment when resection is not possible for HCC. Other local modalities are radiofrequency ablation or chemo embolization. When direst intratumor injection is used, alcohol is most commonly used and it is FDA approved for this purpose. However, acetic acid is more potent in animal models. Only a few studies tested the various modlaities against one another. A systematic review of RCTs published

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Decitabine and epigenetic therapy for solid cancers – pro

Lay search: Decitabine is being studies for "epigenetic" therapy of solid cancers. Genes involved in all aspects of tumor development and growth can become aberrantly methylated in tumor cells, including genes involved in apoptosis and cell cycle regulation. Decitabine, 2´-deoxy-5-azacytidine, can inhibit DNA methyltransferases and reverse epigenetic silencing of aberrantly methylated genes. Nucleoside DNA methyltransferase inhibitors, such as decitabine,

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Routine MCP or ERCP surveillance for Cholagniocarcinoma or Liver Cancer in Patients with Primary Biliary Cirrhosis – pro

Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver disease characterized by inflammation and fibrosis of both intrahepatic and extrahepatic bile ducts. It is thoughtto be an immune mediated, progressive disorder that eventually develops into cirrhosis, portal hypertension and hepatic decompensation, in the majority of patients. Guidelines do not recommend routine MRCP or ERCP to screen for chalngiocarcinoma or hepatocellular carcinoma.

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Routine MCP or ERCP Surveillance for Cholagniocarcinoma or Liver Cancer in Patients with Primary Biliary Cirrhosis.

Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver disease characterized by inflammation and fibrosis of both intrahepatic and extrahepatic bile ducts. It is thoughtto be an immune mediated, progressive disorder that eventually develops into cirrhosis, portal hypertension and hepatic decompensation, in the majority of patients. Guidelines do not recommend routine MRCP or ERCP to screen for chalngiocarcinoma or hepatocellular carcinoma.

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