Duodenal Ampulla Cancer: Treatment Options and Prognosis

Duodenal ampullary cancer

My mother was diagnosed with duodenal ampulla cancer and just completed her ninth round of chemotherapy yesterday.
During this time, she has also been taking traditional Chinese medicine for conditioning.
Her weight has dropped to 42 kg since the start of chemotherapy but has stabilized around 50 kg now.
Since starting the Chinese medicine, her sleep quality has improved; she can sleep through the night for about eight hours and has a good appetite.
However, each time before chemotherapy, her white blood cell count has not met the standard, and the tumor has not shrunk.
It has been six months since her diagnosis, and the doctor initially said she might have at most one year left.
Given this situation, is the treatment effective or not? Additionally, I have asked the doctor about the possibility of using immunotherapy or a combination therapy known as "cancer must rest," but the doctor dismissed these options, stating they are ineffective and a waste of money.
Is it true that my mother’s cancer can only be treated with continuous chemotherapy in hopes of shrinking the tumor for surgery, with no other treatment options available?

buee, 40~49 year old female. Ask Date: 2021/11/07

Dr. Hu Ziren reply Oncology

The tumor has not decreased in size but has also not increased (indicating that the tumor is in a stable control state).
Additionally, the patient's overall condition has improved, and there has been weight gain, which suggests that the current treatment is still effective.
If the current treatment is deemed effective (with stable tumor control), it is recommended to continue the current treatment.
However, it may be beneficial to discuss with the physician the possibility of conducting some special tests (such as MMR, PD-L1, etc.) so that if the current treatment becomes ineffective, there will be additional treatment options available (such as immunotherapy).

Reply Date: 2021/11/07

More Info

Duodenal ampulla cancer, also known as ampullary cancer, is a rare type of cancer that arises at the junction of the duodenum and the bile duct. The treatment options and prognosis for this condition can vary significantly based on the stage of the cancer, the overall health of the patient, and the response to initial treatments.

In your mother's case, it appears she has undergone nine cycles of chemotherapy, which is a common treatment approach for advanced ampullary cancer. Chemotherapy aims to shrink tumors and control the spread of cancer, but it is not uncommon for patients to experience challenges such as low white blood cell counts, which can complicate treatment. The fact that her tumor has not shrunk despite ongoing chemotherapy is concerning, as it may indicate that the cancer is resistant to the current regimen.

The prognosis for ampullary cancer can be quite variable. Factors such as the size of the tumor, whether it has spread to lymph nodes or distant organs, and the patient's overall health play crucial roles in determining outcomes. Unfortunately, if the cancer is diagnosed at an advanced stage, the prognosis tends to be poorer. The initial estimate of one year left to live, based on the diagnosis, is a difficult but not uncommon scenario in oncology, especially for aggressive cancers.

While your mother has experienced some improvements in her quality of life, such as better sleep and weight stabilization, these do not necessarily correlate with tumor response. It is essential to have ongoing discussions with her oncologist about the effectiveness of her current treatment plan. If her white blood cell counts remain low, this could limit her ability to continue with chemotherapy, and alternative treatment options may need to be considered.

Regarding the use of immunotherapy or alternative treatments like "cancer-fighting" herbs, it is crucial to approach these options with caution. While some patients seek complementary therapies, the evidence supporting their effectiveness in treating ampullary cancer is limited. Oncologists often recommend sticking to evidence-based treatments, especially when dealing with aggressive cancers. If your mother's current chemotherapy is not effective, it may be worth discussing clinical trials or other systemic therapies that may be available.

Surgical intervention is often considered when the tumor is localized and can be removed. However, if the cancer has metastasized or is not responding to chemotherapy, surgery may not be a viable option. The goal of treatment should always be to improve quality of life while managing the disease effectively.

In summary, your mother's situation is complex, and while chemotherapy is a standard treatment, its effectiveness can vary. It is essential to maintain open communication with her healthcare team to explore all available options, including potential clinical trials or alternative therapies that may provide additional benefits. The focus should be on her overall well-being and quality of life, alongside managing the cancer effectively.

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It is recommended to discuss with the attending physician for more appropriate guidance!