Duodenal Ampulla Cancer: Insights from Treatment Reports

Duodenal ampullary cancer

Hello,
In May of this year, my mother was diagnosed with stage IV duodenal ampullary cancer and is not a candidate for surgery.
After six cycles of chemotherapy, the tumor did not shrink, and she underwent three additional cycles.
She just completed her ninth chemotherapy session last Saturday.
I reviewed the reports in my health passbook, but since they are in English, I would like to ask the physician what they indicate.
This is the report from May, when chemotherapy first started:
Imaging findings: CT of the abdomen: The pre- and post-enhanced axial images are obtained with a slice thickness of 5mm.
There are cystic space-occupying lesions identified at liver segment 7.
The gallbladder was filled with air-fluid levels, and the bile ducts are unremarkable.
Cortical renal cysts were noted.
The pancreas, spleen, urinary bladder, bowel loops, and adrenal glands appear unremarkable.
The collecting systems are well-opacified without dilation.
No enlarged lymph nodes are found.
No focal osteolytic lesions are depicted.
The abdomen is free of abnormal fluid and free air collection.

Impression: Suspicious lung metastases in both lungs (segment 5, lung 2, 8; 6), segment 7 measuring 1.66 cm, segment 5 measuring 1 cm liver metastasis (segment 7, lung 12, 21, 24) suspected.
Pneumobilia and suppurative cholangitis with intrahepatic ductal dilation and prominent ampulla of Vater malignancy suspected (segment 7, lung 32).
Choledochoduodenal fistula suspected (segment 7, lung 20).
Suggest clinical correlation and follow-up.
Bilateral renal cortical cysts and splenic capsular calcifications.
Suspicious splenic cyst.
Spondylosis deformans of cervical, thoracic, and lumbar spine.
This is the report after the first phase of six cycles of chemotherapy in September:
Imaging findings: CT of the abdomen: The pre- and post-enhanced axial images are obtained with a slice thickness of 5mm.
There are cystic space-occupying lesions identified at liver segment 7.
The gallbladder was filled with air-fluid levels, and the bile ducts are unremarkable.
Cortical renal cysts were noted.
The pancreas, spleen, urinary bladder, bowel loops, and adrenal glands appear unremarkable.
The collecting systems are well-opacified without dilation.
No enlarged lymph nodes are found.
Could you please help me understand the differences between the first and sixth reports regarding the changes in her condition? Additionally, I have attached the CEA and CA19-9 data, which seem to have suddenly spiked recently.
Does this indicate that the chemotherapy is no longer effective?
CEA and CA19-9 data:
- 3/30: CEA 1.62, CA19-9 14.14
- 6/30: CEA 1.64, CA19-9 26.90
- 10/12: CEA 2.02, CA19-9 26.74
- 11/22: CEA 2.70, CA19-9 32.68
- 29/10: CEA 2.62, CA19-9 29.14
- 10/12: CEA 4.09, CA19-9 39.80
- 11/3: CEA 4.38, CA19-9 44.34
I apologize for the lengthy message, and I appreciate your assistance in clarifying these matters.
Thank you.

buee, 40~49 year old female. Ask Date: 2021/11/09

Dr. Chen Sirong reply Oncology

Buee / 42 years old / Male
1.
How is the progression of the disease?
A: The assessment of the condition is best left to his attending physician.
2.
Attached are the CEA and CA19-9 data, which seem to have suddenly surged twice recently.
Does this indicate that the chemotherapy is no longer effective?
A: A slow increase may suggest ineffectiveness, but it could also be due to the suppressive effects of chemotherapy, which is why the levels have not risen rapidly.
3.
Stage IV duodenal ampullary cancer is inoperable, and this type of cancer has a poor prognosis, especially at stage IV.
Therefore, even if chemotherapy is temporarily effective, the condition will likely deteriorate again.
If your emotions fluctuate due to temporary improvements or declines, it is merely an emotional response.
In terms of this disease, it is a gradual journey toward the final endpoint.

Make the most of the remaining time together: express gratitude, love, apologies, and farewells; these are the most important things right now.

Best wishes,
Chen Si-Rong, Taoyuan Hospital

Reply Date: 2021/11/09

More Info

Duodenal ampulla cancer, particularly in its advanced stages, poses significant challenges in terms of treatment and prognosis. Your mother's diagnosis of stage IV duodenal ampulla cancer, coupled with the fact that she is unable to undergo surgery, indicates a complex clinical scenario. The treatment regimen she has been following, which includes multiple cycles of chemotherapy, is a common approach for managing advanced cancers when surgical options are not viable.

Understanding the Imaging Reports
From the initial imaging findings in May, it was noted that there were cystic lesions in the liver, and suspicious lung metastases were identified. The gallbladder and bile ducts appeared unremarkable, which is a positive sign, but the presence of liver metastasis is concerning. The follow-up imaging report after six cycles of chemotherapy indicates that the liver lesions remain, and there are no new findings of enlarged lymph nodes or other significant changes in the abdominal organs. This suggests that while the chemotherapy may not have significantly reduced the size of the tumors, it has not led to new complications or metastases, which is a critical aspect of cancer management.

Changes in Tumor Markers
The rise in CEA (Carcinoembryonic Antigen) and CA19-9 levels is particularly noteworthy. These tumor markers are often used to monitor treatment response in gastrointestinal cancers. An increase in these markers can indicate that the cancer is not responding to treatment effectively. In your mother's case, the significant rise in both markers after the sixth cycle of chemotherapy could suggest that the chemotherapy is becoming less effective, or that the disease is progressing despite treatment. However, it is essential to interpret these results in conjunction with imaging findings and clinical symptoms.

Treatment Options and Prognosis
Given that your mother is in stage IV, the prognosis can be quite poor, as this stage indicates that the cancer has spread beyond the primary site. The effectiveness of chemotherapy can vary significantly among patients. In some cases, chemotherapy can stabilize the disease or even lead to a partial response, but in others, it may not be effective at all. The decision to continue or change the treatment regimen should be made in consultation with her oncologist, who can provide insights based on her overall health, response to previous treatments, and the specific characteristics of her cancer.

Next Steps
1. Consultation with Oncologist: It is crucial to discuss the recent imaging and tumor marker results with her oncologist. They can provide a comprehensive assessment of her current treatment plan and whether adjustments are necessary.

2. Consideration of Clinical Trials: Given the advanced nature of her cancer and the limited effectiveness of standard chemotherapy, exploring clinical trials may be an option. These trials can offer access to new therapies that are not yet widely available.

3. Supportive Care: Managing symptoms and maintaining quality of life is essential. Palliative care services can provide support for managing pain, nausea, and other symptoms associated with advanced cancer.

4. Nutritional Support: Ensuring that your mother maintains a balanced diet can help support her overall health during treatment. Consulting with a nutritionist who specializes in oncology can be beneficial.

In summary, the situation is complex, and while the imaging reports and tumor markers provide valuable information, they should be interpreted within the broader context of her overall health and treatment response. Continuous communication with her healthcare team is vital to navigate the challenges posed by advanced duodenal ampulla cancer.

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