What about?

Here is an answer to a question I recieved today.

What about a transplant? Apparently, Klatskin's tumor follows the walls of the bile duct system and does not actually attack active liver cells, just the walls of the ducts. For that reason, a liver transplant would not work because Mary's bile duct system is being removed. Medical science has not mastered bile duct transplants.

Think of the bile duct system as the delta of a river (Mississippi) with hundreds and hundreds of channels in a large area (the liver). The difference is that the bile fluid flows from the liver with all of these interwoven small channels to collect into larger and larger ducts until it reaches the largest ducts we know as hepatic ducts and further down, bile duct. In the case of Klatskin's, the cancer only grows on the shores of the channel (walls of the ducts) and never leaves the shore area. It does grow in size to dam up the channel (constricted duct). And, Klatskin's easily moves up the duct to the smaller and smaller ducts. Hence, removing the common bile duct, the right hepatic duct and all the small ducts connected to the right hepatic duct is the best way to remove the cancer. Unfortunately, the liver material has to come along because there is no way to separate them. The associated arteries and veins also need to be removed too. And, the more that is removed, the less likely of recurrence because the cancer is gone.

Why the right hepatic duct? Because ERCP#4 showed it too was constricted and a stent was placed to allow the bile to flow to the intestine. Stents are good for about 8 weeks so we know the stent was temporary relief. None of the ERCP procedures showed a constriction in the left hepatic duct.

We are also making plans for Mary's adult children to come visit either pre or post surgery. Unfortunately, because of the risk of infection, flu, colds, etc., the granddaughters will not be visiting for a while. But, they were here for Easter so there has been a recent gathering.

Mary and Reenie planned a good day today including a walk in our local park, a drive with the top down on the convertible and generally a relaxing, low key day. I've been at work all day so I didn't get to play with Mary and her sister.


Pat