DEAR DR. ROACH: A family friend has just been diagnosed with bile duct cancer. She is a breast cancer survivor and is 75 years old. The tumor is said to be the size of a quarter, and it was discovered after she complained of heartburn symptoms.
Are there screening tests that could have detected the condition before the heartburn symptoms? Are there things that she could have done to avoid the cancer? My family members are frightened and want to avoid her condition. -- Anon.
ANSWER: Cholangiocarcinoma, cancer of the bile ducts, is a rare cancer that is, unfortunately, associated with a high mortality rate. There are no symptoms in most people until it is advanced. Since the cancer is in the bile ducts, the most common symptoms are caused by obstruction of the bile ducts: jaundice (yellow in skin/eyes), generalized itching, dark urine and light-colored stools. Abdominal pain, fever and weight loss are other symptoms.
Cholangiocarcinoma is not a disease that’s amenable for screening; it is rare in North America (it is more common in East Asia, where there are screening programs). Further, the available screening tests, such as blood tests and imaging studies, are not very sensitive, meaning the tests will miss cases. And they are not very specific -- a positive result on the screening test does not necessarily mean cancer. For these reasons, screening is not currently recommended for people at average risk, although it may be considered in people at high risk, such as people with primary sclerosing cholangitis, a chronic liver disease that puts people at high risk for cholangiocarcinoma.
Other risk factors for cholangiocarcinoma are mostly beyond a person’s control: other liver diseases, parasites and genetic conditions. There is some evidence that obesity and diabetes increase the risk of this cancer; however, it does no good for you or your friend to look backward. Never blame the victim. She should concentrate on getting treated. I don’t have enough information to comment on her prognosis, but the fact that it was diagnosed early -- apparently before obstruction of the bile ducts -- and with a tumor only the size of a quarter, are favorable. Treatment may include surgery and chemotherapy (before or after surgery).
DEAR DR. ROACH: My 22-year-old daughter was diagnosed with overactive bladder at the end of June. She tried medications, but they made her sick. She was given a prescription for a physical therapist to work with her for her condition. Unfortunately, she has hit dead ends. How can she find a physical therapist to work with her? -- A.F.
ANSWER: Physical therapists, like most other health care professionals, have individual skill sets. Pelvic-floor physical therapy requires a level of expertise that not all physical therapists have. I suspect she may have just been calling physical therapist offices near her and not finding a therapist with that expertise. A quick internet search found a good number of specially trained therapists where she lives.
There are many online reviews of physical therapists, just as there are reviews of doctors and dentists. They have some value, but I would be cautious about both overenthusiastic and overly negative reviews.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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