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Abstract: Malignant gallbladder tumor is a very malignant tumor, and local invasion or distant metastasis may also occur in early stages. The patient in this case was a 61-year-old woman who was found to have localized invasion of gallbladder cancer and liver involvement. The patient reported on admission: right upper abdominal pain and generalized yellow staining. The diagnosis of malignancy was made by abdominal ultrasound and intensive CT. Through surgery + chemotherapy, the patient’s tumor shrunk, symptoms were reduced and general condition improved.
[Basic information] Female, 61 years old
Disease Type】Malignant tumor of gallbladder
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan】Surgical treatment (bile duct puncture and external drainage) + chemotherapy
Treatment Period】6 cycles of chemotherapy (21 days per cycle)
Treatment effect】Tumor shrinkage, symptom reduction, general condition improvement
I. Initial consultation
In November 2021, a patient came to the clinic. Observe the patient, the face was yellowish, a state of jaundice; the body type wasted. The patient’s medical history was followed up. The patient reported that he had been experiencing pain in the right upper abdomen, which was not very serious before, so he had been tolerating it and had not come to the clinic due to poor family conditions. However, in recent days, the pain increased and a generalized yellow stain appeared. The patient’s child felt that the condition was getting worse, so he came to the hospital. Through routine liver function tests, it was suggested that the transaminases were elevated and the bilirubin was elevated as a clear sign of obstructive jaundice. At this point I highly suspected a disease of the biliary system. Next, an abdominal ultrasound was performed for the patient, suggesting gallbladder occupancy, dilated intrahepatic bile ducts, and poorly displayed bile ducts in the hilar region. To further confirm the diagnosis, the patient was admitted to the hospital.
II. Treatment process
After admission, the patient was treated with conventional hepatoprotection and intravenous nutrition, and then intensive CT examination was performed, which showed that there were obvious tumors in the gallbladder, and the tumors of the gallbladder continued to grow along the bile ducts and had invaded the bile ducts and arteries in the hilar region. At this point, it was assessed as unresectable gallbladder cancer. After the condition was told to the patient’s family, the patient’s family wanted to give up the treatment at that time once they heard that it was an advanced tumor and there was no way to do surgery. However, patients with advanced tumor are not without treatment opportunities, they can be treated by chemotherapy, and patients may also get better treatment results. After communicating with the patient’s family, they agreed to undergo chemotherapy. However, the general condition and physical condition of the patient needed to be improved before chemotherapy. Because of obstructive jaundice, external biliary puncture drainage was performed first to achieve the purpose of reducing yellowing, and after the general condition improved, chemotherapy was administered to the patient in a conventional regimen.
III. Treatment results
After the patient underwent bile duct puncture and drainage, the bile drainage was clear, the bilirubin level slowly decreased, the jaundice was significantly reduced, and the diet gradually resumed. After the patient’s general condition improved, chemotherapy was administered to the patient. Since the patient tolerated the chemotherapy regimen relatively well and had mild adverse effects, after 2 cycles of chemotherapy, the patient’s tumor marker CA199 was significantly decreased on recheck. After 2 cycles of chemotherapy, the patient’s tumor marker CA199 has significantly decreased. The patient’s right upper abdominal discomfort has gradually decreased, and the patient and his family are satisfied with the treatment effect.
IV. Notes
We are glad that the patient’s condition is under control after the comprehensive treatment. The patient currently has obstructive jaundice, so the family needs to pay attention to the need to ensure that the drainage tube is usually in place during daily care. There are more adverse reactions to chemotherapy, the most common cases are bone marrow suppression, nausea and vomiting, so regular follow-up is needed to review the blood routine, and if the white blood cells are low and there is anemia, symptomatic treatment may be needed. For daily diet, it is recommended to eat light and easily digestible food and avoid spicy, stimulating and greasy food to avoid adverse reactions such as vomiting after eating.
V. Personal insight
At present, the incidence of malignant tumors are increasing year by year, especially the malignant tumors of hepatobiliary system, which are more malignant and are often in advanced stage when found, and may lose the chance of radical surgery. However, there are many treatment options available for this condition to improve the quality of life and prolong the life span of patients. For example, various chemotherapy regimens, immunotherapy regimens, targeted therapy regimens, and integrated therapies such as radiotherapy, patients with advanced malignant tumors can also reap good treatment results. Therefore, in the face of the disease, one should not give up, but should find it early, seek medical consultation early, and grasp the critical recovery period to improve the quality of life.