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Abstract: The patient, a 73-year-old male, presented to the hospital with right upper abdominal discomfort. Through intensive abdominal CT examination, it was found that gallbladder cancer had invaded the liver and showed lymph node metastasis in the hilar region and abdominal cavity. After communication about the patient’s condition, the patient was given 3 cycles of chemotherapy. After chemotherapy, the patient’s tumor shrank significantly, tumor markers decreased, and his condition was significantly relieved. The patient and his family expressed satisfaction with the treatment.
Basic information】Male, 73 years old
Disease Type】Gallbladder cancer
Hospital】Liaocheng People’s Hospital
Time of consultation】November 2021
Treatment plan】Injectable gemcitabine hydrochloride + injectable paclitaxel (albumin-bound)
Treatment Period】3 cycles of chemotherapy
Effectiveness】Symptom relief, tumor shrinkage, and improvement of disease
I. Initial consultation
The patient reported that he had been suffering from right upper abdominal discomfort for more than half a year, but recently his symptoms have worsened, accompanied by nausea, loss of appetite and weight loss, but no fever, and he has lost 10 pounds in the past 2 months. The patient was routinely given an abdominal ultrasound examination and was found to have tumor growth in the gallbladder and invasion to the surrounding area, which was considered to be possible gallbladder cancer. In order to further clarify the diagnosis and determine the treatment plan, the patient was admitted to the hospital.
After admission, the patient’s routine blood and liver function examination results suggested that the values were basically within the normal range, but the tumor markers CA199>1700U/ml and CEA8.5ng/ml; after completing the intensive abdominal CT examination, it was found that the gallbladder was filled with malignant tumor and invaded to the gallbladder bed and liver, accompanied by lymph node metastasis in the hilar region and abdominal lymph node metastasis in the abdomen. According to the current examination results, the patient’s gallbladder cancer is clearly diagnosed, and it is also accompanied by multiple metastases in the abdominal cavity.
II. Treatment process
Due to the seriousness of the patient’s condition, the patient is already in the advanced stage of gallbladder cancer, which is not suitable for surgical treatment. If the patient does not have any treatment, it may have an impact on the length of life. The above condition was then explained to the patient and his family, and the patient agreed to undergo chemotherapy. Based on the patient’s condition, the regimen of injectable gemcitabine hydrochloride + injectable paclitaxel (albumin-bound) was selected. After 3 cycles of chemotherapy, the patient tolerated the treatment moderately well.
III. Treatment effect
After 3 cycles of chemotherapy, the patient had a significant decrease in tumor markers CEA and CA199 on reexamination; a review of abdominal CT revealed that the tumor shrank, the abdominal metastatic lymph nodes shrank, and the tumor did not show any progression, but shrank instead. At the same time, the patient’s symptoms of right upper abdominal pain were also significantly reduced, appetite was improving, food intake was gradually increased, and weight was also significantly increased compared with before. Chemotherapy is often associated with adverse effects such as nausea, vomiting and bone marrow suppression, but the patient in this case tolerated the chemotherapy regimen well and had mild adverse effects.
IV. Precautions
The patient’s condition was controlled after chemotherapy, and as a doctor, we are sincerely happy for the patient and his family. In daily life, because the patient’s digestive function is currently weak and there are also adverse reactions to chemotherapy, it is recommended that the diet be light and well digested to avoid nausea and vomiting; at the same time, attention should be paid to increasing nutrition and intake of high-protein foods, such as milk, lean meat, fish and shrimp, etc., and also with fresh fruits and vegetables to supplement vitamins. In addition, patients should pay attention to the adverse reactions of chemotherapy. If they have nausea and vomiting, they can take antiemetic drugs orally for treatment, and at the same time, they should review the blood routine, liver and kidney function regularly to avoid adverse reactions such as bone marrow suppression and liver and kidney damage.
V. Personal insight
When gallbladder cancer is found, it is often accompanied by liver metastasis and abdominal lymph node metastasis, which is not suitable for surgical treatment, but can be chosen as comprehensive anti-tumor treatment. In this case, the patient chose the regimen of injectable gemcitabine hydrochloride + injectable paclitaxel (albumin-binding type), and the condition was significantly relieved. There are more treatment options for patients with advanced tumor, like various chemotherapy drugs, as well as targeted therapy and immunotherapy. Patients should avoid discouragement and can choose anti-tumor combination therapy under the guidance of professional doctors, which may get better treatment effect.