Tue Oct 04 13:56:21 EDT 2011 Welcome to LiveHelp, the National Cancer Institute's On-Line cancer information service.

LiveHelp users sometimes lose their connection because of technical problems on the Internet. If that happens, please try to reconnect or, if you live in the United States, you may call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) between 8:00 AM and 8:00 PM Eastern time. NCI Information Specialists on LiveHelp can give you information about cancer from the National Cancer Institute. However, they are not health care providers and do not provide medical advice. LiveHelp is not a substitute for talking with a health care professional.

Welcome! Please wait for the next available specialist... NCI Information Specialist : How may I help you? CA_225031 : hello NCI Information Specialist : Hello. Thank you for contacting us today. CA_225031 : my mother is diagnosed with liver cancer CA_225031 : multiple liver metastasis CA_225031 : its in advance stage, i just want to know if anything can be done NCI Information Specialist : Thank you for sharing that with me. It is understandable to want to know what the options are for a loved one with advanced cancer. I will do my best to assist you using the resources of the National Cancer Institute (NCI). NCI Information Specialist : To clarify, is this cancer that started in the liver? Or did it start elsewhere and metastasize (spread) to the liver? CA_225031 : it might have started at gall bladder or bile duct NCI Information Specialist : Okay, thank you for clarifying. It helps to know where the cancer began since cancer is treated based on the organ where it started. Has your mother recieved any treatment? CA_225031 : first chemotherapy is done CA_225031 : she is not responding well to that, so symmtomatic treatment is being done now CA_225031 : chemotherapy was done 11 days ago NCI Information Specialist : Thank you for sharing more information with me. It must have been difficult to hear that your mother's cancer did not respond well to the chemotherapy. It sounds like at this point the doctors are focusing on treating her symptoms (this is sometimes called palliative care). Have they suggested anything else to treat the cancer? CA_225031 : no suggestion yet, they are planning to stabilise her and suggest composition for further chemotherapies NCI Information Specialist : Thank you for sharing that with me; it helps me to share the most appropriate information.

Bile duct cancer and gallbladder cancer are both treated differently. I would be glad to share information about the treatment for both of these cancers, and you could clarify with the doctors which type she has. Would that be helpful today? CA_225031 : yes please NCI Information Specialist : Okay, it will be a few minutes while I gather and type up some information. Thank you for your patience. NCI Information Specialist : Thank you for waiting. Both gallbladder cancer and cancers of the bile duct are difficult to treat. Treatment of metastatic gallladder cancer is usually within a clinical trial (research study). However, treatment may include palliative treatments (such as a stent placement), chemotherapy, or other drug combinations. You can read more about the treatment of gallbladder cancer here: http://www.cancer.gov/cancertopics/pdq/treatment/gallbladder/Patient/AllPages#Section_129 More information is coming. But please let me know at any time if you have questions about what I am sharing. NCI Information Specialist : The bile duct is the tube that collects bile from the liver and joins a duct from the gallbladder to form the common bile duct, which carries bile into the small intestine when food is being digested. When cancer starts in the portion of the bile duct that is outside of the liver, it is called extrahepatic bile duct cancer. Advanced extrahepatic bile duct cancer is similar to the treatment of gallbladder cancer. Treatment is often in the context of a clinical trial. Treatment may include palliative care, chemotherapy, and other drug combinations. You can read more about the treatment of extrahepatic bile duct cancer here: http://www.cancer.gov/cancertopics/pdq/treatment/bileduct/Patient/AllPages#Section_67

NCI Information Specialist : For more detailed information, you can click on the ?Health Professional Version? tab at the top of the page. NCI Information Specialist : You can learn more about clinical trials and how they work here: http://www.cancer.gov/cancertopics/factsheet/Information/clinical-trials

NCI Information Specialist : Please take a few minutes to look over these resources and let me know if they are helpful. CA_225031 : thanks for sharing all informations NCI Information Specialist : You are welcome. I know this is not an easy topic to consider. CA_225031 : i will go through these and will talk to doctor as well NCI Information Specialist : We also have a variety of other resources, including information about second opinions, referrals to supportive organizations, financial assistance, and coping. Is there anything else I can help you with at this time? CA_225031 : yes, CA_225031 : referral and financial assistance will be great NCI Information Specialist : Okay, I am glad to share information about those topics. NCI Information Specialist : We can start with second opinions. You might even begin by asking for a referral for a second opinion from the doctor. This is commonly done and is often the quickest, easiest way to find another doctor.

Also, the following information sheet can help you find a doctor or cancer treatment facility for a second opinion: http://www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility

NCI Information Specialist : Does your mother live in the United States? If so, which one? CA_225031 : we live in india NCI Information Specialist : Thank you for sharing. More information coming... NCI Information Specialist : For guidance on getting a second opinion, you may wish to contact an organization in India that offers information services. The International Cancer Information Service Group (ICISG) aims to provide high quality cancer information services and resources on all aspects of cancer, for those concerned or affected by cancer throughout the world. The link below will direct you to contact information for member organizations of the ICISG in India: http://www.icisg.org/meet_memberslist.htm#f21

NCI Information Specialist : Also, the International Union Against Cancer (UICC) consists of international cancerrelated organizations devoted to the worldwide fight against cancer. These organizations serve as resources for the public and may have helpful information about cancer, treatment facilities, and financial assistance. You can find organizations in India listed in the link below: http://www.uicc.org/membership/list

CA_225031 : thanks NCI Information Specialist : You are welcome. The NCI is the principal cancer research organization in the United States and has limited information about financial resources for people living outside this country. Patients and their families should speak with their doctor, social worker, or hospital to see if financial help is available locally. Cancer patients and their families can also inquire about any available government-sponsored programs and services supported by volunteer organizations in their country. Additional information can be found in this NCI fact sheet: Resources for People Living Outside the United States https://cissecure.nci.nih.gov/factsheet/FactsheetSearchResult8

NCI Information Specialist : If you don't have any other questions, before you go, may I ask you a few questions to help us evaluate our program and see whom we are serving? Your responses will be completely confidential.

CA_225031 : yes, u may ask NCI Information Specialist : Thank you. Have you used our service before? CA_225031 : no NCI Information Specialist : Thank you. I'm sending you a link to the rest of the questions. By clicking on this link you will open the questions in another window on your computer. If you cannot open the link, please let me know and I can open it for you on your computer. https://cissecure.nci.nih.gov/demo/demographics.asp?USID=US1795951915

Thank you in advance for answering these questions and for using the NCI's LiveHelp service. Please don't hesitate to contact us again in the future if you need further assistance.

CA_225031 : okay, thanks CA_225031 : bye for now NCI Information Specialist : You are welcome. Best wishes to you and your mother. Good bye.