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Loss of appetite, weakness in old age. USG guided FNAC is the confirmatory test for presence of malignant cells?

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My father is 72 year old and had developed loss of appettite one month back. Gradually he became very weak and required to be admitted to the hospital with symptoms of drowsiness. while all other parameters were normal, but he constantly showed very high level of Plasma Ammonia. The doctors suggested USG and then CT of abdomen, which showed some low density areas in the liver right lobe. He was suggested for USG guided FNAC, which confirmed presence of carcinoma cells with abnormal mitosis. Finally he was suggested for clinical correlation with Alfa Foedo Protein test (AFP test) and was sent back home, saying that since his age did not permit for any chemotherapy on him and thus now no hopes.
A very quick response to the following with reference to the above will be gratefully appreciated.

Is is correct that USG guided FNAC is the confirmatory test for presence of malignant cells i.e., cancer ?
and that Is it true that he can not sustain chemotherapy, since his physical health is not able to sustain that ?
Posted Sun, 3 Jun 2012 in Cancer
Answered by Dr. Indranil Ghosh 2 hours later

Thanks for writing in.
I am sorry to hear about your father. It appears that he has multiple liver lesions which are malignant on FNAC. In my opinion FNAC is fairly acccurate in experienced hands. The drowsiness could point toward impaired liver function.

These liver lesions can be due to two things- either primary liver cancer or cancer of some other organ like intestine which has spread to the liver. If it is a primary liver cancer then AFP is high while some other markers like CEA and CA 19-9 may be elevated if it is from some other source.

Primary liver tumors do not respond to chemotherapy. They can however respond to a drug called sorafenib. Other cancers sometimes respond to chemotherapy but if the general condition of the patient is not well, then these cause more harm than good. The condition is incurable anyway.

Hence I would suggest that if the doctors feel that the general condition of the patient does not permit chemo then just go with it. Chemo has lots of side effects and there is no point impairing his quality of life at this point.

Hope I have answered your query. I will be available to answer your follow-up queries, if any.
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