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My mother has stage 4 ovarian cancer . Her medical

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Posted on Wed, 1 Aug 2018
Question: My mother has stage 4 ovarian cancer. Her medical history is provided below. She has been vomiting for the last 2 weeks and was shown to a Goasto specialist who performed an endoscopy and referred further for a CT. She seems to have a blockage around the stomach area. All testing reports are attached.
Can you please provide a diagnosis.
doctor
Answered by Dr. Anders Mark Christensen (1 hour later)
Brief Answer:
I cannot find the reports.

Detailed Answer:
Dear XXXXXXX

I cannot see that you have attached any reports. Please do so, and I shall be happy to help you.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Anders Mark Christensen (9 hours later)
Please see it now.
doctor
Answered by Dr. Anders Mark Christensen (17 hours later)
Brief Answer:
Possibly infiltration of metastasis to duodenum

Detailed Answer:
From the reports it seems that there is a suspicion of metastatic spread of ovarian cancer to the liver and duodenum causing an obstruction. The disease is not curable, but a feeding tube placed in the jejunum may help her, alternatively a PEG tube both of which can help decompress the stomach. An important question is however how physically fit she is.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Anders Mark Christensen (22 hours later)
Thank you for the response. She is currently in the hospital as she is not able to take any food orally. She is being given food supplement through IV. She is also taking clear liquids orally but that is coming our most of the time by vomit. She underwent one round of chemotherapy 3 days back. The oncologist feels it might help reduce the obstruction. She has some physical weakness but takes a short walk 4-5 during the day. what is the difference between the two tube insertion procedures. How long is this tube needed. Is there any other treatment possible. She was suggested some sort of bypass to divert the food away from the obstruction. Is there any treatment needed for liver and pancreas to treat the spread there. Can it case concern in the short term. anything we should watch out for in this area.
doctor
Answered by Dr. Anders Mark Christensen (43 minutes later)
Brief Answer:
Please see below.

Detailed Answer:
A PEG tube is placed through the abdominal wall into the stomach, thereby by-passing the mouth and esophagus. A jejunum tube is usually placed through the nostril down the esophagus all the way to the small intestine beyond the duodenum. These procedures are relatively easy to perform, and there are pros and cons for each. You should consult a local surgeon to hear more, as there may also be regional differences in the approach to this. Surgery to bypass the obstruction could be through a gastroenteroanastomosis (GEA), but this is a more extensive procedure and requires that your mother is relatively physically fit. Chemotherapy - and possibly corticosteroids - can help reduce the obstruction, and it could be fair to see if it helps. In regards of the metastases, palliative chemotherapy is probably the only treatment possible, and it will only (and maybe) slow the progression of the tumor cells.
Hope this helps.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Anders Mark Christensen (1 hour later)
Thank you. How long are these tubes needed. She had debulking surgery for Ovarian Cancer in 2016. Is further debulking surgery a possible option to reduce the extent of disease.
doctor
Answered by Dr. Anders Mark Christensen (19 minutes later)
Brief Answer:
The tubes can be in place virtually indefinitely.

Detailed Answer:
In most cases, the tubes are considered palliation when the anticipated remaining lifetime is relatively short. If the patient is fit and considered to have some months or years left of his/her life, surgery may be more relevant.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Anders Mark Christensen (4 hours later)
how much time does jejunum tube insertion takes? what about GEA?
doctor
Answered by Dr. Anders Mark Christensen (35 minutes later)
Brief Answer:
Tube is shortest.

Detailed Answer:
Tube is certainly a quicker procedure, and GEA comes with all the potential problems of surgery (anastomotic leakage, bleeding, perforation).
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Anders Mark Christensen (12 hours later)
Could you please tell me if the obstruction is before or after the stomach? Also, how much of the liver is affected. Can it be operated and removed based on the region affected.
doctor
Answered by Dr. Anders Mark Christensen (19 minutes later)
Brief Answer:
After the stomach.

Detailed Answer:
To me it seems the obstruction is after the stomach, in the duodenum. If the obstruction is not complete, both a jejunum tube and a GEA could be viable alternatives, keeping their limitations previously mentioned in mind.
Above answer was peer-reviewed by : Dr. Kampana
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Dr. Anders Mark Christensen

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My mother has stage 4 ovarian cancer . Her medical

Brief Answer: I cannot find the reports. Detailed Answer: Dear XXXXXXX I cannot see that you have attached any reports. Please do so, and I shall be happy to help you.