Moderately Differentiated Adenocarcinoma G2

Question

My mother recently went through Gallbladder Lap. Chole. And pathology report revealed  Moderately Differentiated G2 Adenocarcinoma. Oncoligist further suggested few tests including PET CT Scan and the results are below.
CA19.9------16.42
CA-125------16.9
CEA------1.49
PET SCAN findings revealed Metabolically active INTRA-thoracic lymph nodes are concerning for Metastatic disease.
Hypermetabolic lymph node measures 11mm is observed in descending aorto-esopageal recess likely Metastatic.
Now what should be next procedure? Is it curable.
I am attaching the reports.

Dr. Muhammad Arif · Answer

Thank you for the information. It&#39;s not curable. If she is in good physical condition,  she could be treated with chemotherapy and it helps some patients .

Dr. Amjad Sk Durrani · Answer

Thank you for your mail.As a matter of fact decision is not straight  forward.Since a couple active lymph nodes are localised on PET then lymphadenetomy( removal of lymph nodes and sending for histopathology to prove it is a metastatic disease ) if not then no need for chemotherapy.If positive yes.But it is quite difficult surgery at times.The other approach is to give chemotherapy and Radiotherapy (for local area of gall bladder surgery). After completing chemotherapy perform PET again to see results.if ok means no active nodes then follow  with PET or CT over the period of 5 years.

Dr. Mariam Gul · Answer

Very complex situation. Disease is metastasised, but if patients general condition is good , she can be given chemotherapy,,, unfortunately  chances are not very high.

Asst. Prof. Dr. Abbas Khokhar · Answer

Its stage 4. I agree with the opinion of all the other learned oncologist

Dr. Abdul Qayyum · Answer

The guideline for gallbladder cancer surgery is wide local excision with removal of all related lymph nodes. In this case laparoscopic surgery was done and lymph nodes were not recovered in pathological specimen. PET Scan revealed metastatic thoracic lymph nodes. These lymph nodes should be confirmed for mets. (but it is v difficult). Otherwise chemotherapy can be given, which will be some helpful.

Dr. Rana Qamar Javed · Answer

It's very interesting. Usually disease go nearby Lymph nodes but in this case metabolic activity is found intra thoracic. if we consider it as metastasis, cure is not possible unfortunately but there are new drugs available which can shrink this cancer and let patient live some longer

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