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To Your Good Health

by Dr. Keith Roach

DEAR DR. ROACH: A family friend has just been diagnosed with bile duct cancer. She is a breast cancer survivor and is 75 years old. The tumor is said to be the size of a quarter, and it was discovered after she complained of heartburn symptoms. 

Are there screening tests that could have detected the condition before the heartburn symptoms? Are there things that she could have done to avoid the cancer? My family members are frightened and want to avoid her condition. ~Anon.

ANSWER: Cholangiocarcinoma, cancer of the bile ducts, is a rare cancer that is, unfortunately, associated with a high mortality rate. There are no symptoms in most people until it is advanced. Since the cancer is in the bile ducts, the most common symptoms are caused by obstruction of the bile ducts: jaundice (yellow in skin/eyes), generalized itching, dark urine and light-colored stools. Abdominal pain, fever and weight loss are other symptoms.

Cholangiocarcinoma is not a disease that’s amenable for screening; it is rare in North America (it is more common in East Asia, where there are screening programs). Further, the available screening tests, such as blood tests and imaging studies, are not very sensitive, meaning the tests will miss cases. And they are not very specific —a positive result on the screening test does not necessarily mean cancer. For these reasons, screening is not currently recommended for people at average risk, although it may be considered in people at high risk, such as people with primary sclerosing cholangitis, a chronic liver disease that puts people at high risk for cholangiocarcinoma.

Other risk factors for cholangiocarcinoma are mostly beyond a person’s control: other liver diseases, parasites and genetic conditions. There is some evidence that obesity and diabetes increase the risk of this cancer; however, it does no good for you or your friend to look backward. Never blame the victim.

She should concentrate on getting treated. I don’t have enough information to comment on her prognosis, but the fact that it was diagnosed early — apparently before obstruction of the bile ducts — and with a tumor only the size of a quarter, are favorable. Treatment may include surgery and chemotherapy (before or after surgery).

DEAR DR. ROACH: My wife is 69 and in very good health, exercising at least two hours a day. She has suffered from “knots in the back” for over ten years. It comes on suddenly at any time of the day or night, and lasts hours, days and occasionally weeks. She has tried chiropractic, massage therapy, prescription and OTC painkillers, stretching and home massage, all to no avail. A glass of wine is the only reliable relief, and it lasts only a few hours. Is there any recourse to this condition? ~ J.P.

ANSWER: I am sure you and your wife must be frustrated.

The fact that it comes on suddenly, can be felt as tightness and gets a bit better with alcohol makes me strongly suspect she is having muscle spasms. These most often come on in the legs and feet, but they can affect the back too.

Two hours a day of exercising sounds like a lot, and she may be overexercising some muscles, while possibly not exercising others. This can lead to imbalances in muscle strength.

Another common problem stemming from exercising is inadequate stretching. Stretching is the first place to start for many people with muscle cramps. A physical therapist or physiologist may be of immense benefit, and your wife should explain in detail what her exercise regimen is. We are taught to think carefully of the mechanism of injury, and I am concerned the exercise may be that injury.

Abnormalities in electrolytes (blood salts, especially potassium, sodium, magnesium and phosphate) are only rarely the cause, although many people write me that they have been helped by taking one or more of these. Primary muscle diseases, side effects from medications and inadequate hydration are possible, but also unlikely.

In absence of detailed knowledge about her exercise regimen, I’d recommend she try backing off a bit, maybe using ice after exercise, stretching the back under supervision and trying a hot bath or shower before bed.

Dr. Roach regrets he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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