Dive into the facts and explores the delicate balance between the potential risk of cancer seeding and the critical insights gained

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Steve Holmes
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Seeding the cancer; Cholangiocarcinoma Biopsy Risks and Rewards



Tumor Seeding Cholangiocarcinoma Genetic Blueprint Risk/Reward Cancer Growth Immunotherapy

Tackling the Big Question: Will a Biopsy Seed the Cancer’s Growth?

Hey fellow warriors, it’s Steve here, and today I’m diving into a big question that’s been buzzing around in our cholangiocarcinoma community. You know, when you’re dealing with bile duct cancer, there’s one critical step that often comes up – getting a biopsy of the tumor. But I know many of us are worried – could this biopsy actually spread, or ‘seed,’ the cancer? It is also an often-used reason by oncologists.

So let’s chat about what we know so far.

The Nitty-Gritty: Biopsy and Cancer Seeding

A biopsy, as most of you know, usually involves using a needle to extract tissue that contains cells from the tumor. And the big worry is that this procedure could potentially activate the spread of cancer cells, which could then speed up the formation of new tumors and metastasis. That’s a really tough thought to grapple with, and it’s absolutely a concern that the medical community – and us patients – take seriously.

Recent research does point out that while the chance of cancer seeding due to biopsy is generally small, it’s not zero. One study I came across in the Annals of Gastroenterology (Katsinelos et al., 2014) suggests that tumor seeding could happen at a rate of around 2.2% to 2.7%. That’s a low number, but it’s still something to consider.

The Hard Truth: Not Everyone Can Have Surgery

Here’s something important we need to remember. Not many cholangiocarcinoma patients qualify for surgery. So if surgery isn’t an option to get a tissue sample for genomic profiling, then we really need to consider the biopsy procedure. And if your oncologist or surgeon isn’t keen on it, then you’ve got to take a hard look at seeking a second opinion. It’s your right as a patient facing such high stakes to have as much information on board as possible, our medical professionals are trained to understand this – that is a foundation pillar to being a patient-centric medical professional. An independent second opinion can give you the extra insight and comfort you need, empowering you to make genuine, unrushed decisions.

I can’t stress this enough – it’s critically important to engage oncologists and surgeons who don’t just know about cholangiocarcinoma, but also have current expertise and a track record in diagnosing and treating it. This distinction could literally be a matter of life and death. So this is what you have to do; Ask them point blank (nicely of course) ‘Do you have current expertise and experience with my exact cholangiocarcinoma diagnosis? If not, how will you introduce the expertise and experience required to treat it?

As patients, we definitely have the power to participate with greater parity in our diagnosis and treatment. But you have to ask or they will not provide the answers we are really asking, it’s about getting out of your own way and becoming more proactive and persistent than you are used to, there are many options and doctors are only human and can fall behind the knowledge curve or simply having a bad or busy day. It’s our health, our life. Only oncologists with the current expertise and experience truly understand the risk/reward profile of obtaining a biopsy within the cholangiocarcinoma setting -that s who you need on your team!

But What About the Silver Lining?

Despite the potential risk, there are some big positives to getting a biopsy. The real gold in the process is the valuable information a biopsy can provide about your cancer, which can steer the ship toward the most effective treatment.

The insights and information gained from a biopsy can provide a roadmap to the exact mutation that is driving the cancer’s growth, without it your oncologist can only utilize historic treatment approaches. When an oncologist is empowered with a genomic roadmap then they are able to guide the choice of chemotherapy, targeted therapies, or immunotherapies that are specifically tailored to target your tumor. We’re now living in the era of precision medicine and we as patients have more options than ever before. Understanding the genetic blueprint of your tumor is becoming super important for kicking this cancer to the curb.

Weighing It All Up

We’re all in different boats in the same rough sea, and I know from personal experience how important it is to weigh the pros and cons. I will declare that I have had many biopsies. Have a heart-to-heart with your oncologist, share your worries, and let them guide you based on your unique situation. And remember the importance of getting that second opinion.

In the meanwhile, why not visit the Cholangiocarcinoma Australia website? It’s a fantastic resource with heaps of information for patients and caregivers alike.

Remember, we’re in a race that’s getting faster every day. Researchers are working around the clock to hone biopsy techniques and reduce potential risks. There’s also talk of new imaging techniques, like contrast-enhanced ultrasound, and innovative methods like liquid biopsies, which could further shrink that risk of tumor seeding.

So, bottom line? Getting a biopsy of a cholangiocarcinoma tumor does carry a small risk, but the evidence points to the rewards outweighing the risk.

The Empowered Patient

Simplifying and distilling medical information in a way that we as patients can understand and act on is the beginning of patient empowerment and ‘informed choice.’ Understanding creates confidence and leads to better decision-making and confidence. Please share your thoughts and questions about the article in the comments section below so I can continue to simplify it.

Ps if you would like a template of the questions that you should ask your oncologist or surgeon, then drop me an email and I will send you a copy.

Questions I have

Questions help expand and bridge:

This article did not explicitly address the following questions:

  1. What are the specific risks associated with undergoing a biopsy for cholangiocarcinoma?
  2. How can the spread or seeding of cancer cells during a biopsy be minimized?
  3. What are the potential benefits and rewards of undergoing a biopsy for cholangiocarcinoma?
  4. How can genomic profiling from a biopsy help in determining personalized treatment options?
  5. Are there any alternative methods or technologies, such as liquid biopsies or contrast-enhanced ultrasound, that could reduce the risk of tumor seeding during biopsy?

While the article and review provide general information about the risks and benefits of cholangiocarcinoma biopsies, it does not directly address these specific questions. However, the article does provide some context and insights that can inform the reader’s understanding and prompt further discussion, questions, and investigation with their Oncologist.

Can you add an observation, or a question to improve how it empowers patient understanding and action?

An IHC Immunohistochemical Test Saved My Life:

You need to look no matter how slim the statistics, I am alive because my Oncologist looked – it is that simple and that’s all it took to set my success in motion against 100% odds that I would pass, I know others who are very similar to me.

The biggest problem I encounter with patients who reach out to me for help, is too many do not look, their oncologists have not educated them on this choice, or further, still, they have actively discouraged them into the belief that it is only a rare chance – so it’s not worth looking or asking the question!

I personally believe that biopsies are the second most important option we as patients have after surgery and must be a subject fully pursued and ruled in or out, that is why a second opinion is essential, and it must come from an Oncologist in concert with a surgeon who both have the current expertise and experience with your exact cholangiocarcinoma diagnosis

IHC: is a type of pathology test that takes 1-2 weeks for results.

For cholangiocarcinoma patients, certain biomarkers can play a significant role in determining treatment options. These biomarkers can be identified through immunohistochemistry (IHC) testing.

Some important biomarkers include IDH1/IDH2 mutations, FGFR2 fusions, BRAF V600E mutations, PD-L1 expression, microsatellite instability (MSI), and HER2 overexpression/amplification. Each of these biomarkers has specific targeted therapies or immunotherapy options associated with them. It is important that patients know this.

Genomic Profiling: a more in-depth look which takes 4 – 6 weeks for results

Additionally, it is highly recommended that cholangiocarcinoma patients consider genetic profiling of their tumor. Genomic profiling provides a more in-depth understanding of the genetic alterations driving tumor growth. This information can help identify additional biomarkers and potential targeted therapies, offering a more precise and personalized treatment approach. By undergoing genetic profiling, patients can unlock valuable insights into their cancer and potentially access more effective treatment options.

I hope this article has helped empower your knowledge and understanding, let me know your thoughts in the comments below. 

Regards Steve
Ps Have you visited the CCA Patient Toolkit?
Eat light – Move light, be Open, Be Willing, be consistent.