I am finally learning the truth, but not from my H

[trustinginHim]

Just got the biopsy results and diagnosis of my H's mother's condition. She has cholangiocarcinoma. The blue words denote what is specific in my mother-in-law's case.

Background: Cholangiocarcinomas (CCC) are malignancies of the biliary duct system, originating in the liver and terminating at the ampulla of Vater. CCCs are encountered in 3 geographic regions: intrahepatic, extrahepatic (ie, perihilar), and distal extrahepatic. Perihilar tumors are the most common, and intrahepatic tumors are the least common. Perihilar tumors, also called Klatskin tumors (after Klatskin's description of them in 1965), occur at the bifurcation of right and left hepatic ducts. Distal extrahepatic tumors are located from the upper border of the pancreas to the ampulla. More than 95% of these tumors are ductal adenocarcinomas; many patients present with unresectable or metastatic disease.

Pathophysiology: Cholangiocarcinoma is a tumor that arises from the intrahepatic or extrahepatic biliary epithelium. More than 90% are adenocarcinomas, and the remainder are squamous cell tumors. The etiology of most bile duct cancers remains undetermined. Long-standing inflammation, as with primary sclerosing cholangitis (PSC) or chronic parasitic infection, has been suggested to play a role by inducing hyperplasia, cellular proliferation, and, ultimately, malignant transformation. Cholangiocarcinomas tend to grow slowly and to infiltrate the walls of the ducts, dissecting along tissue planes. Local extension occurs into the liver, porta hepatis, and regional lymph nodes of the celiac and pancreaticoduodenal chains. Life-threatening infection may occur that requires immediate antibiotic intervention and aggressive biliary drainage.

Surgery will be scheduled soon to remove what can be removed, then a course of chemotherapy will be initiated. Her prognosis is not good. My H is not taking this well at all, as I expected. Now we are waiting on word of his grandmother's survival of her surgery. H's world is slowly collapsing in on him and I fear that I will be sucked down with him. As my H is fond of saying on occasion, "God does not reward certain behaviors."