Help needed deciding course of action

impactzone
impactzone Member Posts: 551 Member
edited March 2014 in Colorectal Cancer #1
First thank you to all who have written in the past.Your wisdom and kindness is great. I am healthy 47 yr old male with 2 kids, Stage 4 colon cancer with 1 liver met (2.8 X 1.8 cm). On 9/1 I had the colectomy.

I have a dilemna after meeting with 2 specialists. Simply put, do I have:
1. Surgery on the met and then chemo
or
2. Chemo, surgery then chemo.

I met with Dr Warren at UCSF Chief of Surgical Oncology and a very respected liver specialist. He said he could do the surgery soon (even next week) and to expect a 6 week recovery. He wants me strong going into surgery, would do ultrasound during surgery and use resection and RFA if needed. He recommended surgery and then follow up chemo. This means no chemo from 9/1 until at least 12/1. He feels it is best to deal with the known tumor where it is and while it can be operated on. He then suggests using chemo to destroy any potential micromets.

On Thursday I met with Dr Fisher at Stanford, (an oncologist). He recommended the following course:
3 months of chemo followed by surgery. His suggestion is Xeloda with oxaliplatin and Erbitux.
His plan is Day 1 an infusion of oxaliplatin followed by the Xeloda (8 pills / day for 14 days)
The next week an infusion of Erbitux and then a 1 week wait and do this again for 6 treatments. He also said that the use of leucovorin does not show any statistical benefit when used with Xeloda. He is not looking at Avastin because I am going to be a candidate for surgery at the end of the 3 months and a 6 week minimum is needed to stop avastin pre surgery. He feels it is best to look at the tumor response, try to wipe out any micromets with chemo and then go in for resection.


My local onc had suggested Folfox6 ( 5 - FU with the pump for 48 hours) infusion, leucovorin and oxaliplatin) + avastin.

1. Has anyone used Xeloda instead of 5-FU infusions?
2. Any experience with Eribtux?
3. Advice?

Help!!

And Thank You,

Chip Fenenga

Comments

  • vinny3
    vinny3 Member Posts: 928 Member
    #2
    It is a difficult decision. I have had the 5-FU but not Xeloda or Eribtux. Since you have had spread I would favor having the chemo first so kill off any micromets and then having surgery. Take your time in making the decision but be aware that none of us, even the doctors, can know exactly the best course but often you have to go with the consensus and that is why it is good to get alot of opinions.

    ****
  • jana11
    jana11 Member Posts: 705
    #3
    Chip, here's my story. After lungs mets were seen, again, my surgeon (all care at MD Anderson) wanted me to do chemo first to make sure the cancer would respond to it. He felt jumping into surgery was silly if the tumor was resistant to the chemo. I did CPT11, xeloda, avastin, and erbitux. My tumor shrank a little... and then I had surgery.

    Xeloda is JUST as effective as 5FU - xeloda is a predrug. After you swallow it the digestive process breaks it down... makes the chemo process MUCH EASIER. You do not need leucovorin with xeloda. I agree with the avastin decision. Try the chemo without it first - if necessary, you can add it later.

    I am not telling you to do either decision - just giving you the plan I had from MD Anderson. Neither option is right or wrong. Maybe a second opinion would be in order. Give it a try to get more information. Each person is different, each case different, and cancer doesn't follow any rules.

    Good luck with your treatment. jana
  • impactzone
    impactzone Member Posts: 551 Member
    #4
    jana11 said:

    Chip, here's my story. After lungs mets were seen, again, my surgeon (all care at MD Anderson) wanted me to do chemo first to make sure the cancer would respond to it. He felt jumping into surgery was silly if the tumor was resistant to the chemo. I did CPT11, xeloda, avastin, and erbitux. My tumor shrank a little... and then I had surgery.

    Xeloda is JUST as effective as 5FU - xeloda is a predrug. After you swallow it the digestive process breaks it down... makes the chemo process MUCH EASIER. You do not need leucovorin with xeloda. I agree with the avastin decision. Try the chemo without it first - if necessary, you can add it later.

    I am not telling you to do either decision - just giving you the plan I had from MD Anderson. Neither option is right or wrong. Maybe a second opinion would be in order. Give it a try to get more information. Each person is different, each case different, and cancer doesn't follow any rules.

    Good luck with your treatment. jana

    Jana
    Was your surgeon either Lee Ellis or Stephen Curley? I do have the option of going to MD and have paperwork in place but everything is much easier if I stay here in CA. I have heard nothing but great things about MD. What was your experience with xeloda and eributux? side effects?
    Thanks
    Chip
  • levensweg
    levensweg Member Posts: 55
    #5
    Hi chip,
    I had cc with liver mets. One liver met about the size of yours and to tiny ones next to it. One they barely picked up with ultrasound during the resection, but wasn't picked up in ct scan.

    When I met with my liver surgeon and onc to discuss my options they were very similar to yours. Studies didn't show a higher survival rate for my specific situation one way or another, so I opted for the surgery first, then the chemo: folfox with avastin. I was anxious to just get it out at that point. I feel like I lost the knowledge of wether or not the chemo would have shrank the tumors. If it did, would they have caught the third tiny tumor and resected it?

    Another thought that was thrown at me by the assistant surgeon was to have a hepatic pump put in during the resection. This sends chemo straight to the liver and is less toxic to the rest of the body. The argument with this was that the pump can sometimes damage a liver and that was an unecessary risk. If my surgery left me with a clean liver, they would leave the pump out, which is what happened.

    It's such a tough question. I still think about this all the time. Also, have you had a PET scan? This is important. That should be done before any of this. Of course it didn't work with me (the unlucky 8% I guess). A PET scan can make a false negative (as in my case) but not a false positive.

    I finished chemo October 05. My scan and blood test were clear two weeks ago.

    Reuben
  • AuthorUnknown
    AuthorUnknown Member Posts: 1,537 Member
    #6
    Maybe you can get 3rd opinion? This way hopefuly 2 doctors out of 3 will agree. This may help you to decide.
  • CAMaura
    CAMaura Member Posts: 719 Member
    #7
    HI Chip, Well, these are two strong opinions. I would opt for a third -- with luck, someone who would agree with one option over the other. I have met Dr. Fisher for my second opinion and he does know chemo; but that is not a reason for me to send you his way. Wisning you all the best. I am sure you can find the answer and a doctor with whom you can put all of your trust. - Maura
  • Limey
    Limey Member Posts: 446 Member
    #8
    Hi Chip, I am finding with this diease, the only wrong answer is to do nothing and ignore it. The best choice is usually the one you pick. I was stage IV on my 2nd diagnosis, mine had no mets to the liver but has spread outside of the colon into the tissue. I did Folfox6 ( 5 - FU with the pump for 48 hours) infusion, leucovorin and oxaliplatin) + avastin first then was going in for surgery. My tumors shrunk to NED so there was nothing to operate on but I still needed an operation to fix a blocked Ureter. That was in May. Today I now have evidence of cancer at the resection again and 1 met to the liver. I am going in for surgery Oct 13th first this time then deciding on follow up radiation/ chemo afterwords. I attend the U of Minnesota and they are a teaching hospital for cancer. They get allot of "i dont know what to do" cases from smaller hospitals that do not know what route to go. I am told a problem today is that the chemo shrinks tumors so well that the surgeons do not know what to remove after the chemo. They have to wait for re-growth of the tumors. so what way is right? I had a great summer recovering at my lake house, I was brown as a berry and I had allot of time with my family. I can only say no matter how it turned out, it was right for me. Just remember that if both choises were not good choices, you would not be struggling with the decision.
    Good Luck
    Mark
  • Moesimo
    Moesimo Member Posts: 1,072 Member
    #9
    Would MD Anderson give you an opinion even if you don't recieve treatment there?

    Or could you get another opinion at another major cancer center.

    I know it is tough when they ask you to decide.

    I was 46 when diagnosed with stage 3 rectal. I had 5 fu and leukovorin and worked while receiving treatment. My only side affect was diarrhea. Lots of it. It was so bad I only received 4 out of 12 treaments. But, I had just had an ileostomy reversal and had all my rectal tissue removed.

    Good luck with whatever you decide. I know you want that tumor out, but I think sometimes the chemo is done and then surgery.

    Maureen
  • KathiM
    KathiM Member Posts: 8,028 Member
    #10
    Chip,
    Only stage III here, but I agree with others...maybe a third 'tie breaker' opinion. I went to number 5 (sorry) second opinion...and it was the one that gave me the most convincing argument....

    Hugs, Kathi
  • mindy10
    mindy10 Member Posts: 182 Member
    #11
    Hi Chip, first of all I want to say I wish the best for you. There a alot of stage 4 suvirors here so this is a good site to be on. Second of all, every patient reacts differently to chemo. From my experience with my dad. The best chemo for him was the 5 F-U and the oxi and avistan. I beleive the Oxi worked best with him because when he got off the Oxi the tumors grew. He then switched to Xeloda and the tumors still grew. Like I said everyone is differnet what worked for him might not work for you. From the research I have done I think Oxi really does a good job. All the best to you. Mindy
  • shmurciakova
    shmurciakova Member Posts: 906 Member
    #12
    Hi again,
    I would recommend getting a third opinion as well. As I think I told you before, my doctor is Stephen Curley. He did my liver resection and continues to be my oncologist. He is very well respected in the field and I would value his opinion on this matter.
    Personally I had my liver resection then chemo. It is my feeling that surgery is what really helped me, I do not place too much faith in chemo, although others on this board have had much success with it. At a later time I was diagnosed with 2 mets to the lung (right lung). They (at MD Anderson) believe that these mets were there all along and were not recurrences per se.
    I had them resected and did not have chemo done afterwards. That was nearly 2 years ago. I believe that surgery is your best chance at a cure or long term remission.
    I had Xeloda after my liver resection and although it is convenient, I got severe hand and foot syndrome which was a real drag for me since I am an avid hiker/backpacker.
    At any rate, I think that I would say to only do the chemo if it is necessary for the surgery. Otherwise I would not do it twice. I am under the impression that cancer can build up a tolerance to certain chemo regimens, so they would not be as effective the second time. I may be wrong about that though, so maybe that is a question for the doctors.
    Best of luck w/ your decision,
    Susan H.
  • JADot
    JADot Member Posts: 709 Member
    #13
    Hi Chip:

    I would vote for getting the lump of bad character out of there as soon as possible. I don't have experience or data to back up that gut feeling. While getting another opinion sounds like a good idea, but it can take a while to organize. Perhpas you should ask your two doctors to talk and get to some kind of concensus between them for you. But intuition says that you should get it out as soon as possible. I had surgery the morning after my cancer was seen during my colonoscopy. My doctors told me in no uncertain terms that I should get the tumor out as soon as possible, that was before we knew what stage, if any mets.

    Cheers,
    Ying

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