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Husband's 2nd liver recurrence

alexinlv's picture
alexinlv
Posts: 192
Joined: Jul 2010

Hi Everyone.  I've been away for a while. Last Dec . My husband had his liver resection.  Latest pet scan as of last week said "one new lesion in right inferior hepatic lobe that has further increased on size and shows more uptake consistent with focal progression of disease.  SUV previously 4.0 now 7.6 and measures 4.7x2.2 Cm. "    I don't understand that if it is a new lesion, then how was it seen on previous scan  Can anyone explain? Also a "developing left upper lobe nodule. report says it did not show abnormal uptake but the appearance on ct is worrisome for additional,spread of disease."  His oncologist said we'd biopsy the liver lesion then determine if ablation or surgery is possible again. I would appreciate any thoughts or experiences on prognosis and having 2 liver resections.     oncologist also said no chemo now and he is not concerned about the lung nodule.   thank you! 

Brenda Bricco's picture
Brenda Bricco
Posts: 551
Joined: Aug 2011

I don't have a lot 0f info for you but I just wanted to say I am so sorry that you are faced with reoccurence. I know there are many people that have a second liver resection (and some that have stayed NED for many years after) which gives me hope. I pray that it is operable and ultimately cured. GOD bless you.

Brenda

herdizziness's picture
herdizziness
Posts: 3398
Joined: Apr 2010

I don't know about the other things.  But, yes, you can have more liver resections.  Hopefully I will have my 2nd liver resection in a couple of months.  As my onc said after the first time, if it comes back, we'll cut it out again.  And that is the plan after the tumors shrink a bit more.  So it is possible to have more resections!! (mine aren't overly concerned about lung tumors at moment either, they said they would take care of those after liver resection).

Winter Marie

luvinlife2
Posts: 172
Joined: Jul 2012

Given your husband's history, I wonder why they would do a biopsy?  If the PET shows uptake and he's already had mets there.....

I just want to warn you that with liver biopsies, there is a possibility of dropping cells into the abdomen which is why so many oncologists won't recommond that anymore.   An ultra sound can help to confirm mets because it will show depth and density.   I'm guessing but maybe the spot that is now 4.7x2.2 cm was a little seedling that showed some uptake but was too small to measure?  Sometimes the PET can show uptake but it turns out to be some sort of inflammation and is gone on the next scan.

As for liver resections, I've heard of up to 3 but that was one person only.  I know several people who have had 2 resections.   Before my lung mets appeared, the plan for me was a 2 stage resection.  Most of right lobe out on the first go.  Heal for 3 months and take the left lobe out.  It's not and unusual procedure anymore.  Keep an eye on that lung nodule!  Smile

 

geotina's picture
geotina
Posts: 2056
Joined: Oct 2009

I am so very sorry about the recurrence.  It can be so disheartening after all you have been through.  There is one person on the board, Maglets, whom I believe has had two liver resections and is now NED and has been for some time.  Hopefully she will see this and if not, send her a PM.  She is a frequent poster on the board.

Wishing you the best in moving forward.

Take care - Tina

janderson1964's picture
janderson1964
Posts: 1579
Joined: Oct 2011

I have had three liver resections over the course of 7 years.

janderson1964's picture
janderson1964
Posts: 1579
Joined: Oct 2011

I have had three liver resections over the course of 7 years.

Chelsea71
Posts: 1170
Joined: Sep 2012

Yes, I'm sure another resection is possible. Sorry you're having to deal with all this again. My husband had a recurrence in his liver recently. Numerous lesions distributed from one end to the other. We're trying to find a liver specialist that can help. Good luck to you and your husband.

Chelsea

PatchAdams
Posts: 272
Joined: Nov 2011

"one new lesion in right inferior hepatic lobe that has further increased on size and shows more uptake consistent with focal progression of disease.  SUV previously 4.0 now 7.6 and measures 4.7x2.2 Cm. " 


 How can it be new if they noted 'inceased size and more uptake"?  I see on your profile that hubby had four lesions removed in Dec. 2011.  Guessing this one was like someone else said.... there but too tiny to dx. 

That's a large tumor and there is no need for a biopsy.  I am assuming they would use a needle to biopsy and that has been shown to cause 'seeding' of cancer cells throughout the area where the needle passes.  I would push for an immediate liver resection.   

Here are the links on liver resection someone shared off www.colonclub.org 

This one is when there is more than one tumor at a time and in different areas but has some GREAT survival stats. 

Two-Stage Resection and Improved Chemotherapy Regimens Lengthen Survival for Patients with Liver Metastases from Colorectal Cancer

This paper is from 6 years ago but discusses and provides proof that liver resection is much more curative than RFA or other forms of tumor destruction.  This one also discusses the importance of removing tumors under 3 cm and greatly increased curative results in even smaller tumors (say under 2 cm). 

Arch Surg -- Abstract: Solitary Colorectal Liver Metastasis: Resection Determines Outcome, May 2006, Aloia et al. 141 (5): 460

 

jasminsaba
Posts: 149
Joined: Jul 2011

My understanding, based on research and consultations with specialists, is that while liver resection remains the current gold standard for treatment of hepatic mets, it is certainly not the ONLY curative avenue to pursue.

There is shortage of long-term data on RFA because it's a rather recent procedure though what data is available is very promising and indicates good response and long-term remissions ... and even cure. It's far less invasive than a liver resection which is why it's likely more attractive to patients. So resection remains the gold standard in the absense of more extensive data for RFA ... once more data becomes available, current practice might shift a bit as well.

Also, in light of recent advancements in chemotherapy for mCRC, there is even a possibility of cure/long-term remission for those with limited metastatic disease. Combination chemo regimens are especially effective on hepatic metastases.

I wish you and your husband all the best with whatever you decide to do ... though there is risk of tumor seeding with a biopsy, many oncologists still recommend the procedure to confirm metastases prior to subjecting their patients to invasive procedures/surgery. That's usually in an early diagnosis setting or for patients with no history of metastatic diasese. In your husband's case, it's very likely that what appears on the CT/PET is indeed another lesion so I agree with others that it's likely not necessary to do a biopsy prior to resection.

Thinking about you guys ... sorry you have to go through this again ... and wishing you all the very best.

Sundanceh's picture
Sundanceh
Posts: 4294
Joined: Jun 2009

Because I think I'm the ONLY liver person who just had the RFA done and not a liver resection....along with a fatty liver with stage 1 fibrosis to boot.

The studies I read (waiting room literature) stated:

"RFA success is Equal To - If not Better" than a liver resection...long considered the gold standard of treatment.

I'm living proof (8.7 years) that RFA is a bonafide procedure...Equal To...and perhaps better.

I've not recurred in the liver (docs/surgeon said I would)...and many others have recurred in liver WITH resection.

No definitive answer either way.

Mine was invasive, because they prepped me for a resection...until they opened and saw my liver...surgeon told my wife I would die on the O/R table...and that he was moving to RFA...the rest is history.

Mine was also a BIG tumor.....about 6cm X 8cm....size of an orange.

They say RFA is better and more effective for much smaller tumors, but I showed how it can be effective for very large tumors as well.

And while, we could not burn all of the tumor out, due to its location....he got the majority of it....and we finished up locally with 3x Cyberknife treatments.

It was...and is...considered a success story. 

-Craig

PatchAdams
Posts: 272
Joined: Nov 2011

 

Solitary Colorectal Liver Metastasis Resection Determines Outcome FREE

 

Thomas A. Aloia, MD; Jean-Nicolas Vauthey, MD; Evelyne M. Loyer, MD; Dario Ribero, MD; Timothy M. Pawlik, MD, MPH; Steven H. Wei, MS, PA-C; Steven A. Curley, MD; Daria Zorzi, MD; Eddie K. Abdalla, MD, Researchers at M.D. Anderson Cancer Center at the University of Texas

 For HR as compared with RFA, the 5-year RFS rates (40% vs 0%, respectively; P = .006) and DFS rates (50% vs 0%, respectively; P = .001) were significantly higher. In addition, 3- and 5-year OS rates were higher after HR (79% and 71%, respectively) compared with RFA (57% and 27%, respectively) (P<.001).

Present study shows an 80% 3-year survival rate (and a 71% 5-year survival rate) after HR and well-established data showing 10- and 20-year survivors after HR of solitary and multiple metastases, even without adjuvant chemotherapy

 In contrast, survival was significantly shorter in patients treated with RFA. Local tumor recurrence appeared to be the major explanation for inferior survival after RFA (37% of patients found to have LR at a median follow-up interval of 31 months), which was reflected in the markedly reduced DFS rate in patients treated with RFA (0% at 5 years). Whereas the 5-year OS rate after HR was 71%, it was only 27% after RFA. This outcome after RFA is only marginally better than the carefully documented natural history of untreated solitary CLM in patients without extrahepatic disease reported by Wagner et al26 more than 20 years ago.

alexinlv's picture
alexinlv
Posts: 192
Joined: Jul 2010

Wow! A lot of info to take in and a lot of work ahead to figure this out! But we've done it before and can do it again. I knew you guys would give more help than the 20 min  visit with oncologist last Thursday. .  i'm not wasting any time with the dr here.   Tony had  his resection at ucla with a fabulous team! I'm going to email them right away. ill let you know,their  answers.  Xo. Ps- when I mentioned to my husband yesterday that surgery is better than rfa he cringed at the thought of going through it again.   

maglets's picture
maglets
Posts: 2404
Joined: Jun 2006

ahhhh I understand his reaction of cringing....it is not a fun operation ....actually I think my second resection was less intense than the first.  For one thing they had to take less tissue but I think you know what to expect second time round.  My surgeon used the same incision site to reduce scars but he also warned that the rate of infection is slightly higher on number 2 because the scar tissue does not not mend as well.  I had no trouble with infection.  

My last resection was in 2008 and I did a full course of oxalyplatin and xeloda afterwards.....indeed i have been NED since then.....

 

I wish you both all the very very best....stay in touch and let us know how you are doing....

 

maggie

Sundanceh's picture
Sundanceh
Posts: 4294
Joined: Jun 2009

Surgery is not absolutely better, Alex...

I had RFA done on the liver over 5-years ago...the studies said "Equal To - if not Better" than resection.

I could be the LONE person on the board, who was RFA'd on the liver...not resected....and is a long time survivor...8.7 years now.

-Craig

lilacbrroller's picture
lilacbrroller
Posts: 278
Joined: Jun 2012

HI, Craig. Where did you have your RFA done, if I might ask?  

 

thanks

Karin

Sundanceh's picture
Sundanceh
Posts: 4294
Joined: Jun 2009

It was done at Baylor Medical Center in Dallas, Texas. 

Surgeon was Dr. Robert Goldstein. He specializes in liver and does transplants...even did Mickey Mantle's liver transplant.

 

lilacbrroller's picture
lilacbrroller
Posts: 278
Joined: Jun 2012

thanks - appreciate the info. 

 

take good care

 

Karin

lilacbrroller's picture
lilacbrroller
Posts: 278
Joined: Jun 2012

P.S. he has a ponytail!  (looked him up on the web)

Sundanceh's picture
Sundanceh
Posts: 4294
Joined: Jun 2009

Recurrence always makes it a much harder fight, Alex...you want to tell the new folks about it...but I remember when you were first starting out...and new folks just don't want to hear that it might take more than once.

I'm sorry your husband has recurred and there's still plenty of gas left in the tank for both of you....wishing you both the strength you need for the latest fight.

-Craig

annalexandria's picture
annalexandria
Posts: 2230
Joined: Oct 2011

lots of good info here so I have nothing to add, except to say that it took me five major surgeries to get to NED (for now).  It wasn't fun, and I have the ugliest abdominal scar ever, but I don't wear bikinis anymore anyway, so oh well...I'll take being alive over looking pretty.  Your husband can do this, and get to NED too!  Hugs and strength to you both~AA

alexinlv's picture
alexinlv
Posts: 192
Joined: Jul 2010

Does anyone have experience with having a second liver resection while having 2 small nodules in lungs? Onc said it is unlikely the liver surgeon would operate. Thank you for you input! 

herdizziness's picture
herdizziness
Posts: 3398
Joined: Apr 2010

I had two spots in lungs and had liver resection, now I have about six in lungs and they are still willing to do resection when liver tumors shrink.  That plan on radiation after the liver resection For my lungs.

Winter Marie

Maxiecat's picture
Maxiecat
Posts: 524
Joined: Jul 2012

Thank you everyone for this discussion.   I have a liver MRI scheduled for tis Friday... To check out a liver lesion that was found in my ct scan from dec...don't know why the dr waited almost a month to order it.   Anyway I have been researching options if this issomething that has to come out.  I am signet ring...so I definitely don't want a biopsy....worried about abdominal seeding?  I have been looking into rfa.  

Alex

PatchAdams
Posts: 272
Joined: Nov 2011

Arch Surg -- Abstract: Solitary Colorectal Liver Metastasis: Resection Determines Outcome, May 2006, Aloia et al. 141 (5): 460

 

Please read the article on RFA vs resection.  Resection has been shown to be much, much better than RFA.

Sundanceh's picture
Sundanceh
Posts: 4294
Joined: Jun 2009

Alex:

I couldn't qualify for a liver resection...so we had to do RFA...tumor was huge 6cm by 8cm...size of an orange....that's alot of tumor to burn out with RFA, but we had no choice.

Most of the tumor was burned out, but they could not get all of it due to location....so we Cyberknife'd 3x and eradicated the tumor at a local level...it was considered a success.

So, while resection will always be the ultimate goal...they wanted to take 80% of my liver....RFA as a procedure...and using myself as a test case, have shown that RFA is an effective procedure.

The surgeon I did it with told me that resection is the gold standard, but that RFA was moving up...and that the odds were equal to...if not better than a resection.

I haven't had cancer recur in the liver again.  I was "Guaranteed" that it would return within one year....and that it would be unlikely if I saw the following Xmas.

That was 5-years ago this past holiday season...

This is a real-life statistic talking to you...not an abstract article...

I believe in RFA...because RFA extended my life...and while I recurred anyway...I can't tell you how many folks around here did liver resections and recurred again...and even again. 

 

 

 

tko683
Posts: 257
Joined: Aug 2011

Hi Alex, I am so sorry to hear your news.  It is so confusing to me also.  
I agree with not needing another liver biopsy.  I would not do that.  We are dealing with similar situation.  New lesions popping up or ones that were there before but too small to see....who knows.  Our surgeon took my husband off chemo for a few months to see what would happen after his clear scan in November and his cea started going way up so they put him back on chemo.  I think you are smart to go to UCLA, you were happy with them and they will most likely be much more helpful.  I am confused as to why they are not doing chemo right now though....sending you wishes for some answers to your questions so that you can move forward....Hugs, Teri

BusterBrown's picture
BusterBrown
Posts: 221
Joined: Mar 2005

 

Just 6 months after my first surgery (colon resection), a tumor reappeared on my liver. My doctor decided to use the RFA procedure, which consisteted of a large incision on my belly and the needle in to my liver.  The surgeon was happy with the margins and the way the surgery turned out.  I went approximately 2.5 years without any problems. After one of my many CT scans my Onc noticed that a tumor was back in roughly the same spot where the RFA procedure had occcured.  This time around, my surgeon decided to resect, taking 60% of my liver.  That was rougly 2009, and my liver has been clean ever since, granted I took chemo on and off till Oct. 2011. 

Good luck with whatever it is you decide.

Buster

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