Surgery for Mets?

Options
Cazz
Cazz Member Posts: 106
in Anal Cancer #1

I have metastatic anal cancer, but I also read various colon cancer forums as its all happening in the same general neck of the woods.  Something that I find curious is that they talk about having four or five liver resections, and lung resections as well as really serious open up the abdomen and take out 10 or 15 tumors from there.  I've got two mets on my liver, two or three lymph nodes and one mass on my calf that my radiation doc has said she can get rid of with only two weeks of radiation.  So I asked my oncologist if my current chemo, Cisplatin/5-FU, manages to shrink the fairly small nodes on my lymph nodes so they can no longer be seen, and shrinks the liver mets to a more manageable size, can I then get the two surgically removed from my liver and he said no.  I also asked Dr Eng at MD Anderson if they would take them out and she said no.  When I asked why, she said that as I had mets in more than one place no surgeon would remove them and that they had to be treated systemically through chemo.

So, how do the colo-rectal guys get all these surgeries when us anals can't?  Has anyone else run into this and have you got a better answer than I have come up with?  I mean, I can see that they may think its futile to take out two tumors when I will most likely only develop a couple more down the road, but surely that should be my decision?  I would be quite happy to play whack-a-mole with the tumors if I only got one or two every year or so.

Just asking.

Comments

  • eihtak
    eihtak Member Posts: 1,473 Member
    #2
    Options
    Cazz.....

    Hmmmm......you have me curious as well. I am trying to educate myself as much as possible on mets of anal cancer as I was recently treated with lung mets. (surgery to remove followed by chemo to clean up any potential rouge cells) Unfortunately there is not much data available on late stage or anal mets. I have a great deal of respect for my doctor and will ask his opinion this week and get back to you.

    katheryn

  • Cazz
    Cazz Member Posts: 106
    #3
    Options
    eihtak said:

    Cazz.....

    Hmmmm......you have me curious as well. I am trying to educate myself as much as possible on mets of anal cancer as I was recently treated with lung mets. (surgery to remove followed by chemo to clean up any potential rouge cells) Unfortunately there is not much data available on late stage or anal mets. I have a great deal of respect for my doctor and will ask his opinion this week and get back to you.

    katheryn

    Thanks, Katheryn

    I did have surgery to remove a lung met immediately after finishing initial treatment for the anal and hip tumors, but that was before the "cysts" in my liver grew enough to be identifiable as mets.  It may be that if you only have mets in one place they will cut them out, but if they are in two or more - or maybe in the lymph nodes as well - then surgery is no longer an option?  On the other hand, I would think that if chemo can get rid of all but one or two big ones, there should be an option to cut, or radiate, them out too.  I will be interested to hear what your doctor has to say.

    Carol

  • lp1964
    lp1964 Member Posts: 1,239 Member
    #4
    Options
    Cazz said:

    Thanks, Katheryn

    I did have surgery to remove a lung met immediately after finishing initial treatment for the anal and hip tumors, but that was before the "cysts" in my liver grew enough to be identifiable as mets.  It may be that if you only have mets in one place they will cut them out, but if they are in two or more - or maybe in the lymph nodes as well - then surgery is no longer an option?  On the other hand, I would think that if chemo can get rid of all but one or two big ones, there should be an option to cut, or radiate, them out too.  I will be interested to hear what your doctor has to say.

    Carol

    Dear Friend,

    All I know what I read from other Stage 4 patients here, but my impression is that it's a matter of finding a willing surgeon. It is the surgeons discretion after consulting with the oncologist if she ur he takes on the case. I'm sure different hospitals have different basic guidelines, but every case is different. I myself would never stop looking for a surgery option if it gave me a better chance to survive. 

    i hope you can get what you want and need,

    Laz

  • nicotianna
    nicotianna Member Posts: 209
    #5
    Options
    Cazz said:

    Thanks, Katheryn

    I did have surgery to remove a lung met immediately after finishing initial treatment for the anal and hip tumors, but that was before the "cysts" in my liver grew enough to be identifiable as mets.  It may be that if you only have mets in one place they will cut them out, but if they are in two or more - or maybe in the lymph nodes as well - then surgery is no longer an option?  On the other hand, I would think that if chemo can get rid of all but one or two big ones, there should be an option to cut, or radiate, them out too.  I will be interested to hear what your doctor has to say.

    Carol

    surgery after mets

    Hi Carol - I have a similar situation.  I have apparent lung mets & an area near the vagina which lights up on PET/CT.  The thoracic surgeon said "no" for further surgery.  I wonder if insurance companies pay up under those circumstances?  Also, are you enrolled in Cathy Eng's clinical trial with nivolumab?

    Nic

  • Cazz
    Cazz Member Posts: 106
    #6
    Options
    nicotianna said:

    surgery after mets

    Hi Carol - I have a similar situation.  I have apparent lung mets & an area near the vagina which lights up on PET/CT.  The thoracic surgeon said "no" for further surgery.  I wonder if insurance companies pay up under those circumstances?  Also, are you enrolled in Cathy Eng's clinical trial with nivolumab?

    Nic

    Thanks, Laz and Nic

    I'm not yet at a point where I only have a couple of mets to be removed, but I guess if I got there and they were stable, I would go surgeon-shopping in the hope of getting them out of me one way or another, but its the rationale behind it that I don't really get.  Like Nic, I don't know why they wouldn't remove your mets if they are well-defined and relatively easy to get at.  Even if, down the road, you develop more mets, at least these particular ones wouldn't be around to grow any more, or throw off mets of their own, where is the down side to that?  I know, whine, whine, but, as I say, I just don't get it.

    No, I am not yet enrolled in the Nivolumab trial.  Dr Eng said that the trial protocol required that I go through a course of Cisplatin/5-FU treatment, which I chafed at because I thought it was pretty futile, but I went along with it.  Now, having just had my fourth infusion today at a half-dose every two weeks, I have to admit that its working pretty well.  I've got the tumor in my calf to use as a measure and that has definitely shrunk.  When I started it was a rather large, maybe 3" long lump and now it is back to about the size when I discovered it, 2 months prior to chemo, about the size of a medium egg, but its also much denser and harder, don't know what that means.  Anyway, my doc says that as long as the chemo is working, Dr Eng will keep me on it until either it stops working or I can no longer tolerate it - or, as I said, the tumors shrink entirely away to nothing - he just smiled!  I am going back to Houston next week for follow-up CT scan and to meet with Dr Eng again, so will hopefully learn more then.  Are you looking at that trial too?

    Carol

  • nicotianna
    nicotianna Member Posts: 209
    #7
    Options
    Cazz said:

    Thanks, Laz and Nic

    I'm not yet at a point where I only have a couple of mets to be removed, but I guess if I got there and they were stable, I would go surgeon-shopping in the hope of getting them out of me one way or another, but its the rationale behind it that I don't really get.  Like Nic, I don't know why they wouldn't remove your mets if they are well-defined and relatively easy to get at.  Even if, down the road, you develop more mets, at least these particular ones wouldn't be around to grow any more, or throw off mets of their own, where is the down side to that?  I know, whine, whine, but, as I say, I just don't get it.

    No, I am not yet enrolled in the Nivolumab trial.  Dr Eng said that the trial protocol required that I go through a course of Cisplatin/5-FU treatment, which I chafed at because I thought it was pretty futile, but I went along with it.  Now, having just had my fourth infusion today at a half-dose every two weeks, I have to admit that its working pretty well.  I've got the tumor in my calf to use as a measure and that has definitely shrunk.  When I started it was a rather large, maybe 3" long lump and now it is back to about the size when I discovered it, 2 months prior to chemo, about the size of a medium egg, but its also much denser and harder, don't know what that means.  Anyway, my doc says that as long as the chemo is working, Dr Eng will keep me on it until either it stops working or I can no longer tolerate it - or, as I said, the tumors shrink entirely away to nothing - he just smiled!  I am going back to Houston next week for follow-up CT scan and to meet with Dr Eng again, so will hopefully learn more then.  Are you looking at that trial too?

    Carol

    Cazz

    Hi Carol - I have an app't w/Dr. Eng this week for an evaluation.  I have rec'd 2 rounds of cisplatin & 5 FU on a 28 day cycle.  The first dose was 50 mg/m2 cisplatin & the 2nd was 75 mg/m2.  The 5FU ran over 4 days.  It did help my breathing but the side effects the first 10 days were rough each time...quesiness, fatigue, nausea, taste changes.

    Nic

Discussion Boards