Husband's 2nd liver recurrence

alexinlv
alexinlv Member Posts: 194 Member

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! 

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Comments

  • Brenda Bricco
    Brenda Bricco Member Posts: 579 Member
    I don't have a lot 0f info

    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
    herdizziness Member Posts: 3,624 Member
    Alex

    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
    luvinlife2 Member Posts: 172 Member
    Liver biopsy

    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
    geotina Member Posts: 2,111 Member
    Hi:

    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
    janderson1964 Member Posts: 2,215 Member
    I have had three liver
    I have had three liver resections over the course of 7 years.
  • janderson1964
    janderson1964 Member Posts: 2,215 Member
    I have had three liver
    I have had three liver resections over the course of 7 years.
  • Chelsea71
    Chelsea71 Member Posts: 1,169 Member
    Yes, I'm sure another
    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
    PatchAdams Member Posts: 271
    I'd demand resection NOW!

    "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

     

  • alexinlv
    alexinlv Member Posts: 194 Member
    Thank you,

    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.   

  • jasminsaba
    jasminsaba Member Posts: 157 Member

    I'd demand resection NOW!

    "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

     

    RFA vs. Resection

    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.

  • maglets
    maglets Member Posts: 2,576 Member
    alexinlv said:

    Thank you,

    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.   

    haha yes cringe

    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
    Sundanceh Member Posts: 4,392 Member
    alexinlv said:

    Thank you,

    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.   

    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

  • Sundanceh
    Sundanceh Member Posts: 4,392 Member

    RFA vs. Resection

    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.

    "Not the Only" - You're Right, Jas

    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

  • Sundanceh
    Sundanceh Member Posts: 4,392 Member
    Mr. Recurrence

    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

  • lilacbrroller
    lilacbrroller Member Posts: 412 Member
    Sundanceh said:

    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

    RFA

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

     

    thanks

    Karin

  • Sundanceh
    Sundanceh Member Posts: 4,392 Member

    RFA

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

     

    thanks

    Karin

    Hi Karin:)

    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
    lilacbrroller Member Posts: 412 Member
    Sundanceh said:

    Hi Karin:)

    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.

     

    liver guy

    thanks - appreciate the info. 

     

    take good care

     

    Karin

  • lilacbrroller
    lilacbrroller Member Posts: 412 Member
    Sundanceh said:

    Hi Karin:)

    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.

     

    liver guy

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

  • annalexandria
    annalexandria Member Posts: 2,571 Member
    Good luck to you and your husband, Alex...

    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
    alexinlv Member Posts: 194 Member
    Liver resection with lung nodules

    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!