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surgery for stage 4 with liver, lung mets

Posts: 49
Joined: Jul 2016

I am wanting surgery but two oncologists just say no, not with mets in liver, lungs, and possible aortacaval lymph nodes.....just in a six week break from 5fu but still go for erbitux....back in hometown, after undergoing 12 sessios in LA, ten with oxyaliplatin, that was dropped...couldn't keep up the drive twice a month so am getting the supposed maintenance of 5fu and erbitux with local doctor .....she's not for any surgery either, tho surgeon in LA thought liver resection on one met, with ablating out the other met in liver, and to resect out the lymph nodes as long if the next pt scan showed the suv numbers came significantly down........at the end of aug. had the scan, the suv's came down by half but the onco there in LA was not for surgery and was not even there to give me the results and what was next upon my going home to start the 'maintenance'  The doc here is good, but thinks chemo is the answer also ....what to do.....I know the protocal seems to be if it has only gone to one other orgon, surgery is doable, but then read here and other places that stage iv's often have the surgeries? I won't know til the next scan what is going on since the one at the end of august was done and it showed nothing new, small amount of shrinkage, but significant reduction in all areas of the suv rate....two years it has been....anyone been in similar circumstances?

blessed39's picture
Posts: 91
Joined: Dec 2016

Dear Dancer2, I so sorry that you are going through this cancer experience. It's all bad but You are on right website.

There are many people in similiar circumstances and have many good suggestions. If you would care to read my story.

It's on my blog which is on my home page. It's entitled "How I Beat Stage Four Colon Cancer."   God bless you


Posts: 112
Joined: Jun 2017

I have kind of similar situation. I have liver mets and tiny lung metastasis. I am on 35 cycle of chemo and feel very good. My oncologist says no for surgery. I had second opinion from different hospital they said they can operate but no gurantee so I am scared to have surgery. My oncologist told me that in some cases surgery may decrease life expectancy, therefore I am very cautios about surgery. I wish you the best!!

impactzone's picture
Posts: 542
Joined: Aug 2006

Stage 4 here and mine was 11 years ago. Every case is different but I had colon surgery followed by chemo to get mets in liver and lungs. With response after 5 months had surgery for liver, continued chemo. The I had 4 differernt thoracic surgeries ( all at Stanford) over the next 4 years as mets kept showing up. Knock on wood... no mets seen in 5 years. I say if you can get surgery, do it.

All my Best


lizard44's picture
Posts: 409
Joined: Apr 2015

I was diagnosed with stage 4 rectal cancer with liver mets in May 2015. The tumor was very low and surgery would involve removing the rectum, anus, and anal sphincter.The colorectal surgeon did not want to operate on the primary tumor until the liver tumor was taken care of. I began chemo with eight rounds of Folfox plus Avastin followed by 28 radiation treatments while hooked up to a 5fu pump. The rectal tumor shrank, and following more chemo with Erbitux and irinotecan the liver tumor shrank to the point it could be ablated in August 2016. Since then I continued on the Erbitux and irinotecan until early last month when the surgeon decided it was time to tackle the rectal tumor. I had an abdominoperineal resection two weeks ago and will begin maintenance chemo next month. So far everything seems to be going well, the surgeon says he got clear margins and the lymph nodes were clear. In my case, delaying the surgery seems to have worked out well, and hopefully we willl keep the beast at bay for a good while.




OzarkGal's picture
Posts: 41
Joined: Oct 2017

With stage 4, it is very important to see doctors that have experience with more advanced cases. 


lizard44's picture
Posts: 409
Joined: Apr 2015

This article applies to rectal, rather than colon, cancer, but may help explain why surgery is not always recommended in some cases. I read an article about similar research at MD Anderson.



Mikenh's picture
Posts: 779
Joined: Oct 2017

Interesting article. Not related to this thread but I found this surprising:

"After treatment for rectal cancer, many patients develop urinary, sexual, and bowel dysfunction. Furthermore — unlike patients with colon cancer — few patients with rectal cancer ever complete postoperative systemic chemotherapy, because surgery-related complications make it impossible for them to tolerate it. This is very important, as many rectal cancer patients are denied the benefits of adjuvant chemotherapy and are thus more likely to succumb to distant metastatic disease."

I got the impression that people couldn't finish complete postoperative chemo because they couldn't tolerate the side-effects, not because of surgery-related complications. The article is from 2014 - maybe things were different back then?


BTW, how are you doing these days?

lizard44's picture
Posts: 409
Joined: Apr 2015

The risk for complications and infections is sometimes greater following rectal cancer surgeries like apr, which could account for the inability of some rectal cancer patients to complete chemo. But I've also read that fewer apr surgeries are being done now, and less radical surgeries are more an option due to better screening and improved techniques

I'm getting there slowly but surely after my apr surgery. No problems with the colostomy, although there is a learning curve that I'm still trying to master. My biggest problem is an inability to sit comfortably and a definite lack of energy. My drain tube came out Tuesday, so things are getting better, but recovery is always a bit slow when you're in your 70s, I think.

Best of luck to you on Monday. I hope everything goes well and that your recovery is swift.

Annabelle41415's picture
Posts: 6715
Joined: Feb 2009

I'm not able to help you but just wanted to let you know that this board and all it's members are in my prayers.  Wishing you the best outcome and hopfully one of those doctors will do the surgery to get it all out.  I've heard of more than one area being operated at one time - hopefully that will be your case.


Posts: 49
Joined: Jul 2016

Thanks all for writing....I'm hanging in there, just feel upset as I am trying .....don't see my doctor here til the end of next month, not sure or if doc will put me back on the pump...maybe i'll know next week when i go for erbitux...course I  feel every ache and abdominal pain thinking why no one is really explaining matters to me or the strategy....I am considering calling out of state again, LA is nearest, anyone from there who has experience? I know UCLA is considered a top center....I just want this crap out of me. Yet I understand where the docs are at, still i want every option. But would like some informative bed side manner so to speak as all i hear is chemo except for the one and only surgeon i saw...of course the lungs had not been tested when he saw me, now they have been , but they were always saying mets from the get go....only two tiny spots then. The liver mets are 1.8 and 1.7, not sure if that is considered big or not?

Trubrit's picture
Posts: 5487
Joined: Jan 2013

Have they mentioned the possibility of ablation on the liver mets?  I had a 2.2 cm liver met, that was ablated. I believe they don't like to ablate on mets bigger that 2 cm, so I would ask about it, as your mets are smaller. 


Posts: 49
Joined: Jul 2016

in the beginning two years ago i only had one liver met 1.8 by 1.2 and a tiny spot in each lung....had the colon tumor taken out, no pos. lymphs....with first onco i was given oxy plus xeloda and after only three treatments he stopped it and said it was not working?? the scan i had at the time showed the met still there, had not grown and the two lung spots still there with no new...so i was confused....doc had me go home for three months but i was to have an ablation before coming back...i did, was told it was successful after a month by the int. rad...liver was homogenous and only one lung spot...but the onc wanted a pt scan done and the three months had not passes so it all glowed...told to go home for another three months and come back......i never went back, got another doc...by that time i was confused why he wouldn't send me to get it resected so i went to another doc.....six months had passed w/o anything. 2 new liver mets, and multiples in each lung....8 session of avastin plus the pump and not sure if at that time it was f5u or the other one....had a scan, the doc thought it all would be gone, but it was all there, plus what looked like another one and one lymph node enlarged....they lost me when lonsurf was mentioned....so i got on the phone and called a surgeon near family in LA and he told me he only saw the two in the liver and the one lymph node and they were small enough he could take them out the next day but we needed a chemo that worked...so i met there with one and decided to do the twice month drive for 12 sessions.....they had my tissue sent out to see if it would react in an immunological agent and it did and ended taking erbitux with 5fu and oxaliplatin ( 10 sessions of 12 with oxali) it was discontinued because of the feet/hand neuropathy, and the a month ago the 5fu was stopped for six weeks to see if that would get better, so far no, not better.....i really don't know what is planned now because i don't see the doc for a month, but have treatment next week with erbitux maybe the nurse will or not fill me in......i would think they would scan before giving me anymore 5fu, since i have had 14 or 15 treatments in a row with it......anyone know how long they will keep you on the ones that are the workhorses?  I'm sorry, i want a doc that will come in say hi, this is what is happening and why i am doing this...if such and such happens we can do this maybe at a later date and give me a plan with options.......and why they won't operate? I know it's bloody, but then the c is in your blood regardless...One would think they would want to get some of the mets out of there to downgrade your status.....have had quite a few treatments now and nothing disappears, supposedly it's stable.....have any of you many many treatments before seeing complete disappearance? Mine seem to hang on for dear life :{ begging to stay in.....I'll have to start naming them at this rate!! Anyway, would love to know how you all deal with, dealth with persistant mets.....I'd love to go see the doc the gentleman undergoing lung ops now......hit them one at a time, can it hurt?

Posts: 281
Joined: Aug 2016

Hello kyolcu - Just wondering the chemo cocktail you have been taking.  I have multiple liver mets as well.  I have had 28 treatments of avastin + folfiri.  Thanks for your input and wishing you well.   

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