Future liver resection

menright

I had rectal cancer that spread to the liver (3-spots). The rectal tumor was removed in surgery (AP resection) along with the rectum and a portion of my lower colon. The beast is gone?

Now we are tackling the liver mtx's. Chemo for 3-6 months, MRI scan and then a right lobe liver resection. Currently all mtx's have been on the right lobe.

The waiting is to assure no mtx's show up in the left lobe.

Does this make sense? I am eager to get the liver surgery done. Waiting is one thing, having to endure chemo is yet another and I want to get it all over with.

Any similar cancer stories with comments on the plan will be greatly appreciated.

Mike

maglets

Hello Mike....my heart goes out to you having to wait and endure the chemo ....be that as it may that's the way it seems to be going. I have said more than once on this forum my experience was different....as soon as the liver was diagnosed it was surgery then chemo....but that seems to be a different protocol....sooo. And then for me the second round of liver mets was surgery then chemo...but you notice I had the second reoccurence so maybe chemo first then surgery is a good idea.

Also just aother thought....my liver surgeon is three hours away.....the first time I vistited with 7 mets on both lobes no one had told me to bring a copy of a ct scan so he sent me home again.....to arrange a ct scan of the liver. I was freakin because I thought let's get going on this....but he was very cool and said...no hurry/// so maybe hepatologists have a different version of hurry.

Wish i were more help...if you get a surgery date please allow me to help you any way....been there twice.


best regards,
mags

kimby

Liver Resection
Mike,

I think standard protocol is to be sure the liver tumors are stable prior to resecting. It's frustrating, I know. There really is no way of knowing how many tiny tumors you already have unless they wait and see. Tiny ones don't show up on scans. I assume that the goal of your resection is to be curative. So, you just have to wait. Man, I HATE that word...sorry.

Liver resection now with the possibility of missing something small diminishes the odds of cure. Hold out for the cure. It will be worth it in the long run. That's what your life can be - LONG.

Kimby

mom_2_3

My liver resection
Mike,

When I was first diagnosed I had 5 liver mets (largest was 6.2 cm). There were 3 on the left lobe, 1 on the right and 1 in the middle. I did 2 rounds (4 treatments) of FOLFOX and my oncologist and liver surgeon said I was ready for surgery. I had one more round of FOLFOX in the time between the surgery planning and the actual surgery. At my actual surgery I had the colon resected, my left lobe of liver removed, my gallbladder removed as well as had an HAI pump implanted. When I had my surgery the 6.2 cm met was down to 1.4 cm and 90% necrotic.

When I first consulted with my oncologist she said that we would do 2 rounds of chemo and then scan. If the mets shrunk we would continue with chemo and if they stayed the same or grew she was going to go for the HAI pump immediately. Because I had such a good response to the chemo we went into surgery much sooner than anticipated.

If you are going to go for 6 months on chemo I would make sure to have CT scans every 2 months to ensure that the mets are shrinking/stable and are not increasing in size. You certainly don't want to become inoperable during that period of time, especially as you are currently operable. Also, what is your chemo treatment plan for after your liver is resected?

One thing you may want to ask your oncologist about is the HAI pump as adjuvant treatment. I know they don't do them everywhere but they are really big where I go (MSK). Your oncologist may tell you that the treatment protocol is old/outdated or that it isn't shown to be more effective than the new chemo agents but anecdotally I have found many long-term survivors that had liver mets and used the pump as their adjuvant therapy. The chemo I receive from the liver pump (HAI) is painless (just a little stick like your regular port) and there are no side effects from the treatment. I will have a total of 6-7 months (every 5 weeks I get liver chemo) of the pump chemo. In addition to the liver chemo I do get systemic (5FU) every 2 weeks.

On a sidenote, when I was first diagnosed I did get an initial opinion from an oncologist at our local regional hospital. He told me I was inoperable, had 2 years to live and that he would put me on 6 months of chemo and then scan me at 6 months. Looking at my beautiful new baby girl I was heartbroken to think I would not see her grow up. So I went for a 2nd opinion at Memorial Sloan Kettering. The oncologist I see is renowned in this particular field (colon cancer with liver mets) and while she is short on the bedside manner she is long in the brains department...

Would it be easier for me to drive 5 miles to the regional hospital for chemo treatment? Sure would! But I chose instead to drive the 30 miles into NYC, pay exorbitant amounts for parking and submit to highway robbery to even get into the city (tunnel toll). But I feel getting a second opinion and getting treated at MSK will make a world of difference for me.


My baby is now 7 months old and I have been NED since February (my surgery date). I don't know if my NED status will continue but I juice everyday and I exercise (6 times per week) to give myself the best shot I can at making it to seeing my grandkids. So if you are feeling doubt about your oncologist's opinion is it an option to at least get a second opinion?

menright

mom_2_3 said:

My liver resection
Mike,

When I was first diagnosed I had 5 liver mets (largest was 6.2 cm). There were 3 on the left lobe, 1 on the right and 1 in the middle. I did 2 rounds (4 treatments) of FOLFOX and my oncologist and liver surgeon said I was ready for surgery. I had one more round of FOLFOX in the time between the surgery planning and the actual surgery. At my actual surgery I had the colon resected, my left lobe of liver removed, my gallbladder removed as well as had an HAI pump implanted. When I had my surgery the 6.2 cm met was down to 1.4 cm and 90% necrotic.

When I first consulted with my oncologist she said that we would do 2 rounds of chemo and then scan. If the mets shrunk we would continue with chemo and if they stayed the same or grew she was going to go for the HAI pump immediately. Because I had such a good response to the chemo we went into surgery much sooner than anticipated.

If you are going to go for 6 months on chemo I would make sure to have CT scans every 2 months to ensure that the mets are shrinking/stable and are not increasing in size. You certainly don't want to become inoperable during that period of time, especially as you are currently operable. Also, what is your chemo treatment plan for after your liver is resected?

One thing you may want to ask your oncologist about is the HAI pump as adjuvant treatment. I know they don't do them everywhere but they are really big where I go (MSK). Your oncologist may tell you that the treatment protocol is old/outdated or that it isn't shown to be more effective than the new chemo agents but anecdotally I have found many long-term survivors that had liver mets and used the pump as their adjuvant therapy. The chemo I receive from the liver pump (HAI) is painless (just a little stick like your regular port) and there are no side effects from the treatment. I will have a total of 6-7 months (every 5 weeks I get liver chemo) of the pump chemo. In addition to the liver chemo I do get systemic (5FU) every 2 weeks.

On a sidenote, when I was first diagnosed I did get an initial opinion from an oncologist at our local regional hospital. He told me I was inoperable, had 2 years to live and that he would put me on 6 months of chemo and then scan me at 6 months. Looking at my beautiful new baby girl I was heartbroken to think I would not see her grow up. So I went for a 2nd opinion at Memorial Sloan Kettering. The oncologist I see is renowned in this particular field (colon cancer with liver mets) and while she is short on the bedside manner she is long in the brains department...

Would it be easier for me to drive 5 miles to the regional hospital for chemo treatment? Sure would! But I chose instead to drive the 30 miles into NYC, pay exorbitant amounts for parking and submit to highway robbery to even get into the city (tunnel toll). But I feel getting a second opinion and getting treated at MSK will make a world of difference for me.


My baby is now 7 months old and I have been NED since February (my surgery date). I don't know if my NED status will continue but I juice everyday and I exercise (6 times per week) to give myself the best shot I can at making it to seeing my grandkids. So if you are feeling doubt about your oncologist's opinion is it an option to at least get a second opinion?

Sloan Kettering
I have been considering a second opinion. I live in Connecticut and MSK has been recommended before. You mentioned the renowned oncologist at MSK. Are you willing to share the name? Perhaps by PM you could let me know. I will consider this if I chose the grueling task of going into NYC. Thanks for the information.

Mike

mom_2_3

menright said:

Sloan Kettering
I have been considering a second opinion. I live in Connecticut and MSK has been recommended before. You mentioned the renowned oncologist at MSK. Are you willing to share the name? Perhaps by PM you could let me know. I will consider this if I chose the grueling task of going into NYC. Thanks for the information.

Mike

My oncologist
Here is a link to my oncologist's information.

http://www.mskcc.org/prg/prg/bios/123.cfm

Also review http://www.nextbio.com/b/search/author/Nancy Kemeny for a list of studies/papers in which she has participated.

If you google her you will see she is a thought-leader in the field. I know it can be a hike to NYC, however, if you are on the HAI protocol you don't need to go there for your systemic treatments. She will work with your local oncologist to do your treatment plan. I have met people in the waiting room that fly in from other areas of the country (usually once a month). I just thought you perhaps should consider the role of HAI as adjuvant therapy for your liver. I am hoping it does the trick for me!

kimby

menright said:

Sloan Kettering
I have been considering a second opinion. I live in Connecticut and MSK has been recommended before. You mentioned the renowned oncologist at MSK. Are you willing to share the name? Perhaps by PM you could let me know. I will consider this if I chose the grueling task of going into NYC. Thanks for the information.

Mike

2nd Opinion
Mike,

If you are considering a 2nd opinion, that means you should get one! I really, really, believe in them. What do you have to lose? Either the docs will agree and you'll feel more confident or they'll disagree and you'll have options. Win, win. Go for it.

Kimby

lesvanb

In no hurry
My liver resection surgeon was also in no hurry and the word I got was that the waiting was to make sure that the mets were stable with no further spread. My liver surgery (50% right lobe) was 7 weeks after my LAR surgery. My surgeon also did a very through job during the surgery itself checking out everything to make sure nothing was missed. Good Luck!

luv3jay

Different treatment
I have found that my treatment has been different from everyone else that I hear about. I too had rectal cancer with mets to the liver. I actually had 4 cycles of neo adjuvant chemo and then surgery. I had such a good response to chemo that we went against the standard of care. The primary rectal tumor completely melted away during the neo adjuvant and the 2 mets to the liver shrank considerably. We decided to have the liver resection done first...upon opening they actually found a third tumor, but the margins were clear after taking 60%, the entire right lobe along with the gallbladder. After 6 weeks recovery, we went back in for the primary and nodes. Even though the primary was still not there, they decided to remove 50% of the rectum along with part of my colon (LAR) and 11 nodes, 6 of which were positive. I'm back on adjuvant chemo now with a small "spot" on my liver that is too small to biopsy and they aren't sure whether it's even cancer or just residual scar tissue from surgery. The only way they could be sure would be if it grows, which it hasn't...so hopefully we'll never know! Anyway, I have 3 more cycles of chemo (Avastin + Xeloda) and then chemoradiation. I also got a second opinion and I'm being treated at Lombardi in Washington DC.

PhillieG

mom_2_3 said:

My oncologist
Here is a link to my oncologist's information.

http://www.mskcc.org/prg/prg/bios/123.cfm

Also review http://www.nextbio.com/b/search/author/Nancy Kemeny for a list of studies/papers in which she has participated.

If you google her you will see she is a thought-leader in the field. I know it can be a hike to NYC, however, if you are on the HAI protocol you don't need to go there for your systemic treatments. She will work with your local oncologist to do your treatment plan. I have met people in the waiting room that fly in from other areas of the country (usually once a month). I just thought you perhaps should consider the role of HAI as adjuvant therapy for your liver. I am hoping it does the trick for me!

Small world
I'd make the trip. She is my oncologist too. Stage IV colon cancer with mets to liver and lung. Dx 5+ years ago. Now down to a few small spots in lung. I'd be dead probably without her.
Just a word of caution, don't expect any hugs. You pay for brains, the nurses are the warm and fuzzy ones.
On a side note, just saw her today and we are staying with every other month chemo for now. Just Erbitux
-p

dixchi

Different Plans
I had a liver resection in 2008; had colon resection in 2004.
I had four Folfox treatments before surgery and eight afterwards.
When the first scan was done after the first treatment it showed
that the tumor in my right lobe had grown, according to the
oncologist. Then when the surgeon got in there he said that
there was more necrosis than anything else; it had not
spread, most likely liquified.....whether that meant that
the tumor over-responded to the chemo, I don't know but
it really scared me and that was when I thought about getting
a second opinion......but did not.....and at this moment,
I am doing well, scans and bloodwork are coming back NED....
chemo ended in December....it probably would have helped
my frame of mind if I had gotten a second opinion...a lot
of the interpretation depends on the radiologist and they
more often than not will "cover" for themselves and err
on the side of being negative.....I did change places to
get my scans and am now going to the University of Cincinnati
radiology department. They have the most up to date equipment
and I trust their interpretations more. It's sort of like
dominoes: the oncologist depends on the radiologist; wonder
if they ever disagree with the radiologist's findings??
Anyway, that is my story. I made a very good recovery
from the surgery but it did take more out of me than the
colon resection did. Good luck with whatever your
decision is.
Hugs,
Barbara

snommintj

dixchi said:

Different Plans
I had a liver resection in 2008; had colon resection in 2004.
I had four Folfox treatments before surgery and eight afterwards.
When the first scan was done after the first treatment it showed
that the tumor in my right lobe had grown, according to the
oncologist. Then when the surgeon got in there he said that
there was more necrosis than anything else; it had not
spread, most likely liquified.....whether that meant that
the tumor over-responded to the chemo, I don't know but
it really scared me and that was when I thought about getting
a second opinion......but did not.....and at this moment,
I am doing well, scans and bloodwork are coming back NED....
chemo ended in December....it probably would have helped
my frame of mind if I had gotten a second opinion...a lot
of the interpretation depends on the radiologist and they
more often than not will "cover" for themselves and err
on the side of being negative.....I did change places to
get my scans and am now going to the University of Cincinnati
radiology department. They have the most up to date equipment
and I trust their interpretations more. It's sort of like
dominoes: the oncologist depends on the radiologist; wonder
if they ever disagree with the radiologist's findings??
Anyway, that is my story. I made a very good recovery
from the surgery but it did take more out of me than the
colon resection did. Good luck with whatever your
decision is.
Hugs,
Barbara

There could be several reasons for waiting. There are several different resection techniques. One such technique has a much lower recurrence rate than the others. I think it's called the anterior approach, I wasn't able to have this technique in either of my resections because of the number and locations of my tumors. I think having just right lobe involvement might allow you to have this approach. If you can get this type of surgery your recurrence rate drops dramatically. I hope this is why they are waiting.