Surgery or Chemo first

seabass19

Hi everyone, my 36 yo wife was diagnosed with Colorectal Cancer last July, and went through 5 weeks of radiation and chemo followed by complete colectomy last November. We thought things were going well and were scheduled to start 6 months of Folfox last week, when they found some lesions on her liver. We have now been given the options of: A) have the resections done immediately (8 weeks after her colectomy, but she has healed well), then follow it with the chemo or do the chemo first and keep an eye on the tumors to monitor how the chemo reacts and then do the surgery afterwards. Our medical oncologist and oncology surgeon have both said that both have to happen, but they have differing opinions on which needs to happen first.

Do any of you have experience with this situation or advice? Thanks.

Buzzard

Only my opinion....
I do not know all the facts but if it were me I would want the growths out. If they are out then there is no question of whether they will grow or not. Again, this is only the option that I would want only knowing what I know about your diagnosis........Love and Hope to you and your wife...Buzz

Lovekitties

My 2 cents
My preference is to have surgery first. Better to get it out and then deal with the rest of the treatment.

dmdwins

Lovekitties said:

My 2 cents
My preference is to have surgery first. Better to get it out and then deal with the rest of the treatment.

Agree
If you think she is strong enough for another surgery ....I agree......get it out before it has any opportunity to spread then chemo treatment.

AnneCan

Welcome seabass
I am sorry you need to be here. My question is, Do you have a tumour board at your cancer centre? These boards are made up of surgeons, oncologists, radiation oncologists + other medical personnel. It is their job to determine what they think is the best course of action for each patient. I think you need a recommendation from a board like this, if your oncologist + surgeon cannot agree. There are ~ 50 professionals on the tumour board at my cancer centre. When I was diagnosed in 2009, my case was put before the board + the best course of action was determined to be radiation/chemo, then surgery. At that time they suspected I had liver mets but were not certain. After the radiation + chemo it was confirmed that I had 4 liver mets + I was told colon surgery was not an option at this time. I was told that if I had the colorectal surgery, I would be off chemo for several weeks before + after surgery, giving the liver mets a chance to grow. Instead, I have been on chemo since Sept/09. Was I disappointed? I cannot even tell you how disappointed I was. Do I still continue to hope that I will have the surgery? You bet. With chemo, I have done pretty well. I believe there is no "one size fits all" treatment for colon cancer, particularly with mets involved. I think when there are multi liver mets (I don't know how how many your wife has) there is concern that there may be more that can't be seen. You might want to get an opinion from another (major) cancer centre. Personally I think you want a medical team who agrees on what the best plan is for your wife.

mom_2_3

Liver resection
Sea bass,

In my own particular case we went the route of having the colon and liver resection done simultaneously. If I was in your wife's shoes I would probably go the route of immediate liver resection with follow-up chemo. I know it may be informative to find out if the liver mets will respond to the chemo but the truth is, the cancer cells either will or won't respond. If they do respond you know you can continue with that regimen as adjuvant chemo. But if they don't, you run the risk of additional mets forming or these increasing in size and possibly attaching to or nearing critical liver arteries that would then possibly prevent resection. If she has the resection and and the chemo regimen doesn't work you will know from recurrence but you can then address it at that time.

I would suggest, however, that you quickly look into a therapy called HAI pump therapy which is a pump installed directly into the hepatic artery and pumps chemo right into the liver. I did this as adjuvant therapy after my resection. My surgeon told me that chances of liver recurrence after resection would be 70 percent but that with the pump the chance of recurrence would drop to 50 percent. They don't do this particular therapy in many locations but do so at Memorial Sloan Kettering where I am a patient. This therapy can be of even more benefit to those with multiple mets as your wife has. If you have any questions about this, please let me know.

Best wishes to you both,
Amy

plh4gail

May I ask please?
I have a question for you please? How did they find your wife's lesions on the liver at that point in her treatment? You see, I was diagnosed in June with colorectal and then went through the 5 week radiation and chemo. Surgery was in October and I started folfox in December. This worries me about my own diagnosis. I wish you and your wife the best of everything and will look forward to more follow ups.

Gail

PhillieG

My experience was
to have chemo first to shrink tumors, then surgery. I was DX with stage IV colon cancer in Feb 04 and did 6 months chemo to shrink the liver tumors. I had tumors in my liver that were in a bad spot so they had to be shrunk in order to operate. I have absolutely no regrets.
-p

CherylHutch

To operate or to wait... that is the $million question!
Hi Seabass,

First... welcome to the board, although I'm so sorry you and your wife have to be here. Still, you have found this board so early in your wife's journey and I think you will be glad you did. It's a great bunch of folk here

Now... as for your question. I think you are going to get many who are for surgery and many who are for chemo and then variations in between. The reason... there really is no right answer. Whichever one you choose, there will be followup care/treatment... and if there are any changes between now and then, the plan will have to change to accommodate them.

I may see things differently but I think I would want to go with the chemo first, then surgery. Your wife has been through a major surgery and although she may be doing really well and have come through with flying colours, her body does need some time to heal on the inside before hitting her up with another surgery, if there is another plan that one can start. If she goes on chemo, they will monitor her liver like a hawk to check if the lesions are at all shrinking... and if they are, then this is a good thing because it will make the surgery that much easier if everything is shrunk. Also, the fact the cancer has spread from it's original location in the colon/intestine to the liver, unfortunately it is like many of ours and considered "systemic". That means there could be microscopic cancer cells roaming around in her system, just waiting to land somewhere and grow (liver and lungs are two of the more common organs for colon cancer spread). Surgery is focused on one area (IE: the liver) whereas chemo is systemic. The chemo won't just be going to the liver but will be traveling throughout her blood system, her lymph system and to all organs. So the hope would not just be that the chemo shrink the known lesions, but kill off cancer cells in the lesions that might not be seen yet on a scan, or even the microscopic cells that might just be roaming around.

So, just another opinion to throw into the pot... but my vote would be chemo first, then surgery.

Keep us posted which one you two choose!

Cheryl

PS: And I agree with Anne's question about the Tumour Board. If your wife's oncologist and surgeon can't agree on the plan, you need to get a concensus from a group of experts, not just one or two.

seabass19

plh4gail said:

May I ask please?
I have a question for you please? How did they find your wife's lesions on the liver at that point in her treatment? You see, I was diagnosed in June with colorectal and then went through the 5 week radiation and chemo. Surgery was in October and I started folfox in December. This worries me about my own diagnosis. I wish you and your wife the best of everything and will look forward to more follow ups.

Gail

Finding the Mets
Gail,
She had a CT to take a look at her abdomen as part of her workup to start the Folfox, the week before our scheduled start date. That revealed lesions, and was followed up with a MRI and PET. Wow, we are almost exactly 1 month behind where you are in all of your treatments.