Why not liver surgery?

Ladyboots

Hi all, 

Hubby was just diagnosed stage IV colon with cancer in the liver, lungs and lymph nodes. He had major surgery to remove the large tumor on the colon. He just had his surgical staples removed laft Friday, and has been cleared to talk to the Onc on Jan 17, 17 about starting chemo.

I have been reading several posts today, and many of them talk about surgery to remove the cancer from the Liver. I wish I had asked why no one was talking about surgery for my hubby's Liver.

Anyone have any ideas why the surgon hasn't mentioned removing the Liver disease? Is this a positive or a negitive?

 

Trubrit

It can be both

It can depend on where in the liver your husband's tumours are. Sometimes they are too close to arteries and can't be surgically removed without lifethreatening consequenses. 

It also depends on the size of the tumours. If they are smaller, then the Onc may think that chemo will shrink them down. 

I know you will have a list of questions for the Oncologist on the 17th.  Talk about surgery options, including ablation, which is pretty new and very promising. 

Good luck on the 17th. 

TRU

harleywiz

liver surgery

im stage 4 for 3 1/2 years and i had mets to the liver and the first round of chemo removed it and my liver was clean but now on my 3rd chemo i have a live spot again and i asked about surgery and was told that its in your blood so its really not a option so talked to my surgon who would do it but im waithing on the pet scan to see what the this chemo does first .

beaumontdave

A surgical option has to do

A surgical option has to do with a number of things; size, location, and number of mets. I've heard they won't operate if it's spread elsewhere, that chemo and radiation are the main tools at that point, but definitely keep pushing them for answers and options..........................Dave

dancer2

why indeed

well. after 8 sessions of avastin, leucovorin(sp), irnenotecan, and pump with 5 FU, this second oncologist after looking at the pt scan just done wouldn't answer my question ( once again) about getting those liver mets resected. She mumbled something about the lungs( four spots, very very low suv, and that means six went away after scan in July, and each report says metatastic lesions in lungs without ever testing any and all are  around five or six or four mm except for one...I want everything out, knowing "it's in the blood", but gosh, the onc's here just ignores that plea. Now she wants me to go on lonsurf which i never have heard about and once i read about it, not sure if want to take it as it has only been given the ok by FDA since sometime in 2015 so there is almost nothing to read about it...just says for those who have gone through most chemo drugs and they didn't appear to work, then said the next step was clinical trial....my, don't like that...plus i read a lot about this, and most recent journals seem to say it is feasible...so now i have to see her and tell her would like another opinion about surgery by a liver specialist/surgeon. Not sure whether to start taking the stuff whenever they let me know if i get assistance or not or wait for an appt. and go out state to a center that does a thousand or more resections a year....Can't believe she just didn't try another cocktail, but am aware that the combo of oxy/xeloda that the first onc had me on just for three sessions and because the one and only liver spot had not shrunk or grown, and the only two lung nodules, well, only one shrunk from six mm to four just said go home and come back in three months but see this doc about an ablation and that radiologist told me i could have resection at that time but talked me into the rfa......did have the rfa ablation on liver at the end of April '15' and was told by radiologist it was a success, nothing new in liver and he could only see one spot in lungs....six weeks later had to have pt for original onc who ( if any remember , told me to just come back in three months as the liver just glowed) meaning four new lesions in liver, ten in lungs...I never went back. Now this one wants me to go on a drug that hasn't been around long enough for people to even write about it, then clinical trials...just let the surgery or radiation skip by.....you all know how that feels when you begin not liking what you are hearing.....tomorrow i will call this center and see how soon i can been seen or whatever their requirements are.....feedback anyone?

nj55

No surgery

I was diagosed with stage IIIC colon cancer in February, 2015 and had colon resection surgery and removal of 20 lymph nodes followed by the usual 12 rounds of Folfox 5 with oxsaliplatin.  I was cancer free for one year, then small spots showed up on my liver and multiple lymph nodes along with a pelvic floor tumor that is in bone and wrapped around organs.  The surgeon felt that the surgery would be so extensive and require such a long recovery time before chemo, that the risk of missing something would be too great - it would spread rapidly while I recovered.  The plan is to shrink or eliminate as many spots as possible with 12 rounds of Folfiri with irinotecan.  Surgery may be an option after the chemo, if most of the small spots are eliminated and the tumor shrinks.  I am hoping for surgery after the chemo since these two regimens are my only options. - I have the KRAS mutation and several others that eliminate other possible treatments.  I am also looking for clinical trials since I really don't have many other options.

beaumontdave

Lord it hurts to hear people

Lord it hurts to hear people wanting a real fix with surgery, which is what I pleaded for through my liver surgeries. They acted like it was optional, but I'd read enough here to know that cutting it out was the gold standard, and anything else came with big maybes. People need to know that many have gone far with other treatments, so I hope they hear Trubrit, JanJan, and Philly, and others, and believe that hope and life exists with these treatments. It's a hard game we have to play, and hope and belief are the only things that keep us from the abyss, the transition, whatever you may call it....................................Dave

PhillieG

Liver & OptionsAs

Sorry to hear about your husband's situation. My experience has been that they addressed things with me in order of importance from a medical point of view. I was dx'D with stage iv colon cancer with mets to the liver and lungs, but there was no blockage in my colon or urgency in my lungs that required them to attack those areas first. My liver had many tumors that made me inoperable. That was the #1 priority.

I did folfox and Avastin with the plan being to shrink the tumors so they could operate. I did ask about the lungs and colon and was told liver first. I was ok with that.

Maybe your husband's case is similar? I suggest you create a list of questions and go through them with his oncologist at the next visit. As Trubrit mentioned, ablations can be very effective as well as the HAI pump* that I had installed.

*Hepatic Arterial Infusion pump

https://youtu.be/dRcMMC11yZ0

Bellen

Folfiri with irinotecan

I have CRC with multiple liver mets - told inoperable.  I had my 8th folfiri chemo - avastin, irinotecan, leucovorin, 5Fu push and 5Fu bottle for 2 additional days.  Having every 2 wks.  I had a CT scan after 6th chemo, and had some encouraging news - still have multiple lesions in my liver, but report said markedly reduced.  Very happy to hear this - I know I have a long way to go and will continue with three more months of this chemo cocktail - this has been the only positive news I have had since an ultrasound saw spots in my liver in June - my dr kept saying "well, I don't have good news to share".  I ask about the CRC, but my Oncologist is focusing on the liver - I think the treatment also treats the CRC.  Wishing you well nj55.  Will let the group know about results from next CT scan, and what will be planned next depending on my results - assuming it will be after 3 mos.

nj55

new CT scan results

I just got the lab report from the CT scans of chest, abdomen and pelvis that were done yesterday.  I don't know what to think except that I am calling for a second opinion first thing Monday morning.  The scans done November 1 were not done at the hospital close to me (where all my reports are sent directly to me) because my husband was in ICU in Omaha, so I had them done there.  I have not actually seen those results, only had my oncologist tell me there was a tumor in the pelvic region, spots on my liver and multiple lymph nodes.  I have now completed 6 rounds of FOLFIRI with irinotecan, so the CT scans were repeated, this time at my normal location.  

This report references the first report to describe changes.  No one ever told me about multiple nodules in my right lung, and new nodules have now appeared.  This report says nothing about a pelvic tumor, not even to reference that it is gone, unchanged, etc.  Multiple new nodes have shown up on my liver, where the report only references 3 very small ones 3 months ago.  The chemo may be slowing progress, but nothing is shrinking.   All nodes are unchanged or enlarging.

I know the tumor exists because it was the only thing actually biopsied and I have those results. I am sure it is not gone since the slow, continuous bleeding it was causing has not changed.  Right now I don't know what to think.  

By education I am a geneticist, chemist, statistician.  I have spent most of my adult life as a research scientist, but because I now teach high school science in a rural school, the assumption is that I am too stupid to understand the reports.  I helped pay my way through school working in a medical lab.  I worked to sequence DNA and develop better techniques before the techniques used today were even developed.  I know how to read the reports. 

I guess I'm just ranting because I am tired of doctors making the decision about what we "need" to know or not know.  It is my body, tell me what is going on and give me real options.  If my doctor had not ordered the chest scan I was going to ask for it.  I know my breathing has been affected the last few weeks and I am constantly coughing up phlegm.  I was hoping for some good news that it was just the virus going around here, but my granddaughter has it and my symptoms don't match. Now I know why.

I have an appointment with him on Thursday and I will be taking a friend for moral support when I demand answers and options.