Tumor Board reversed decision on surgical treatment

Roterosa

Greetings to all my fellow CRC challengers out there! I am in an odd predicament with my mother's current treatment plan and would really appreciate any insights and suggestions you may have. All thoughts and comments are welcomed!

Quick background- My mother was diagnosed with stage IV colorectal cancer at the then end of Jan. this year. The primary tumor is in the sigmoid colon (it causes no obstruction), 4 focal lesions in the liver, 1 in the right lower lobe of the lung, 1 in the right hilar lymph node, 1 in the subcarinal lymph node. The lesions in and near the lungs were not an initial concern, they are extremely small. Because her health is excellent for a woman her age, the doctors believed there was a chance that chemo would reduce the size and intensity of the liver metastasis enough to make her a candidate for a liver resection.

Six rounds of FOLFOX showed significant improvement on PET scans and her main oncologist happily gave the go ahead to surgically remove the tumors in the liver. We met with the liver surgeon, discussed all the details, passed all the tests for a cardiac clearance, and a tentative date was set. THEN, on 6/25, a member of her Tumor Board raised the concern that biopsies of the thorax nodules did show cancer cells and pressured the liver surgeon to not operate in favor of putting my mother on palliative chemo. In the words of another board member, the liver surgeon got "spooked". To be clear, the most recent PET scan of the thorax area showed all the lesions to be under 1cm with an SUV under 2.0. A CT scan taken 4 days ago showed no malignancies in the thorax and her CEA level is now at 5.2. Her pulmonary specialist and main oncologist had suggested surgery/ablation to remove the spots in/near the lungs would be unnecessary, post surgical chemo would likely destroy what might be left of them.

My family is deeply saddened by this abrupt change of plans. No reason outside of cancer cells being found in more places then the liver was ever offered. My mother's main oncologist was apologetic and agreed to support us in finding an outside clinic where the liver resection could be performed. I am deeply grateful for the members of her Tumor Board that still believe there is a curative course for my mother, but they alone can't decide the actions of the board in general. All attempts to request the board reconsider this new position have thus failed.

While there are cancer clinics that can quickly offer a second opinion through a telemedical meeting, the request for a surgical operation will require an in-person medical evaluation and hospital scheduling. Traveling is not a problem for my mother, but the urgency for an operation to be done quickly is. The oncologist has suggested a liver resection be performed no more then 4-6 weeks from now. She can not remain off chemo for too long but more FOLFOX risks making the liver inoperable. The most effective maintenance/palliative chemo would include bevacizumab and an EGFR inhibitor. Both of these targeted treatments are not recommended before surgery.

There are cancer centers with gifted surgeons the CRC community can recommend that are willing to perform liver resections on patients who qualify for the procedure, but are there any medical centers with a reputation for quick scheduling? Any and all recommendations this community may have for clinics I could try will be deeply appreciated!

Thank you and may peace be with you on your own cancer journeys- Mel

Wadsdan777

Hi there, sorry for the up and down's i know of them all to well! I had a no to surgery, then a yes, then a no, then a yes again . ( and now im 3 major surgeries in! )

Are you located in the US or another location?

Definatley a 2nd opinion is warranted on the liver surgery specifically, it can be a GAME CHANGER for your mom, my liver surgery gave me 2 years of NED in the liver itself - something unlikely with just chemo alone. I would push push PUSH for liver surgery.

LPMASON

Hello,

I also would love to make a recommendation for you. Assuming you are in the US, I would recommend the UNC Health system in NC (specifically in Chapel Hill).