CT/PET scan results & the beginnings of a new plan: radioembolism

lindaprocopio said:

Met with the head Liver Surgeon to discuss my options today.
I have 2 appointments this week: today's with the head liver surgeon at the hospital; and on Wednesday I meet with the Interventional Radiologist who would do the actual Yttrium 90 seeding if I get approved. My oncologist wanted me to meet with the liver specialist so that we could review all of my options for my extensive liver mets, and get the bigger picture for down the road of things they could do to help me.

It was a very positive consultation; I am quite hopeful! He said that uterine cancers are very receptive to radiation, which is why women with uterine cancer get radiation ajuvently whereas ovarian cancer patients don't. He said the radioactive 'microbeads' (Yttrium 90) are inserted in 2 sessions 3 to 4 weeks apart, to the left side of the liver and later to the right. Then if my scans show that it has been effective at killing some of the cancer, they can even go back in and do MORE of it to help beat the cancer back even further. He said that a person could still have good liver function even if a LOT of their liver was involved in cancer. He really made me feel MUCH less like a 'short-timer'. My oncologist really wanted this liver expert's approval and concurrence before we took this idea any further, as he considers the Interventional Radiologist overly aggressive. But "overly aggressive" fits my mindset right now, and I am SOOOO hoping I'll be a candidate for this BIG MOVE!

I asked what would exclude me from getting this treatment. He said the Interventional Radiologist would probably do a sonogram, looking for anatomical abnormalities that would keep the radioactive beads from getting where they need to go, or that would allow them to travel outside the liver. That could keep me from getting this,...or my insurance could balk at the crazy high cost. So keep your fingers crossed for me, ladies, and I will keep you posted after I see the Interventional Radiologist on Wednesday if I have any news or tidbits.

lindaprocopio said:

Met with the head Liver Surgeon to discuss my options today.
I have 2 appointments this week: today's with the head liver surgeon at the hospital; and on Wednesday I meet with the Interventional Radiologist who would do the actual Yttrium 90 seeding if I get approved. My oncologist wanted me to meet with the liver specialist so that we could review all of my options for my extensive liver mets, and get the bigger picture for down the road of things they could do to help me.

It was a very positive consultation; I am quite hopeful! He said that uterine cancers are very receptive to radiation, which is why women with uterine cancer get radiation ajuvently whereas ovarian cancer patients don't. He said the radioactive 'microbeads' (Yttrium 90) are inserted in 2 sessions 3 to 4 weeks apart, to the left side of the liver and later to the right. Then if my scans show that it has been effective at killing some of the cancer, they can even go back in and do MORE of it to help beat the cancer back even further. He said that a person could still have good liver function even if a LOT of their liver was involved in cancer. He really made me feel MUCH less like a 'short-timer'. My oncologist really wanted this liver expert's approval and concurrence before we took this idea any further, as he considers the Interventional Radiologist overly aggressive. But "overly aggressive" fits my mindset right now, and I am SOOOO hoping I'll be a candidate for this BIG MOVE!

I asked what would exclude me from getting this treatment. He said the Interventional Radiologist would probably do a sonogram, looking for anatomical abnormalities that would keep the radioactive beads from getting where they need to go, or that would allow them to travel outside the liver. That could keep me from getting this,...or my insurance could balk at the crazy high cost. So keep your fingers crossed for me, ladies, and I will keep you posted after I see the Interventional Radiologist on Wednesday if I have any news or tidbits.

lindaprocopio said:

Met with the head Liver Surgeon to discuss my options today.
I have 2 appointments this week: today's with the head liver surgeon at the hospital; and on Wednesday I meet with the Interventional Radiologist who would do the actual Yttrium 90 seeding if I get approved. My oncologist wanted me to meet with the liver specialist so that we could review all of my options for my extensive liver mets, and get the bigger picture for down the road of things they could do to help me.

It was a very positive consultation; I am quite hopeful! He said that uterine cancers are very receptive to radiation, which is why women with uterine cancer get radiation ajuvently whereas ovarian cancer patients don't. He said the radioactive 'microbeads' (Yttrium 90) are inserted in 2 sessions 3 to 4 weeks apart, to the left side of the liver and later to the right. Then if my scans show that it has been effective at killing some of the cancer, they can even go back in and do MORE of it to help beat the cancer back even further. He said that a person could still have good liver function even if a LOT of their liver was involved in cancer. He really made me feel MUCH less like a 'short-timer'. My oncologist really wanted this liver expert's approval and concurrence before we took this idea any further, as he considers the Interventional Radiologist overly aggressive. But "overly aggressive" fits my mindset right now, and I am SOOOO hoping I'll be a candidate for this BIG MOVE!

I asked what would exclude me from getting this treatment. He said the Interventional Radiologist would probably do a sonogram, looking for anatomical abnormalities that would keep the radioactive beads from getting where they need to go, or that would allow them to travel outside the liver. That could keep me from getting this,...or my insurance could balk at the crazy high cost. So keep your fingers crossed for me, ladies, and I will keep you posted after I see the Interventional Radiologist on Wednesday if I have any news or tidbits.

lindaprocopio said:

Met with the head Liver Surgeon to discuss my options today.
I have 2 appointments this week: today's with the head liver surgeon at the hospital; and on Wednesday I meet with the Interventional Radiologist who would do the actual Yttrium 90 seeding if I get approved. My oncologist wanted me to meet with the liver specialist so that we could review all of my options for my extensive liver mets, and get the bigger picture for down the road of things they could do to help me.

It was a very positive consultation; I am quite hopeful! He said that uterine cancers are very receptive to radiation, which is why women with uterine cancer get radiation ajuvently whereas ovarian cancer patients don't. He said the radioactive 'microbeads' (Yttrium 90) are inserted in 2 sessions 3 to 4 weeks apart, to the left side of the liver and later to the right. Then if my scans show that it has been effective at killing some of the cancer, they can even go back in and do MORE of it to help beat the cancer back even further. He said that a person could still have good liver function even if a LOT of their liver was involved in cancer. He really made me feel MUCH less like a 'short-timer'. My oncologist really wanted this liver expert's approval and concurrence before we took this idea any further, as he considers the Interventional Radiologist overly aggressive. But "overly aggressive" fits my mindset right now, and I am SOOOO hoping I'll be a candidate for this BIG MOVE!

I asked what would exclude me from getting this treatment. He said the Interventional Radiologist would probably do a sonogram, looking for anatomical abnormalities that would keep the radioactive beads from getting where they need to go, or that would allow them to travel outside the liver. That could keep me from getting this,...or my insurance could balk at the crazy high cost. So keep your fingers crossed for me, ladies, and I will keep you posted after I see the Interventional Radiologist on Wednesday if I have any news or tidbits.

lindaprocopio said:

GREAT meeting with the Interventional radiologist today!
The interventional radiologist took 2 hours with us today, almost as excited about doing this with me as I am about doing it with him. A resident sat in on the consultation, and a P.A. also spent a lot of time talking with us about it. They have only ever done ONE other radioembolism treatment for a gynecologic cancer patient (a cervical cancer patient whose metastisis was predominently in her liver), but they all believe they are on to something very promising as uterine cancer responds so well to radiation. But it really hit home how 'cuttimg edge' this is to try it for uterine cancer and I am proud and will be thrilled if I can be their guinea pig. Now if they can just sell the idea to my insurance provider!!

I learned a lot about the treatment and how the liver works. Did you know that cancer tumors create their own 'shunts' to get the blood they need? That is why I will have to have a 'dry run' of the procedure where they will shoot contrast up there to see if my cancer has built any shunts from my liver to my lungs or elsewhere. They are already planning )as a part of the treatment) on inserting plugs to any shunts in my liver that go down towards my bowel or lower regions. But if a shunt goes up into my lungs, they will need to shoot a different material in there to try and plug up that pathway to the lungs. If there is a shunt to the lungs that they can't plug, it will be too dangerous for me to get this treatment and that will be that. If I can get this radioembolism, it is an outpatient surgery that I would be awake for, and they would do half the liver first; give me 4 weeks to recover; and do the other half a month later. Each time I would be radioactive about 10 days and have to sleep alone and forego any close prolonged contact with anyone for 10 days. Other than some fatigue there are no other side effects; I should feel fine. Then I have to wait a minimum of 4 months before I can have an accurate PET scan because the radiation throws PET scans off.

Our fallback if I have a shunt to the lungs that cannot be plugged up, is that I could try chemoembolism instead of the radioembolism. This is chemo inserted directly into the artery and into the liver. It combines crazy-concentrated chemo with the blood-starving embolism qualities of the procedure, killing the cancer 2 ways. Chemo-embolism requires an overnight hospitalization to manage the expected accompanying pain and nausea. But chemoembolism is only being looked at if 'shunts' preclude me getting the radioembolism.

Now let's see how hard my insurance pushes back here. They have had 2 people with other cancers turned down flat by their insurance for radioembolism, even after appeal. Then we'll have to decide if we dare spend $200,000 of our OWN money on this. I don't think I could let my family do that for something palliative, not curative. & this IS a palliative thing; I still will have cancer when it's done. Just less of it. I won't even be in remission. But statistically radioembolism DOUBLES your life expectancy of time left on this beautiful earth. I'll keep you posted. Meanwhile I start tamoxifen/megace tomorrow to hold me during all of this.

Sorry for the LONG POST.

HellieC said:

Very informative post
Don't apologise for the length of the post - it was full of useful, cutting edge information.
I have everything crossed that your insurers will pay and that they can close all the shunts in order to try this new procedure. But, as Ro says, there is also a back up plan, which is always good news.
You are always so positive Linda. I admire you so much - as I've said before - you are a beacon of light to us all.
Kindest wishes
Hellie

lindaprocopio said:

GREAT meeting with the Interventional radiologist today!
The interventional radiologist took 2 hours with us today, almost as excited about doing this with me as I am about doing it with him. A resident sat in on the consultation, and a P.A. also spent a lot of time talking with us about it. They have only ever done ONE other radioembolism treatment for a gynecologic cancer patient (a cervical cancer patient whose metastisis was predominently in her liver), but they all believe they are on to something very promising as uterine cancer responds so well to radiation. But it really hit home how 'cuttimg edge' this is to try it for uterine cancer and I am proud and will be thrilled if I can be their guinea pig. Now if they can just sell the idea to my insurance provider!!

I learned a lot about the treatment and how the liver works. Did you know that cancer tumors create their own 'shunts' to get the blood they need? That is why I will have to have a 'dry run' of the procedure where they will shoot contrast up there to see if my cancer has built any shunts from my liver to my lungs or elsewhere. They are already planning )as a part of the treatment) on inserting plugs to any shunts in my liver that go down towards my bowel or lower regions. But if a shunt goes up into my lungs, they will need to shoot a different material in there to try and plug up that pathway to the lungs. If there is a shunt to the lungs that they can't plug, it will be too dangerous for me to get this treatment and that will be that. If I can get this radioembolism, it is an outpatient surgery that I would be awake for, and they would do half the liver first; give me 4 weeks to recover; and do the other half a month later. Each time I would be radioactive about 10 days and have to sleep alone and forego any close prolonged contact with anyone for 10 days. Other than some fatigue there are no other side effects; I should feel fine. Then I have to wait a minimum of 4 months before I can have an accurate PET scan because the radiation throws PET scans off.

Our fallback if I have a shunt to the lungs that cannot be plugged up, is that I could try chemoembolism instead of the radioembolism. This is chemo inserted directly into the artery and into the liver. It combines crazy-concentrated chemo with the blood-starving embolism qualities of the procedure, killing the cancer 2 ways. Chemo-embolism requires an overnight hospitalization to manage the expected accompanying pain and nausea. But chemoembolism is only being looked at if 'shunts' preclude me getting the radioembolism.

Now let's see how hard my insurance pushes back here. They have had 2 people with other cancers turned down flat by their insurance for radioembolism, even after appeal. Then we'll have to decide if we dare spend $200,000 of our OWN money on this. I don't think I could let my family do that for something palliative, not curative. & this IS a palliative thing; I still will have cancer when it's done. Just less of it. I won't even be in remission. But statistically radioembolism DOUBLES your life expectancy of time left on this beautiful earth. I'll keep you posted. Meanwhile I start tamoxifen/megace tomorrow to hold me during all of this.

Sorry for the LONG POST.

lindaprocopio said:

GREAT meeting with the Interventional radiologist today!
The interventional radiologist took 2 hours with us today, almost as excited about doing this with me as I am about doing it with him. A resident sat in on the consultation, and a P.A. also spent a lot of time talking with us about it. They have only ever done ONE other radioembolism treatment for a gynecologic cancer patient (a cervical cancer patient whose metastisis was predominently in her liver), but they all believe they are on to something very promising as uterine cancer responds so well to radiation. But it really hit home how 'cuttimg edge' this is to try it for uterine cancer and I am proud and will be thrilled if I can be their guinea pig. Now if they can just sell the idea to my insurance provider!!

I learned a lot about the treatment and how the liver works. Did you know that cancer tumors create their own 'shunts' to get the blood they need? That is why I will have to have a 'dry run' of the procedure where they will shoot contrast up there to see if my cancer has built any shunts from my liver to my lungs or elsewhere. They are already planning )as a part of the treatment) on inserting plugs to any shunts in my liver that go down towards my bowel or lower regions. But if a shunt goes up into my lungs, they will need to shoot a different material in there to try and plug up that pathway to the lungs. If there is a shunt to the lungs that they can't plug, it will be too dangerous for me to get this treatment and that will be that. If I can get this radioembolism, it is an outpatient surgery that I would be awake for, and they would do half the liver first; give me 4 weeks to recover; and do the other half a month later. Each time I would be radioactive about 10 days and have to sleep alone and forego any close prolonged contact with anyone for 10 days. Other than some fatigue there are no other side effects; I should feel fine. Then I have to wait a minimum of 4 months before I can have an accurate PET scan because the radiation throws PET scans off.

Our fallback if I have a shunt to the lungs that cannot be plugged up, is that I could try chemoembolism instead of the radioembolism. This is chemo inserted directly into the artery and into the liver. It combines crazy-concentrated chemo with the blood-starving embolism qualities of the procedure, killing the cancer 2 ways. Chemo-embolism requires an overnight hospitalization to manage the expected accompanying pain and nausea. But chemoembolism is only being looked at if 'shunts' preclude me getting the radioembolism.

Now let's see how hard my insurance pushes back here. They have had 2 people with other cancers turned down flat by their insurance for radioembolism, even after appeal. Then we'll have to decide if we dare spend $200,000 of our OWN money on this. I don't think I could let my family do that for something palliative, not curative. & this IS a palliative thing; I still will have cancer when it's done. Just less of it. I won't even be in remission. But statistically radioembolism DOUBLES your life expectancy of time left on this beautiful earth. I'll keep you posted. Meanwhile I start tamoxifen/megace tomorrow to hold me during all of this.

Sorry for the LONG POST.

lindaprocopio said:

RADIOEMBOLISM APPROVED !!! My insurance came through!
I just got off the phone with my insurance company, and they told me that a letter was mailed yesterday saying Assurant would consider this procedure for payment under my insurance. I asked, "does that mean I was approved to have this done?", and she said YES!!! So I phoned the Interventional Radiologist and they said as soon as they get the official letter, we can schedule the 'mapping' that will determine whether I am anatomically a candidate for the radioembolism. I'm very excited & hopeful & we're going out to celebrate this weekend!!