surgery question

pilarica
pilarica Member Posts: 44 Member
in Colorectal Cancer #1

Dear all:

I was diagnosed with colon cancer stage IV with mets to the liver last november, at that time the doctors said that I was not a candidate for surgery...... they put me on Folfox for 8 rounds (the primary tumor reduced by 50% at that time) so they put on Avastin and 5FU for 3 month and back to  Folfox because my colon tumor started to grow (very little but growth) the liver continues to get better.

So..... yesterday I had a meeting with my oncologist after I had the MRI that showed good improvement of the liver and stable colon tumor. She wants to do surgery of the colon and then treat the liver. To do that she said I have to be off chemo for 6 weeks......... I was wondering if any of you have been through a similar situation? Any recommendations or suggestions?? I am meeting with the surgeon in 2 weeks, any specific questions I should ask?

I find this forum extremely informative as well as supportive.......

Thanks,

Pilar

Comments

  • Trubrit
    Trubrit Member Posts: 5,804 Member
    #2
    Two weeks

    Thats frightening, it sounds so long, but when I looked back on my notes, that is how long I waiting between diagnosis and surgery. 

    I handled the surgery very well. I'm overall a pretty healthy person, and looking at your avatar (I presume that it is you) you look slim and trim and bright-eyed, so I bet you're pretty healthy too. 

    I was sore but not overly. I only used my Morphine pump three times. The Surgeon was impressed. 

    Walk. That would be my best adivce for post surgery. As soon as they give you the OK to get out of bed, do so just as much as your body can tolerate. I found so many ways to walk around the hospital ward. I ended up getting very friendly with another patient as I would say hi to everyone one with a door open. 

    Looking back, I wish I had asked the surgeon exactly what he planned to do. His answer may have included a few different options, as they are never to sure until they get inside. My surgeon started off laparoscopically (not sure if thats a word) and then openind me up when it was obvious the damage was too great. 

    I would also have asked him what his after surgery care would be. I was surprised when I didn't see him the follwoing day (which was a Saturday). I've had 12 surgeries, and I've always seen my surgeons the follwoing day. Finally, the follwoing night, a different Doctor arrived and had a look at my incision. He told me that my surgeon had gone on vacation. I was not impressed! I believe that is knowledge I shuold have been made aware of. 

    I find that if you don't ask, they don't tell. So figure out what is important to you, make a list and don't worry how long it is; then make sure they answer your questions to your satisfation. 

    Good luck! I hope you aren't going to spend these two weeks worrying. You have Cancer, no amount of worry will change that now. Enjoy yourself as much as you can. If you are in America, you get to celebrate Thanksgiving, and I hope you have a blast. 

    Sue - Trubrit

     

  • danker
    danker Member Posts: 1,276 Member
    #3
    Pilar

    I had chemo and radiationbefore my surgery. Also a six week rest between them.  Sounds like normal procedure!!! Good luck to you,may you soon be NED.(no evidence of disease)

  • sdp
    sdp Member Posts: 181
    #4
    6 weeks off chemo before the

    6 weeks off chemo before the operation seems right - but it will take at least 2 weeks after that to heal and get back on chemo or any other treatment - so consider 8 to 10 weeks off chemo 

     

    Can u not ask the surgeon if they could do surgery on liver and colon one after another ?

    There is a procedure called ALPPS- it may be possible if you have a

    An aggressive surgeon also consulted in this regard 

     

    If you are based in usa I would suggest an opinion from university of pittsburgh'

    Dr David geller -

     

  • Nana b
    Nana b Member Posts: 3,030 Member
    #5
    danker said:

    Pilar

    I had chemo and radiationbefore my surgery. Also a six week rest between them.  Sounds like normal procedure!!! Good luck to you,may you soon be NED.(no evidence of disease)

    You have to be off Avastin

    You have to be off Avastin for 6 weeks before you have any surgery, can cause bleeding.  I had to wait that long for my liver resction.   I had colon surgery, 3 months of chemo, wait six weeks, have liver resction, then 6 weeks later started my last 3 months of chemo. 

     

    Colon surgery was was done laperscopic, liver surgery was a full surgery  

     

     

  • JanJan63
    JanJan63 Member Posts: 2,478 Member
    #6
    sdp said:

    6 weeks off chemo before the

    6 weeks off chemo before the operation seems right - but it will take at least 2 weeks after that to heal and get back on chemo or any other treatment - so consider 8 to 10 weeks off chemo 

     

    Can u not ask the surgeon if they could do surgery on liver and colon one after another ?

    There is a procedure called ALPPS- it may be possible if you have a

    An aggressive surgeon also consulted in this regard 

     

    If you are based in usa I would suggest an opinion from university of pittsburgh'

    Dr David geller -

     

    I was diagnosed on Dec 31,

    I was diagnosed on Dec 31, 2013 but didn't get the surgery until June 12 of this year. The reason was that he wanted the tumour to be smaller so he had good margins. I had ostomy surgery and chemo and radiation in the meantime. And then they had to wait after the chemo to do the surgery, same as you. Chemo reduces your body's ability to heal and to fight off infection.

    I can't add much other than a couple of tips for after the surgery. One is don't let them take your blood pressure in the arm with the IV, it hurts. And the other is if they're giving you potassium in your IV and it starts to hurt tell them right away to slow it down. If they do it too quickly it's really painful. And always remember that you are in control. They were taking blood form me three times a day and finally I asked why it was so often and nobody had an answer and then suddenly it was once a day without anyone saying anything.

    Jan

  • tanstaafl
    tanstaafl Member Posts: 1,313 Member
    #7
    wife's 48 hr dose to dose

    Liver surgery will be a little trickier, more conservative on bleeding, but...

    It's not a secret here that we do things a little different around our house, perhaps more scientifically than dogmatically.  First the 6 weeks quoted is to get the avastin out, then we were told 3 weeks standard for 5FU infusions.  My wife takes UFT, an oral 5FU derivative that converts more efficiently than capecitabine with less side effects.  At low dose (~1/2 of std full scale, cyclic MTD dosing) oral UFT, 5FU is essentially out of your blood system in 12-24 hours (but not tumor tissues).  Generic forms of UFT are common outside of North America, but oral or low dose infusional 5FU would be closest. Post #1001

    We found successful studies and cases with perioperative chemo with 5FU, UFT and xeloda in the literature near surgery, up to, right through on the day of surgery, and right after. So she dosed her perioperative last (double dose of the day, at 24 hours before, is what we arranged.   We've used high dose, targeted cimetidine + intravaneous vitamin C instead of avastin for my wife all these years.   Also daily IV vitamin C (with high dose vitamin K2) prevents many kinds of surgical complications in sepsis and wound healing, along with some of the other super nutrient levels recommended as the super nutrition alternatives. Once we knew the coast was clear on uncomplicated recovery, she resumed metronomic, low dose UFT 24 hours after surgery with picture perfect recovery after being gutted like a fish (guts removed and replaced) and sliced at the aorta.  

    My wife has been shot through the lymph system on tumor cell seedlings, probably for 5 yrs. A lot of doctors wrote her off early on.  Daily cimetidine (CIM) is our anti-metastasis agent of choice.  **Any** time off of some kind of chemo means more spread and growth... However, there are alternative forms of chemo too, like ADAPT and Apatone or relatives.

    Our realities:

    Propostion a.  high dose cimetidine , IV vitamin C for as good as possible semi-replacement of avastin, throughout the surgical period, highest CIM dose at surgery for replacement of proton pump inhibitors like ranitidine. CIM was the original surgical standard for acid blocker.

    Proposition b. low dose continuous 5FU-LV nearer surgery, before and after.  I would be somewhat more conservative on liver op, and your surgeon will be too

    Proposition c.  wound healing can be optimized nutritionally; specfically including MK4, the active human form of vitamin K2 for anticancer and liver benefits too.     

    Proposition d. post op celecoxib and daily IV vitamin C asap instead of post op morphine. IV vitamin C in post op, with the continuous drip set up, is the physically easiest of all IV vit C, even 24 hr per day. 

    Proposition e. super nutrition in general; some alternatives are cancer inhibiting and even better with 5FU including celecoxib 

    Proposition z. Support by independent professionals outside the hospital system is essential to cover the normal gaps of standard medicine.

    Also having the caretaker on board and legally authorized is important to keep everything and everybody going to plan while you are in the hospital.

  • lp1964
    lp1964 Member Posts: 1,239 Member
    #8
    Dear Friend,

    I would find out if both the colon and liver could be done at the same time. Sometimes tthe colorectal surgeon call in a liver surgeon and do it right after. I had a suspicious spot on my liver and I was offered this. Thnk god it was nothing.

    I told my surgeon that I want no heroics and no short cuts. I'd rather have him take out more than less. He appreciated my input.

    At least 800mg/day of Cimetidine (over the counter) 2 weeks before and at least 2 weeks after the surgery may prevent the spread of cancer during surgery.

    I'm so glag you can have surgery. It will be a great relief knowing that the cancer is out of your body. It may have been an illusion, but mentally I felt healthy again after surgery.

    Laz

     

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