Metastasis to liver - treatment options

My new oncologist sent me a recent article from Wolters Kluwer regarding colorectal cancer and specifically metastatic colorectal cancer.

Because there are 11 pages of material I'm only going to highlight some of the information that seems relevant to this discussion.

The article states "Cure is not possible for most patients with metastatic colorectal cancer, although some patients who have limited involvement of distant organs (particularly restricted to the liver and/or lung can be cured with surgery. Chemotherapy does not cure metastatic colorectal cancer, but it can improve symptoms and prolong life. Sometimes both chemotherapy and surgery are recommended."

Related to the liver "Up to xx% of people may be cured if metastasis in the liver can be completely removed (the medical term for this is "resected"). In order for surgery to be considered, there must be no evidence of cancer outside of the liver, and there must be an adequate amount of normal liver left behind after the resection to sustain life."  (note, I blanked out the percentage of people that may be cured. I don't want to know the odds unless someone can tell me, absolutely, which group I fall under. )

The size and location of the tumors are also considered. Chemotherapy might be recommended to try to shrink the tumors before surgery.

They recommend patients request a consultation with an experienced liver surgeon or surgical oncologist.

I haven't discussed surgery with my oncologist but have raised the question about ablation which I would prefer. I currently have 3 tumors in my liver, the largest being about 2.5 inches. I have one affected lymph node in my lung that for the time being is assumed to be metastasis. It's shown up brightly in 2 separate PET scans.

According to the radiology oncologist the size of the liver tumor makes it too large for ablation and with metastasis in both the liver and the lung, surgery does not seem to be an option.

Everyone is gung-ho on chemo at this point even though they all acknowledge it's not a cure. What the oncologist wants to see happen (optimistically) is that this chemo cocktail will shrink the liver tumor and make the lung spot disappear. At that point I can push for alternatives to remove the tumors.

There are a lot of sites that give a fairly decent summary of the various treatments for metatstasis to the Liver. I have no attachment to the following hospital, I just happened to run across the site during a search and liked the summary.

www.froedtert.com/colorectal-cancer/metastic-disease/liver-metastasis.  On the same page there is a link to another page covering Lung Metastasis.

The chemo cocktail I'm currently on is
- Irinotecan
- Leucovorin
- Panitumumab
- Fluorouracil (5-FU)

Plan was to get it every 2 weeks for 10 cycles.

I've had 2 doses and they had to put #3  on hold because the Irinotecan caused some of my liver enzymes to go out of whack.  So, went for blood work and a PET scan today to make sure it was only liver damage (I joke, sorta) and not the cancer stealing more of my livers real estate.

Enzymes are back to normal or near-normal, levels. Having an extra week to recover, sleeping about twice what I normally do, and eating about 8 cups of homemade vegetable soup everyday and drinking  a gallon of water, watered down fruit juice, and watered down gatorade, probably didn't hurt.

There hasn't been a formal report from nuclear medicine yet on the PET scan but the oncologist reviewed the scan and believes that the cocktail has reduced (not sure how much) the size of the turmors, including the lung node.

That's an improvement over 8 cycles of Folfox that didn't appear to do anything other than to get me out of the apartment so I could socialize with the nurses and for the mets to my liver and lung to grow.

I'll be restarting chemo tomorrow with a reduction in the dose of Irinotecan.

Don't know if anything in all this will help but hope something in here will tell you something you didn't already know or haven't already found.

Best Wishes,
Bill

I know it seems silly to get happy about chemo, but it means the ball is rolling and you are doing something to tame the beast. 

I've never had a Picc line, but I can tell you the port is a wonderful thing. Truly a great blessing, in my opinion. I don't know if I fancy anything stuck in my arm. The chest was a very convienient place and I had no problems with mine. 

As for side effects. They can vary in number and severity. You won't know how its going to affect you until you go through it. I had a whole list (which I have posted before) of side effects, including hair loss (all over) and mouth sores. Nose bleeds, heartburn, metal mouth, vision problems and of course neuropathy, to name just a few of the worse. I never got sick. YAY!

Good luck as you move forward into treatment. And keepp visiting us, we will help you through. 

SUE

Bellen said:

Liver mets

Sue - Do you remember what chemo you had that may have caused the hair loss?  Onco is saying won't cause hair loss with the chemo he mentioned, although last cancer chemo said hair loss was rare and I lost my hair quickly. Have been looking at wigs.  Also had terrible, terrible mouth sores - I wonder if it helps to take swishing mouthwash or other? all along the way - before they start even. Worried about that, as I can't afford a lot of weight loss.  Will get port, as you say better. Will be travelling 2 hrs each way, so hope that I feel okay to travel after the chemo - every 2 wks and then CT scan around month 2 or 3.  He is still meeting with a team, so not sure if plan will change at all.  He sure encourages, telling me to keep my life the same as much as possible, exercise, etc.  Really liked him.  Thank you Sue and the whole group for your support.

I also travelled many miles to my treatments and follow-ups. 2 1/2 hours each way. It made for a long day, but thankfully, I had no problems on the journey home. The steroid part of the infusion takes care of that. 

I was on FOLFOX and 5FU when my hair started falling out. I think the radiation put paid to the rest. I never went bald, like breast Cancer patients do, but I looked like Gollum. I mean, no joke, I looked like Gollum. My boys, at home at the time, did not want me to shave my head; but when I moved to the big city for radiation/chemo, I shaved it, and was very, very glad I did.   I didn't bother with wigs or hats, because I hate anything on my head. I looked great! I rocked the shaved head .

As for the mouth sores; I swished in a mixture of salt, baking soda and warm water. It really worked. I would advice doing it every day, regardless of wether you have active mouth sores of not. 

You will do well. Just go with the flow. It won't be fun, but you'll be alive, and 'Stayin' Alive', and thats what counts. 

SUE

Bellen said:

Liver mets

hi Sue - How many treatments of the folfax did you have?  I know a part of it is 5Fu, so I am getting prepared for hair loss or bad thinning as you say.  Did you say you had a port, as I have a choice,  but I said port - last time picc line, but I think that would be worse this time - ie showering, flushing out, etc.  thanks so much again.  May have more questions, if you don't mind.

and one day, it will be you answering the questions. 

So yes, I did have a port, and loved it. 

I had nine treatment's of FOLFOX followed up each time with 48 hours of 5FU.  Then I had six weeks of Radiation and 5FU. I didn't like the idea of being hooked up 24/7 to the pump, but it wasn't bad at all. 

 I bet it was the 5FU that caused my hair loss. 

SUE

Bellen said:

Liver mets

Thank you for all the encouragement and info.  I am looking at wigs - as I'm very pessimistic about chemo and keeping my hair.  Is there any cream/other that helps with itchy scalp or skin, and for the rash?  Also are the chemo cocktails folfox and folfiri acronyms - thought each had 5Fu - one with oxoliplatin (folfox) and the other with irinotecan (folfiri).  Not sure, as tried to absorb lot of info at appt.  I wish I had the confidence to dye my hair blue too - good for you!  Best to all.

Bellen, I've found that   several different things work well, but on different areas and for different amounts of time. When I first began the Erbitux, coconut oil was my moisturizer of choice and it worked well for a time. I used Aveeno ultra calming foaming cleanser and it still works well on my face, but not as a body wash. I began to get red and itchy every time I showered, so I switched to Aveeno  oatmeal soap and Aveeno lotion, which worked well  for awhile, but then the  flaky skin  got too much for them.   The  Erbitux website offers a free  patient self care kit, and I ordered one.  It contained a bar of Aveeno soap, lip balm, travel-size containers of several different products including Lubriderm and Jergens Ultra Healing moisturizer,  suntan  lotion and a nail care kit. They came in very handy.    I also found that Head and Shoulders shampoo worked well as both a shampoo and body wash. For my feet I use a  cream I mixed up of whipped shea and emu oil and slept in socks.  That really seemed to help. It might be a good idea to buy some of the small travel/sample  sizes of several  different moisturizers and see which works best for you. A friend  recommended Argan oil as the only thing that gave her skin any relief when she was on chemo, but it didn't work as well for me.  It's another of those individual things- everyone seems to react differently and what works well for one person my not work for someone else.

Sue answered the other part of your question about the acronyms  folfox and folfiri, but there are also  combinations outside those two. My oncologist says she hasn't even scratched the surface of what is available and what might work  for me as a particular person in a particular situation with a particular  condition. Good luck with your treatment- and don't get discouraged- there is an awful lot of info to absorb- it seems almost overwhelming at times.  But it's also very fascinating.

Bellen said:

Liver Mets

Re: itchy skin - I used aloe vera squeezed out of a live aloe vera plant for the bad burning I had from radiation treatments years also. Good thing - no perfumes, etc.  Wonder if it would work for itching as well.  It is not sticky like some aloe vera that I have bought.  Thank you for that advice.  What does one use for rashes, as some have said treatment caused that? May be asking more about other side effects soon, if the group doesn't mind.  Trying to stay positive, but unfortunately because I have had so much "waiting", have been online reading and it is very depressing.  Have to read more positive things to stay positive, so thank you for everyone's posts.  

I have a pure Aloe Vera called Abubrey Organics.  I have to keep it in the fridge, as it is the real stuff, with no fillers or gels. You have to apply it carefully, as it is runny. But right out of the fridge on a sore bum is wonderful.  

Good luck with the itching. I know many here have had it, so hopefully someone will pop on and answer your question, soon. 

SUE

I haven't had the same combination- I had Folfox plus Avastin and am now on Irinotecan plus Erbitux. Diarrhea was  the main thing I was warned about with the irinotecan and the doctor wrote me a prescription for Lomotil (Diphenoxylate-Atropine) in case it was needed, but I've only had to take a few tablets, since the Erbitux causes constipation and they mostly balance each other out.  I'm not sure whether  the irinotecan  works the same  in combinaton with the FU and leucovorin in the FOLFIRI combination. The Avastin didn't cause me too many problems, fortunately, and the nurses  monitored me pretty closely during the first infusion. They began with  an infusion of a steroid to counteract any allergic reactions and then an infusion of anti-nausea and anti-diarrhea meds before beginning the  FOLFOX infusion. I imagine it's the pretty same procedure with the FOLFIRI. I was always pretty wiped out  after the infusion  and slept a lot  after I got home and was usually still somewhat fatigued the day after, but that could be   due to my age, too. My oncologist  and the  nurses are pretty good about explaining  what  drugs I'm getting and why and give  very useful info sheets that list what to expect and when to call the doctor,  you could ask if your team has something similar. One odd thing has been that on  all the infusions, the skin on my face gets a deathly grey pallor on the day of the infusion but then begins to  turn beet red by the next day and feels very hot before going  back to normal, but I've never had a fever with it. You may or may not have something similar happen- as I said before we all seem to react differently. I hope your  chemo  zaps those  liver lesions down to a size where they can be removed or ablated and that it does so  with minimal side effects.

Grace/lizard44

Bellen said:

Liver mets and treatment

Hi all - Just talked to my Onco and he mentioned having folfuri with avastin as chemo.  He said radiologist said I have about 15 tumours throughout liver - not good news. Just had MRI liver, having colonoscopy next wk, as saying adenocarcinoma with mets to liver, and port put in - chemo starts end of mo. Boy, has taken a long time to get started - and will be travelling few hrs ea way as my own city has been so untimely with almost everything - sad.  Any suggestions on the Folfuri treatment or side effects.  Thanks so much everyone - so appreciate.

Hi Bellen,

If you get mouth sores the doc can prescribe a majic mouth wash that helps them heal quicker and it numbs them so you can eat better. Another thing I did was to use coconut oil to pull or swish between my teeth for 10 to 15 minutes before I brushed my teeth. I used bioteen tooth paste, it didnt have the burning effects of regular tooth paste. They also have mouth wash and mouth spray to help with dry mouth without burning the sores on your gums. Make sure you spit the coconut oil out in the toilet because it contains toxins, do not swallow it. It also whitens your teeth!

Another side effect that you might eventualy have when you get the nuelesta shot after you get the pump off after 48 hours. The shot is necessary to keep your white blood cells in the right range to keep you on track to keep getting treatment. The shot will cause your bones to ache. I used take 24 hour Allegra, for allergies,  the day before, the day of, and the day after the shot. It alleviates some of the pain.

best wishes,

Linda