Stage IV Treatment Plan???

markatger · February 2005

Hi,
Hope all doing well. I'm a little weary. Last week PET scan pretty much confirmed liver met.
I went to talk to a surgeon outside my HMO today. His plan of attack is :
1. Radiation to rectal cancer and Chemo
2. Surgery to remove rectal cancer
3. More Chemo
4. Surgery for 3 x 3 cm liver tumor.

This wasn't what I was expecting. I had heard that if I had liver mets that I would have liver surgery very soon to remove it.
Could anyone tell me if this is the order of events that occured for them for liver mets? I realize everyone's case is different.
The surgeon says it would be stressful on my system to have them both tumors removed at same time. (I am only 33, though!) And if done seperately there is better chance of healing. Also if after three months, I have more mestastis in my liver then I am not a good candidate for liver surgery. This is a little bit nerve wracking for me for him to suggest to leave the liver tumor there and wait to see if more develop. He said though that there is more of a chance of mestatsis coming from the rectal tumor than coming from the liver tumor.
I'm also still trying to sort out with my HMO for everything. The surgeon (outside HMO) strongly urges that I get all my care coordinated in one place. I really hope HMO agrees to this. Have all chemo/radiation, surgery and follow care done at the surgeon's hospital. I had my PET scan done at my HMO last week. It was a joke. It was in a trailer outside of the building because it is a mobile unit that travels around to hospitals. It was freezing in there. I was wheeled out to it in a wheelchair very uncomfortable because of catheter in place. That is ridiculous. I am in a large city. Why the heck doesn't this HMO just get PET scans done at a nearby hospital. It would be different if I was in the boondocks.
Anyways...long post
Thanks in advance for any info
-Maria

RunnerZ · February 2005

Maria,
I am a 6 year survivor of stage 3 rectal cancer. However, I did have a day long scare when a CT Scan showed what appeared to be a small tumor on my liver. That turned out to be a hemangioma, which they could tell by later ultrasounds. However, I had the best Dr.s in NY City and their plan of attack, had it been a liver met, what the same as you have been given. The preoperative chemoradiation will likely go after that one small liver met as well, so don't stress about it. In fact, by the time you are done treating that rectal cancer, the liver met may just be scar tissue. I had great luck with the preoperative treatment...my cancer was wiped out by it. Don't hesitate to get a 2nd opinion, but I just had to share that the game plan sounds like the one I was facing. By the way, when I had my rectal surgery, the surgeon probed the liver as well. The whole operation will be coordinated with your treatment plan, I can almost guarantee. DO NOT WORRY!! My Dr. said that a single met to the liver can be beat quite easily with treatment and surgery. You will be great...just hang on for the next year or so...that is the hard part. Let us know how you are doing.

sallyjoy · February 2005

Maria,
Hi there. My hubby was diagnosed one year ago this week with stage 4 colon cancer with one 2x 1.8 cm met to the liver... First he had the colon resectioned - his colon nwas all but blocked so there was no time for other pre-op treatment. He then had a mediport placed for chemo and had a few months of chemo. after that he had his liver resected in august. He chose not to have nore chemo after that, but he could have opted to. Anyway it sounds right to me... I know they never considered doing the liver surgery first.

The GREAT news is that the chemo after the first op. shrunk the liver met. And now hubby has NED (no eveidence of disease) REMISSION! He is now a ONE YEAR SURVIVOR! Please fell free to contact me if I can help in any way. Good luck and God Bless and Keep you - (that goes for everyone here - you're all always in my thoughts and prayers)

Sally Jo

MJay · February 2005

Hi MAria-

I am so sorry that you are going through this. I was dx'd with stage 3 rectal cancer last year when I was 37. It certainly rocks your world.

I don't have experience with liver mets so I can't comment on that but I did want to extend my welcome to our family. It stinks that we had to go through what we did (do) but it is wonderful we have each other.

MJay

bryancarson · February 2005

Hi. It's Bryan again...I don't really know how the rectal cancer will effect your treatment plan, but when I had mets to the liver, they started with chemo and waited for the tumor to be necrotic (dying and almost dead...detectable with CEA and CT and PET scans) when that happened, about 4 months of FOLFOX chemo, I had surgery. They wanted to be sure that the tumor was as small as possible and that when removed that it wouldn't spread. Ask your oncologist what chemo they are planning on for the rectal cancer. If it is for adno-carcinoma, then it will also kill the met to your liver. If you want, get a second opinion. I would. I hope you got in at Virginia Mason. Let me know if there is anything I can help you with.

aspaysia · February 2005

I am all for treatment in a comprehensive cancer center if the out-of-network charges are not too much to bear. I am fortunate that my PPO uses Duke University Hospital. THe cancer center is housed in one building and I never have to stray very far from one clinic to another. My surgeon and oncologist share a hallway and know one another on a first-name basis. So Mike consults with Chris on the run as they go about their business. My plastic surgeon, Laura, is just around the corner in the wound management clinic. Radiology is downstairs along with the chemo treatment room. I had to see the liver guy about a shadow on the ct scan and he was right there. His PA is married to the oncologist's nurse. It's just one big happy family. They have regular meetings about patients and more than one doctor can be in the consultation rooms. It gets pretty crowded in there sometimes.
Aspaysia, who has nothing wrong with her liver after all.

shmurciakova · February 2005

Hmmm....Well, I guess my situation was a little different than yours. I did not have a large rectal tumor. Mine was a 1cm polyp in the Sigmoid colon which had gone into the lymph nodes. I did not have any pre-op chemo. So, I am not sure about that part. I would want to know the reason for the radiation/chemo prior to surgery. Is it too large? Can't they just operate and remove it?
That would be my 1st question I would want answered. Secondly, they probably cannot do the two surgeries at once? Maybe they can, but they would not be done by the same surgeon. If you want a second opinion on this matter I would ask to speak to the liver surgeon and see what he/she says.
My liver met was undetected until after I had surgery on the colon and 6 months of chemo. It was found at a followup.
I would not worry about more mets on your liver in such a short period of time. You have to realize that you have probably had cancer for 5-10 years already and you did not even know about it. Nothing has really changed since last month, except for your knowledge of this problem. I don't think things will just start to go nuts in the next 3 months. They are on top of it and I think you just have to trust that they know what they are doing.....that is why they get paid the "big bucks". I am sure they are sensitive to your age and will be as agressive as possible because of it. If you have questions for them, by all means ask! See if you can e-mail them. I speak to my liver surgeon who is also my surgical oncologist via e-mail. The thoracic (lung) surgeon also answers e-mails. Actually, this is the easiest way to get ahold of them.
Good luck and try not to be scared.
-Susan.

P.S. Let us know what is going on as it happens.

shmurciakova · February 2005

OH Yeah, the PET scanner in the trailer! That is not all that unusual. In Anchorage the PET scanner is also in a trailer, well, they might have moved it inside by now...But at any rate, it is also in the trailer in Waco, TX where my brother practices. You may be thinking that Anchorage and Waco are the boonies, but they are not. The thing is that PET is a fairly new technology - also it is exceedingly expensive - so many hospitals share these machines. They are in the trailers so they can be moved from hospital to hospital.
I do live in the boonies and our CT scanner is in a trailer too! LOL.

mikew42 · February 2005

Maria, I to a Stage 4 colon cancer survivor (3months since last treatment and still NED). I had a 2cm tumor that was discovered during my colon surgery (it was not picked up in CAT scan). They could have done surgery to remove it, but we all decided it would be better to have chemo first, then if anything left, remove it. It was 2 cm originally, and reduced down to to less than 1 cm by the time my 7 months of chemo was over. BTW, the tumor was not seen on PET, only MRI. They ablated (RFA)the met last October and no new mets since. As for the mobile PET scan, I live in Portland Oregon (not in the boonies) and our hospital still uses the mobile scan. I've had both (mobile and not) and really not much difference. It was also cold in the mobile, but they had heated blankets to keep you warm. The fact that they can even do the surgery on your liver is great news. Keep up the fight and I look forward to the day you can report to us you are also NED. Mike

KKLoop · March 2005

My Mother was diagnosed with a 1cm rectal tumor in August 04. Dec 04 her tumor was removed and an osti bag was required. At that time they noticed a "cyst" on her liver. Before surgery we discovered that it was 2 liver tumors. She was 49 at the time and in great shape. They too believed that she couldn't handle the stress of removing both rectal and liver tumors. Her liver tumors are on opposite sides and surgeon stated that he had to leave some liver. Get one, let the liver heal and then go back for the other. We waited 2 months for her rectum wound to heal to start chemo. We just found out that the chemo she has been on has not prevented the tumors from spreading. I do believe the procedures you are looking at are common. I mention the other so that you have a heads up. Let me know how things go with you please.

Stage IV Treatment Plan???

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