Future liver resection

Hello Mike....my heart goes out to you having to wait and endure the chemo ....be that as it may that's the way it seems to be going. I have said more than once on this forum my experience was different....as soon as the liver was diagnosed it was surgery then chemo....but that seems to be a different protocol....sooo. And then for me the second round of liver mets was surgery then chemo...but you notice I had the second reoccurence so maybe chemo first then surgery is a good idea.

Also just aother thought....my liver surgeon is three hours away.....the first time I vistited with 7 mets on both lobes no one had told me to bring a copy of a ct scan so he sent me home again.....to arrange a ct scan of the liver. I was freakin because I thought let's get going on this....but he was very cool and said...no hurry/// so maybe hepatologists have a different version of hurry.

Wish i were more help...if you get a surgery date please allow me to help you any way....been there twice.


best regards,
mags

My liver resection
Mike,

When I was first diagnosed I had 5 liver mets (largest was 6.2 cm). There were 3 on the left lobe, 1 on the right and 1 in the middle. I did 2 rounds (4 treatments) of FOLFOX and my oncologist and liver surgeon said I was ready for surgery. I had one more round of FOLFOX in the time between the surgery planning and the actual surgery. At my actual surgery I had the colon resected, my left lobe of liver removed, my gallbladder removed as well as had an HAI pump implanted. When I had my surgery the 6.2 cm met was down to 1.4 cm and 90% necrotic.

When I first consulted with my oncologist she said that we would do 2 rounds of chemo and then scan. If the mets shrunk we would continue with chemo and if they stayed the same or grew she was going to go for the HAI pump immediately. Because I had such a good response to the chemo we went into surgery much sooner than anticipated.

If you are going to go for 6 months on chemo I would make sure to have CT scans every 2 months to ensure that the mets are shrinking/stable and are not increasing in size. You certainly don't want to become inoperable during that period of time, especially as you are currently operable. Also, what is your chemo treatment plan for after your liver is resected?

One thing you may want to ask your oncologist about is the HAI pump as adjuvant treatment. I know they don't do them everywhere but they are really big where I go (MSK). Your oncologist may tell you that the treatment protocol is old/outdated or that it isn't shown to be more effective than the new chemo agents but anecdotally I have found many long-term survivors that had liver mets and used the pump as their adjuvant therapy. The chemo I receive from the liver pump (HAI) is painless (just a little stick like your regular port) and there are no side effects from the treatment. I will have a total of 6-7 months (every 5 weeks I get liver chemo) of the pump chemo. In addition to the liver chemo I do get systemic (5FU) every 2 weeks.

On a sidenote, when I was first diagnosed I did get an initial opinion from an oncologist at our local regional hospital. He told me I was inoperable, had 2 years to live and that he would put me on 6 months of chemo and then scan me at 6 months. Looking at my beautiful new baby girl I was heartbroken to think I would not see her grow up. So I went for a 2nd opinion at Memorial Sloan Kettering. The oncologist I see is renowned in this particular field (colon cancer with liver mets) and while she is short on the bedside manner she is long in the brains department...

Would it be easier for me to drive 5 miles to the regional hospital for chemo treatment? Sure would! But I chose instead to drive the 30 miles into NYC, pay exorbitant amounts for parking and submit to highway robbery to even get into the city (tunnel toll). But I feel getting a second opinion and getting treated at MSK will make a world of difference for me.


My baby is now 7 months old and I have been NED since February (my surgery date). I don't know if my NED status will continue but I juice everyday and I exercise (6 times per week) to give myself the best shot I can at making it to seeing my grandkids. So if you are feeling doubt about your oncologist's opinion is it an option to at least get a second opinion?

menright said:

Sloan Kettering
I have been considering a second opinion. I live in Connecticut and MSK has been recommended before. You mentioned the renowned oncologist at MSK. Are you willing to share the name? Perhaps by PM you could let me know. I will consider this if I chose the grueling task of going into NYC. Thanks for the information.

Mike

My oncologist
Here is a link to my oncologist's information.

http://www.mskcc.org/prg/prg/bios/123.cfm

Also review http://www.nextbio.com/b/search/author/Nancy Kemeny for a list of studies/papers in which she has participated.

If you google her you will see she is a thought-leader in the field. I know it can be a hike to NYC, however, if you are on the HAI protocol you don't need to go there for your systemic treatments. She will work with your local oncologist to do your treatment plan. I have met people in the waiting room that fly in from other areas of the country (usually once a month). I just thought you perhaps should consider the role of HAI as adjuvant therapy for your liver. I am hoping it does the trick for me!

In no hurry
My liver resection surgeon was also in no hurry and the word I got was that the waiting was to make sure that the mets were stable with no further spread. My liver surgery (50% right lobe) was 7 weeks after my LAR surgery. My surgeon also did a very through job during the surgery itself checking out everything to make sure nothing was missed. Good Luck!

mom_2_3 said:

My oncologist
Here is a link to my oncologist's information.

http://www.mskcc.org/prg/prg/bios/123.cfm

Also review http://www.nextbio.com/b/search/author/Nancy Kemeny for a list of studies/papers in which she has participated.

If you google her you will see she is a thought-leader in the field. I know it can be a hike to NYC, however, if you are on the HAI protocol you don't need to go there for your systemic treatments. She will work with your local oncologist to do your treatment plan. I have met people in the waiting room that fly in from other areas of the country (usually once a month). I just thought you perhaps should consider the role of HAI as adjuvant therapy for your liver. I am hoping it does the trick for me!

Small world
I'd make the trip. She is my oncologist too. Stage IV colon cancer with mets to liver and lung. Dx 5+ years ago. Now down to a few small spots in lung. I'd be dead probably without her.
Just a word of caution, don't expect any hugs. You pay for brains, the nurses are the warm and fuzzy ones.
On a side note, just saw her today and we are staying with every other month chemo for now. Just Erbitux
-p

dixchi said:

Different Plans
I had a liver resection in 2008; had colon resection in 2004.
I had four Folfox treatments before surgery and eight afterwards.
When the first scan was done after the first treatment it showed
that the tumor in my right lobe had grown, according to the
oncologist. Then when the surgeon got in there he said that
there was more necrosis than anything else; it had not
spread, most likely liquified.....whether that meant that
the tumor over-responded to the chemo, I don't know but
it really scared me and that was when I thought about getting
a second opinion......but did not.....and at this moment,
I am doing well, scans and bloodwork are coming back NED....
chemo ended in December....it probably would have helped
my frame of mind if I had gotten a second opinion...a lot
of the interpretation depends on the radiologist and they
more often than not will "cover" for themselves and err
on the side of being negative.....I did change places to
get my scans and am now going to the University of Cincinnati
radiology department. They have the most up to date equipment
and I trust their interpretations more. It's sort of like
dominoes: the oncologist depends on the radiologist; wonder
if they ever disagree with the radiologist's findings??
Anyway, that is my story. I made a very good recovery
from the surgery but it did take more out of me than the
colon resection did. Good luck with whatever your
decision is.
Hugs,
Barbara

There could be several reasons for waiting. There are several different resection techniques. One such technique has a much lower recurrence rate than the others. I think it's called the anterior approach, I wasn't able to have this technique in either of my resections because of the number and locations of my tumors. I think having just right lobe involvement might allow you to have this approach. If you can get this type of surgery your recurrence rate drops dramatically. I hope this is why they are waiting.