surgery vs chem

seek@light
seek@light Member Posts: 26
in Colorectal Cancer #1
Hi All,

Sorry that I am going to ask a similar question again.

Last time, my mom had to make decision to go for surgery or not prior to PET/CT scan result. She ended up with a 2.3 cm tumor in her liver right after 2 months from diagnosis and resection of half liver and part of rectum. We decided to go for surgery with a lot of help from this board (very grateful to those who provided comments). However, it was Chinese new year and the doctors decided to postpone the surgery. With one more chem, surprisely this tumor is completely gone now and nothing could be detected by both CT and MRI. And her CEA is back to normal from 200 at diagnosis to 39 to 25 to 16 to 4.4 for now.

Now after discussion among a bunch of doctors, including surgeon and chem clinicians, it was half to half to have a surgery. What a odd, and we are asked to make our decision again!

Any help will be extremely appeciated!

Thanks,

Gary from China

Comments

  • janderson1964
    janderson1964 Member Posts: 2,215 Member
    #2
    Surgery is always better
    Surgery is always better although I am surprised that they will operate if there is no visible cancer
  • jasminsaba
    jasminsaba Member Posts: 157 Member
    #3
    janderson1964 said:

    Surgery is always better
    Surgery is always better although I am surprised that they will operate if there is no visible cancer

    I am surprised as well ...
    Gary - this is exactly what happened to my mom. She had a single 16 mm liver lesion at the time of diagnosis which was detected on PET AFTER she had a colon resection.

    The proposed plan was to do 6 cycles of chemo instead of subjecting her to another surgery right away ... also to address the systemic disease (possible micrometastases). Well, after 6 cycles, chemo had wiped out her lesion to the point that was in longer seen on any imaging modalities so the surgeon would not cut into her liver.

    His explanation was this is a very invasive surgery and unless there is evidence of active disease and/or physical remnants of the tumor, he would not consider surgery and/or even RFA.

    After 12 cycles, another set of scans and the lesion is still gone so now she is starting on maintenance chemo for the unforseeable future.

    It's very surprising that your docs are suggesting surgery in the absence of any visible disease.
  • mom_2_3
    mom_2_3 Member Posts: 953 Member
    #4
    Gary
    I believe most studies have shown that despite the fact that CT shows complete response, there is high likelihood of microscopic cells still present at the lesion site. Please review http://m.jco.ascopubs.org/content/24/24/3939.full. My own surgeon told me that even if I had had a complete response to chemo he would resect the former areas using previous scans as guides if necessary. He felt it would be too risky to not do surgery in that case. I know much depends on your mom's willingness to have an additional surgery as well as her body's ability to tolerate it.

    If it were me, based on everything I have read, I would have the second liver resection. I would worry about those microscopic cells wreaking havoc in an area that may not be potentially resectable in the future.

    All the best to you,
    Amy
  • jasminsaba
    jasminsaba Member Posts: 157 Member
    #5
    Maybe this link will provide help/direction
    http://m.jco.ascopubs.org/content/24/24/3939.full
  • very worried husband
    very worried husband Member Posts: 88
    #6
    Hi Gary,
    I am sorry I wont
    Hi Gary,

    I am sorry I wont be of much help, but was wondering is your mom getting any chinese Traditional treatment? Where about in china she is getting treatment? Pm me if you need a v v good TCM doctors address.
  • son of hal
    son of hal Member Posts: 117
    #7
    Hello Gary- All courses of
    Hello Gary- All courses of treatment are tough decisions so I wish you luck in chosing. Unfortunatley I'm starting to believe the right choice really does come down to luck. I had a similar situation (stageII rectal) where I had a complete response to chemo/radiation and chose the wait-and-see approach. I was in no hurry to get cut up and get a bag. All my scans and test showed nothing for almost nine months. Then my CEA rose slightly.I don't remember which test confirmed it but a scope saw a new formation at the same spot as original so I went ahead with the surgery. The surgery was successfull and things are OK now. Personally I see no fault in the "wait and see" approach and neither did my doctor. They did keep mentioning the surgery though since it's in their protocal. Best of luck on your decisions and don't sweat it too much. It is what it is...
    CJ
  • seek@light
    seek@light Member Posts: 26
    #8
    thanks a million to your comments
    Dear all,

    Much appreciated! I saw two different opinions here as well :) After reading the paper, I am leaning to have a surgery and have informed my mom's oncologist. My mom is still young, 62 years old, and she was very healthy and recoveed extremely well after the first big surgery. Her onc believed that she could telorate well for the second one as well based on her current situation.

    The onc department is going to have one more round discussion on her case with some external experts. This might be a good case for education purpose since this is an affliated hospital to a universtiy.

    I will update what is their opinion in the end.

    Thanks a lot,

    Gary
  • seek@light
    seek@light Member Posts: 26
    #9
    very worried husband said:

    Hi Gary,
    I am sorry I wont
    Hi Gary,

    I am sorry I wont be of much help, but was wondering is your mom getting any chinese Traditional treatment? Where about in china she is getting treatment? Pm me if you need a v v good TCM doctors address.

    Thanks a lot
    I am very grateful for your being willing to help.

    My mom is treated in Guangzhou, one affilicated hospital to Sun yat-sen university. We are living in Hunan, though. My mom does not take TCM yet. I found some prescription online and also saw one doctor for Chinese medicine. My mom tried some of them after the first round of chem; however, her onc told us not to try to use TCM during chem therapy and it is better to take TCM for maintenance. Therefore, we do not take more. My mom drinks "5-red water" every day and use some Chinese medicine, such as Huang Qi and Dan Gu, for soup or tea.

    It is much appreciated if you could let us know the contact informatin of the doctor you would like to recommend.

    Once again, thanks a lot,

    Gary
  • rlridings
    rlridings Member Posts: 42
    #10
    have the surgery
    I just had a CT last week that showed the one tumor in my liver gone after chemo - obviously great news - both my surgeon at MD Anderson in Houston and my Oncologist here in Minneapolis say that you still do surgery to "clean up" any microscopic traces of the tumor that won't show up - they know the area where it was and do ablation to burn the traces - there was no question with either of them that that was the way to go
  • jasminsaba
    jasminsaba Member Posts: 157 Member
    #11
    rlridings said:

    have the surgery
    I just had a CT last week that showed the one tumor in my liver gone after chemo - obviously great news - both my surgeon at MD Anderson in Houston and my Oncologist here in Minneapolis say that you still do surgery to "clean up" any microscopic traces of the tumor that won't show up - they know the area where it was and do ablation to burn the traces - there was no question with either of them that that was the way to go

    rlridings ...
    just to clarify for my own information, MD Anderson's recommendation and protocol is to move forward with a liver resection despite any visible sign of cancer in your liver? OR, are they suggestig RFA?

    I'd appreciate your response.
  • rlridings
    rlridings Member Posts: 42
    #12
    jasminsaba said:

    rlridings ...
    just to clarify for my own information, MD Anderson's recommendation and protocol is to move forward with a liver resection despite any visible sign of cancer in your liver? OR, are they suggestig RFA?

    I'd appreciate your response.

    have the surgery
    I am sending my CT scan down to them since it was done here in Minnie but they will want to do surgery - as he termed it "cleanup" - so I assume it has to be RFA but I will find out more once they look over the scan - sorry if that doesnt clarify for you
  • jasminsaba
    jasminsaba Member Posts: 157 Member
    #13
    rlridings said:

    have the surgery
    I am sending my CT scan down to them since it was done here in Minnie but they will want to do surgery - as he termed it "cleanup" - so I assume it has to be RFA but I will find out more once they look over the scan - sorry if that doesnt clarify for you

    Thanks :-)
    I appreciate your response ... I ask because my mom is on the same boat but her surgeon and the tumor board voted NO for surgery and/or even RFA because there was nothing seen on any imaging modalities.

    I am a huge fan of MD Anderson and respect their expertise ... so I was curious and am eager to see what they recommend for your case as it's very similar to my mom's. I'd be grateful if you could post a follow up once you hear from them regarding next steps.

    Thank you =)
  • very worried husband
    very worried husband Member Posts: 88
    #14
    seek@light said:

    Thanks a lot
    I am very grateful for your being willing to help.

    My mom is treated in Guangzhou, one affilicated hospital to Sun yat-sen university. We are living in Hunan, though. My mom does not take TCM yet. I found some prescription online and also saw one doctor for Chinese medicine. My mom tried some of them after the first round of chem; however, her onc told us not to try to use TCM during chem therapy and it is better to take TCM for maintenance. Therefore, we do not take more. My mom drinks "5-red water" every day and use some Chinese medicine, such as Huang Qi and Dan Gu, for soup or tea.

    It is much appreciated if you could let us know the contact informatin of the doctor you would like to recommend.

    Once again, thanks a lot,

    Gary

    Gary
    Sorry for the very late reply. Your mom is being treated in the same place as my wife, Guangzhou. I think it was the fourth ( or 6th, can't remember properly) affiliated hospital of SYS university. and the TCM hospital is not that far. It's in Jiangmen city near guangzhou. The doctor's name is tang king rong . and the hospital name is Jiangmen TCM hospital attached to jinan university medical college.
    If you are chinese, I dont think you will face any difficulty in finding the place. I was not, but my wife has a super super family, They took very good care of us.
    PM me if you need any help. ( I tried to send you a message, but was unable to do that...dont know why?)
    Best of luck...

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