Need Advice: 1 cm lesion found in liver

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Augustine
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Need Advice: 1 cm lesion found in liver

Postby Augustine » Sat Oct 22, 2011 8:54 pm

Dear All,

I had a CT scan (25/7) done prior to my surgery and shows that my organs are clear. Surgery followed and no lymph nodes involvement are found and i am stage at T3N0M0. Visited the onc and decide to proceed with chemo, the onc suggested a CT scan prior to chemo and results shows that:

"1cm hypodense lesion is found at segment 8 of the liver and may represent metastasis or perfusion related change."

Onc seems not too worried about this, but i push for further action and MRI was done. The MRI report states that:

" The liver hypointense nodule corresponds to that found in the post surgery CT scan. This is likely a true lesion, and appears new from pre-surgery scan. Therefore, metastasis cannot be excluded. If clinically appropriated depending on the treatment regime, close interval follow up imaging is advised in the first instance.

The Onc suggest a PET scan in 3 months time, in the mean time i should stick to my Xeloda as CEA has been decreasing for 56(pre-surgery)-5(post-surgery)-2(completion of 1st Xeloda)-1.2(completion of 2nd Xeloda)

I would like to hear your thoughts on this, what are the chance that this is a metastasis and would you recommend any further action, such as having a more aggressive chemo regime, liver resection, biopsy etc.

Regards
Augustine
25/7/2011:conoloscopy/CT scan
8/8/2011:Right hemicolectomy
T3 subserosal fats, N 0/34, M0
moderately diff adeno
10/2011: CT&MRI,small lesion in liver
12/2011: PET, no lesion detected
07/2012: CT scan clear
08/2013: CT scan clear

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CRguy
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Re: Need Advice: 1 cm lesion found in liver

Postby CRguy » Sat Oct 22, 2011 10:30 pm

Augustine wrote:I would like to hear your thoughts on this...

Given the time frame I would continue Chemo and do follow up imaging (PET, PET/CT, MRI ) as recommended.
I would not jump to a liver resection, and doubt if you could find a surgeon to do it right now... ????
Changing from Xeloda to, say, XELOX would be something you would need to talk to your own Onc about, who knows the details of your exact situation.
JMO....but you asked !

Cheers
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

RixInPhx
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Re: Need Advice: 1 cm lesion found in liver

Postby RixInPhx » Sat Oct 22, 2011 10:34 pm

Since the suspicion of metastisis is now present, I would consider adding Avastin to the cocktail.
M 61, Dx 6/10 CRC st 4, unknown primary CEA 843
2 kg peritoneal mass, met to skull; no surgery
Various regimens of all CRC chemo drugs
Mets to lung 8/11 CEA 135
Folfiri/Erb/Ava 12/11 CEA 320
No progression 5/12 CEA 192

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jmarie
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Re: Need Advice: 1 cm lesion found in liver

Postby jmarie » Sat Oct 22, 2011 10:46 pm

I second Rix suggestion. Is the lesion in a spot the can biopsy?
DX Stage IV 11/25/08
mets liver lung, kras mutant
Baby 2yrs old! I am 32yrs
Too many chemo txs to count
trying to find a clinical trial
"You can't stop the waves, but you can learn to surf"

SkiFletch
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Re: Need Advice: 1 cm lesion found in liver

Postby SkiFletch » Sat Oct 22, 2011 11:04 pm

I'd be asking about a biopsy first. If possible, I'd wait for biopsy results and then decide on adding Oxali/avastin to the mix. If not possible, I'd ask about Oxali/avastin now. Like CRguy said, you asked :)
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D
Still NED and living life to the fullest

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mrdeltoid
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Re: Need Advice: 1 cm lesion found in liver

Postby mrdeltoid » Sun Oct 23, 2011 2:41 pm

I'd insist upon receiving a biopsy as soon as possible as liver lesions in the setting of colorectal cancer aren't something to simply dismiss or treat lightly. If it is a tumor, the earlier it's confirmed the better.
24 years old
Underwent right hemicolectomy on March 4, 2011 for IBD-related stricture
Diagnosed with stage IIB CC on March 25

Augustine
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Re: Need Advice: 1 cm lesion found in liver

Postby Augustine » Mon Oct 24, 2011 12:38 am

Hi,

I did brought up the topic of biospy to my onc, but he does not seems too keen on it. Reasons he gave are the small size of the lesion which makes it hard to locate as well as risks of bleeding and needle-track seeding. I will speak to my colon surgeon next monday to hear his thoughts.

Regards
Augustine
25/7/2011:conoloscopy/CT scan
8/8/2011:Right hemicolectomy
T3 subserosal fats, N 0/34, M0
moderately diff adeno
10/2011: CT&MRI,small lesion in liver
12/2011: PET, no lesion detected
07/2012: CT scan clear
08/2013: CT scan clear

Augustine
Posts: 41
Joined: Wed Aug 31, 2011 8:19 am

Update: Need Advice: 1 cm lesion found in liver

Postby Augustine » Mon Oct 31, 2011 5:26 am

Dear All,

My update, my surgeon believes that the lesion is a met :(. Would be seeing a liver doctor next week.

Now i am totally loss, should i continue with chemo and have frequent scan to monitor the progress, or should i go straight for liver resection?

Does anyone on the board with experience of a single met on the liver, if yes what does your doctor advice you and what action did you take? Also has anyone done a liver biopsy for it seems my doctor does not really encourage it, would like to pick for your thoughts on this.

Thanks
Augustine
25/7/2011:conoloscopy/CT scan
8/8/2011:Right hemicolectomy
T3 subserosal fats, N 0/34, M0
moderately diff adeno
10/2011: CT&MRI,small lesion in liver
12/2011: PET, no lesion detected
07/2012: CT scan clear
08/2013: CT scan clear

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Bev G
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Re: Need Advice: 1 cm lesion found in liver

Postby Bev G » Mon Oct 31, 2011 6:37 am

Hi Augustine:

I'm really sorry you're going through this; I know it's very scary. I had a single liver tumor in a place that couldn't possibly be biopsied. I was very disappointed by that, and really didn't want a resection without a confirmation that it was, in fact, a met. Many people on the board helped me see that a biopsy really wasn't necessary--these docs are good at looking at scans and knowing with decent certainty (in most cases) what's what). My liver met was resected in 4/10 and has not recurred.

The very best thing one can do with any metastatic lesions, whenever reasonable, is cut them out. I would think that your short to long term goal would be to have the liver lesion resected, although it may disappear with chemo, one worries about leaving some bad cells behind.

Best of luck to you,

Bev
58 yo Type1 DM 48 years
12/09 Stage IV 2/22 nodes + liver met, colon resec
3 tx FOLFIRI, liver resec 4/10
9/10 6 mos off chemo, Neg PET&CTC CEA nl
2/11 finished total 10 rounds chemo

9/13 ^17th clean PET/CT NED for now

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Gaelen
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Re: Update: Need Advice: 1 cm lesion found in liver

Postby Gaelen » Mon Oct 31, 2011 7:38 am

Augustine wrote:My update, my surgeon believes that the lesion is a met :(. Would be seeing a liver doctor next week.
Now i am totally loss, should i continue with chemo and have frequent scan to monitor the progress, or should i go straight for liver resection?


Systemic chemo alone - especially just Xeloda - doesn't have a very good record of eliminating liver mets.
When you talk to the liver specialist (who is hopefully a board-certified liver surgeon - usually called a hepatobiliary surgeon), he should have a better idea of what your next course will be. Ideally, he will recommend surgery, and then some mop up chemo after surgery to ensure that there are no cancer cells left behind.
Hope that helps.
Be in harmony with your expectations. - Life Out Loud
4/04: dx'd @48 StageIV RectalCA w/9 liver mets. 8 chemos, 4 surgeries, last remission 34 mos.
2/11 recurrence R lung, spinal bone mets - chemo, RFA lung mets
4/12 stopped treatment

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cinnamongirl56
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Joined: Sun Aug 29, 2010 2:37 pm

Re: Need Advice: 1 cm lesion found in liver

Postby cinnamongirl56 » Mon Oct 31, 2011 7:39 am

I also had one liver met diagnosed 3 weeks after tumor surgery. Mine was located very near vein but I had a great interventional radiologist who was able to biopsy it and found it was a met. The liver surgeon I had gone to about this wasn't comfortable about doing a resection because of how close it was to the vein so I got a second opinion at a major medical hospital and the liver surgeon there felt confident he could remove it but first he had me do 4 treatments of chemo and then a rescan which showed shrinkage so he scheduled my liver resection on March 4th 2011 and he was able to resect. Mine was so close to vein that he said he scrapped the vein. Also he did not get a clear margin on that side so I did 7 more rounds of chemo and in Aug I had another scan done and they said I was NED. I also had a small lung wedge done during the same surgery. I go for my next scan in Dec and am still hoping I stay NED. Hope all goes well .
RC. 4/10 .. 54 yrs old
9/10 surgery
11/10 liver met
12/10 4 tx Avastan/5Fu scan
2/1/11 CT Scan liver met shrunk
3/4/11 Liver resect-lung spot
7/11 finished chemo scan 8/25
8/11 NED

Augustine
Posts: 41
Joined: Wed Aug 31, 2011 8:19 am

Re: Need Advice: 1 cm lesion found in liver

Postby Augustine » Tue Nov 01, 2011 3:05 am

Hi All,

Thanks for the responses, the major headache now is, my onc thinks the lesion has a 50% chance of been a met while my colon surgeon believes that it is a met. And both of them based it on the MRI scan report which states (don't think they even look at the MRI pictures.):

"The liver hypointense nodule corresponds to that found in the post surgery CT scan. This is likely a true lesion, and appears new from pre-surgery scan. Therefore, metastasis cannot be excluded."

Now think i need the liver surgeon to give his thoughts on this one :(.

Is there anyone here who can read in-between the lines and let me know what the statement meant ;)? Also, what is a true lesion?

Regards
Augustine
25/7/2011:conoloscopy/CT scan
8/8/2011:Right hemicolectomy
T3 subserosal fats, N 0/34, M0
moderately diff adeno
10/2011: CT&MRI,small lesion in liver
12/2011: PET, no lesion detected
07/2012: CT scan clear
08/2013: CT scan clear

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CheeseHead
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Location: Netherlands

Re: Need Advice: 1 cm lesion found in liver

Postby CheeseHead » Tue Nov 01, 2011 4:13 am

The ones who can read between the lines would be qualified doctors.

Even then, reading a scan or a report leaves room for interpretation.

How do you know they didn't look at the pics?

You could also get one or both of them to actually.... Talk to the radiologist.

But more importantly, and unfortunately, there will always be some or a lot of uncertainty in this disease. One way to lessen this is to deal with specialists in their field.

I would prefer to have an experienced well qualified liver surgeon look at the situation, if necessary backed up by a radiologist with experience in the same area.

I would focus on making sure your liver guy/gal is well qualified, then trust him/her, keeping in mind that whatever the decision, you need to be comfortable with it, even though the lesion turns out to be what you had not expected.

I Personally would take the downside risk of it being a tumor that does not respond completely to chemo into account and just have it cut out. Not surprising... see my signature.
Your decision could obviously be very different...


Good luck,
Cheese
    2008
    10 Stg 4 colon srgry
    12 Xelox/Avast
    2009
    05 Liver srgry
    -12 Xelox
    2010
    05 Xelox
    08 Iri/Vect
    11 Liver srgry
    2011
    01-05 Iri,Vect,Xeloda
    09 CyberKnife
    2012
    03-07 Ph I trial
    08-11 Regorafenib
    2013-
    Xeloda
    Vecti
    Iri
    Xelox

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CRguy
Posts: 10473
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Re: Need Advice: 1 cm lesion found in liver

Postby CRguy » Tue Nov 01, 2011 10:39 am

Augustine wrote:Now think i need the liver surgeon to give his thoughts on this one
A very good idea.
Augustine wrote:Is there anyone here who can read in-between the lines and let me know what the statement meant
This is just doctor speak. The radiologists reporting their findings in such a manner as to leave the door open for further interpretation and follow up imaging......and NOT to get nailed down to a 100% confirmed diagnosis based just on one set of scans.
Augustine wrote:Also, what is a true lesion
-> not an artifact of the imaging process or "different view" based on the resolution of CT "slices"

Don't know if this helped or hindered your desire to understand what is going on ???? :shock:
Keep in mind though : Radiologists want to scan you, Oncologists want to chemo you and Surgeons want to cut you...SO be prepared for the three to have slightly different versions of what their plan might be....( more scans, more chemo, biopsy, surgery )

Sounds like the chemo now is to assess response of the "lesion" to chemotherapy. Based on that response and the follow up scans, they should be prepared to offer you a plan. Remember these are all experienced folks, and you are putting your trust in them because of that experience. If they are convinced it is a met, and the surgeon wants to get it out...I would definitely do that. What they are doing now, is just making sure they are going in the right direction with you. I think you are being well cared for. JMO.
You can only second guess things so much then ya' gotta act !

Best wishes
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Augustine
Posts: 41
Joined: Wed Aug 31, 2011 8:19 am

My Update

Postby Augustine » Fri Jan 20, 2012 2:14 am

Dear All,

It has been awhile since i post something here, though i have been following the forum closely.

As you all know a 1cm lesion was found at my liver in Oct 2011.

After having 6 rounds of Xeloda, the onc requested a PET scan and results show that the liver is clear, no lesion is detected :D.

I ask the onc if the lesion (which use to be there) is a met, and he says we can never be sure. So for the moment they are going to keep a close watch on it.

I take the clear PET scan as a good news, though my CEA has been on the rise during my last 3 test 0.8 -> 1 -> 1.1, but it is still within the normal range, so i try not to worry too much about it.

Hope everyone here is fine and have a Great 2012 :)

Regards
Augustine
25/7/2011:conoloscopy/CT scan
8/8/2011:Right hemicolectomy
T3 subserosal fats, N 0/34, M0
moderately diff adeno
10/2011: CT&MRI,small lesion in liver
12/2011: PET, no lesion detected
07/2012: CT scan clear
08/2013: CT scan clear


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