Tumor growth 1 month after liver resection - update 9/18

[ForDad]

Hello,

My dad had liver resection on Aug. 1 during which all visible cancer was removed, and he was supposed to resume chemo today. We met with the oncologist before chemo and was told that my dad's CEA today was 9.1. A couple of weeks ago, it was 3.3. He had been off chemo since June.

The doctor cancelled today's chemo because we need to first figure out the reason for the rise in CEA. We have a PET scheduled for Friday and an MRI scheduled for next week. Our oncologist told us that the MRI is better at detecting liver lesions, and PET could identify elsewhere.

The doctor was surprised that Dad's CEA had risen so quickly post-surgery. I asked if it's possible for there to be no growth with a CEA of 9.1, and our doctor said he has seen it once. Have any of you seen regrowth this quickly after surgery? Or perhaps there was a tiny tumor somewhere already that we didn't see before, and it's grown to a size where the CEA can detect… Or could there be another explanation for the jump in CEA? I know we’ll know more after the scans, but I’m curious if this has happened to others.

A month ago, my parents and I were feeling so relieved because we thought all visible cancer was gone. Ugh, we're super stressed again.

Below is Dad’s CEA history:

1/8/14: CEA 21.8
2/14/14: CEA 11 (after 2 rounds of FOLFOXIRI)
2/21/14: CEA 3.8
3/18/14: Colon resection
4/30/14: CEA 2.7
6/11/14: CEA 3.1 (after 4 rounds of FOLFOX)
8/1/14: Liver resection
8/14/14: CEA 3.3
9/3/14: CEA 9.1

Thank you,
Sue

[mstults]

Infection will cause increase. So will smoking. I'm not a Dr but I don't think my oncologist would delay a treatment for an increase such as this. 9.1 is not heart stopping. Just my opinion.

[GrouseMan]

I agree - 9.1 isn't that much an increase. I see that it was going back down even before his primary colon resection (Was he on Chemo prior to that resection?) I imagine his liver is inflamed from the radical surgery he had undergone. Although its been a month, its likely there is still some inflammation and other stuff going on that could be responsible for increase. Its also only one test. Perhaps its a testing error. They do happen. If after another month it continues to increase, then I would be worried. Although I am not an Oncologist, I use to do anti-cancer drug research - If it were me I would not have canceled his previous scheduled chemotherapy, just because of an increase in CEA. It is what it is. If its cancer you want to treat it now while its small and before it gets big and harder to fight. If its not you would have continued with the mop up chemo anyway. So how would getting an early start have been of any harm? I just don't see any positives to waiting for he chemo to start at this point.

Regards,

GrouseMan

[ForDad]

Thank you for your replies, mstults and Grouseman. My dad has never smoked, and he received 3 rounds of chemo prior to his colon resection in March (I will update my earlier post to clarify). We'd be thrilled if the rise in CEA is only due to inflammation or a testing error!

Our oncologist told us that he cancelled today's chemo because with chemo, the tumor might shrink (if there indeed is one), and it'd be tougher for the MRI and PET to locate exactly where it is. Also, if it turned out to be a regrowth in the liver, for example, the oncologist said he might recommend RFA first before resuming chemo. If it turned out to be nothing, we'd resume chemo after the PET scan. His explanation made sense to me, but I see your points as well.

I am now wondering if another CEA test should be ordered before going through MRI and PET. Hm.

Thank you again for your input. Much appreciated.
Sue

[mstults]

I see his reasoning but frankly I don't think a tumor will shrink noticeably in 2 days. However it is only a short delay and I don't see that as causing a problem either. I admit I'm super aggressive. I tried to talk my oncologist into giving me a treatment before sending me to the hospital with pneumonia. I recently had a very close call and was on life support for 3 weeks. All the other doctors gave up on me. The oncologist just said well you don't know him like I do. It's taken 5 months but I'm back to 80% of my strength. I don't say this to brag, only to show others that there is a lot possible and we never need to be satisfied to just perform at the expected levels. And never should we shoot to live the expected time based on statistics.

[SkiFletch]

Seems like your onc is on top of things. Quick turn around for scans with suspicious CEA... I like it. IF it is a met that's causing the increase, it's more likely that the cells were present before the liver surgery than a regrowth from the original surgery.

[stu]

Hi. My mum had a very quick recurrence after a liver resection. She did wait three months on watchful waiting to get a clearer idea of where the tumours were. She had no chemo during this period. Four one cm mets showed up. At that point she went back onto chemo for six cycles then had 73 percent of her liver removed. She has had three great years treatment free living since then. It was difficult at the time but we concluded that the disease was probably there all along. Although hard to face it was better long term to treat it.
Regards stu

[ForDad]

Thank you all for the replies.

mstults, I'm all for going super aggressive with cancer. Life support for 3 weeks... that is indeed a very close call. I hope you're back to 100% of your strength very soon.

SkiFletch, Thank you for the vote of confidence re: my oncologist. I'm glad that the doc is taking the rise in CEA seriously and doing what it takes to figure it out. I agree that if there is indeed a met, that the cancer cells were probably already there. I guess then it's more accurate to call this a growth than a recurrence. Whatever we call it, I don't like it — but we'll deal with it. Hope you're doing well.

Stu, Thank you for sharing your mom's experience. I'm glad that she was able to have to have the liver resected, although that is a lot of liver that got removed! What a relief to hear that she's living treatment free. Stories like hers give me hope. Best wishes to you and your mom.

My parents and I are not trying to stress. My dad is keeping himself busy dealing with plumbing issues. I say that literally — he's having the bathroom sink replaced and having plumbers come in to give us estimates.

Thanks again,
Sue

[singingholly]

I had six liver mets resected to discover after just one month that they were seven!!! Then nothing more for one year and eight months (til nowadays).
So... it may be. But CEA level doesn't seem to me that high...
Olivia

[ForDad]

Hi Olivia,

Thank you so much for your reply. It must have been unnerving to find out that after getting rid of six liver mets, that there was another one in there! Ugh. Also, I'm so sorry to hear about the return of the pesky cancer these days. I hope you recover from your recent surgery very quickly.

Best wishes to you,
Sue

[ForDad]

Hello,

I wanted to update this thread. PET and MRI confirmed there's tumor growth in Dad’s remaining liver a month after his liver resection. It’s currently about 8 mm. It's apparently a tumor that was there all along per MRI from January, immediately following his dx. It was 7 mm back then. The tumor disappeared on all CT scans during chemo, and the surgeon did not detect it during surgery with ultrasound placed directly on the liver. CEA has increased to 12.1 as of Sept. 11.

The interventional radiologist will zap the lesion with microwave ablation on Sept 22. I asked why we're ablating instead of resecting, and he said there won't be enough liver left if we did surgery. The other tumors were in the right lobe, and this is one is in the left lobe.

I am just wondering what is typically done for tumors that disappear on scans during chemo. Do you wait and see, i.e. check CEA and scans? Or do you assume that microscopic cancer still lingers in the area and resect if possible? But how will the surgeon know where to resect exactly?!

Also, does a dead cancer tumor appear on scans, or does it disappear on scans?

Thank you,
Sue

[iitg.ritesh]

My doc suggested that MRI is accurate for liver and pelvis. CT is good in abdomen and thorax. Sometimes CT scan doesn't pick small tumors in liver and pelvis.