Omentum mets? Youth seeking input please

[Lovenothate]

I get really frustrated when I don't have a plan. My mothers abscites were what led to surgery where they would remove her tumor infested left ovary, a total hysterectomy, appendectomy, and colon resection. She was on mop up chemo for 6 months last year where they only found suspicious lung spots. The lymph nodes resected during surgery show no lymph involvement at all. In January she went on maintenance xeloda and avastin but after a month off of maintenance chemo we are told she has mets(some cancerous cells) to her upper omentum so she has begun folfiri. The good news is the lung spots seem inactive with shrinkage on avastin and no growth off all chemo.

I haven't read of a case like this but all I read when I look it up is how omentum metastasis is grouped with peritoneal metastasis and it is difficult to treat. Yet some will be NED after omentum removal yet have a harder time with PC metastasis. I'm a premed student so this just confuses me since I know the omentum is its own organ that can be removed.

Is an omentum metastasis a peritoneal metastasis?

Is systemic folfiri expected to be effective in stabilizing mets outside of the organs?

My mother has no other major mets, should I ask about surgery or wait to see how she responds to folfiri?

Sorry for the word vomit/rant. I hate being the youngest in my family but being the only one to understand what the onc is saying and doing. Going to be tired of premed before I even get to graduate school.

Anyway, I really appreciate any answers. Even any thoughts or comments are welcome!

Em

[Maia]

Is an omentum metastasis a peritoneal metastasis?

Yes, the omentum is part of the peritoneum. It is a fatty tissue between the stomach and the colon --that's probably why the doctor talked to you first about 'stomach cancer cells', as you said in your other thread; but the tumor is inside the peritoneum, just outside the stomach.

Systemic chemotherapy is not well-delivered inside the peritoneum, because of vascularization characteristics. It's often called 'sanctuary'. So the *local* delivery of chemotherapy, or other agents, like HIPEC (Hyperthermic Intra Peritoneal Chemotherapy) is often done, while having CRS (cytoreductive surgery).
I really would encourage you to consult with a main cancer center, as some in LA, which seems to be the nearer location for you, as ACPdiddy suggested viewtopic.php?f=1&t=58480&p=460358#p460425
Has your mother been tested for MS status --do you know if she's MSS or MSI-high? Any mutations? Is she KRAS mutant?

[Lovenothate]

From my moms pathology report I remember her being MSS but I know that peritoneal mets can be mutated. We'll be finding out kras next infusion on the 15th. I will be asking her onc what his plan of action is as well and input the HIPEC procedure.

Thank you Maia