Husband has an appointment with a liver surgeon in Albany tomorrow. I prepared a list of questions for our appointment next week with his oncologist at Mass General and since some of them have to do with liver surgery, we will be bringing the same questions tomorrow. If you have any questions to suggest we add, please let me know! Would be most welcomed! Thanks!
1) What is Dr. Zhu's exact prescription for M----s chemotherapy? Dosages, times/weeks, besides Capeox (as M---- will not do Fol-/FU-) what about EGFR targets? They have severe side effects, like Ox-, and provided limited additional benefit, correct?
2) Do we know, and how do we know, for sure that the liver masses are from colon metastasis and are not independent hepatocellular carcinoma?
3) I asked at our first appointment why ox- is necessary, how did it come to be included in the standard of care first line therapy for metastatic CC. Dr. Zhu said that there are plenty of studies showing it dramatically improves efficacy. While I stated that I would trust him on that, M---- would still like to see some quantitative evidentiary reasoning, please.
4) What about the lesions/cysts on M----'s kidney? The first CT scan said there is a lesion and a cyst. The MRI said that it was nephrolothiasis/kidney stones. None of M----'s doctors have been talking to us about that. The last CT (August 28) scan indicates that there is one 3 cm kidney stone. I guess that is a wait and see thing.
5) If M---- agrees to Capeox, what type of port is recommended for the ox- infusions? PowerPort?
6) Now that Dr. Qadan was unable to complete the plan for the liver chip/ablation and M---- will have to return once he has healed from the colon resection for open liver surgery, should M---- have chemo to reduce the size of the liver tumor first? We have spoken to Dr. Qadan and it seems like this would be the recommendation.
7) Plan A -- heal up from last week's colectomy, then two months chemo, then liver surgery, then four months chemo versus Plan B -- heal up from last week's colectomy, then liver surgery, then chemo:
If I understand correctly, Plan A would be in the hope that chemo shrinks the right lobe tumor a bit so it would be easier to remove as it is up against a blood vessel and could be chipped out, thus saving the whole lobe.
Given its size and how fast its size may have increased since the June 30th MRI, our concern is whether chemo will be able to have any shrinking effect on it at all. If it's that rapidly growing, then chemo might just stabilize its size.
Also factoring in the tiny spots on the same lobe and the additional option of resecting that entire lobe (30% of the liver) thus avoiding any future growths and/or surgeries for that area, if husband decides to go that route, then chemo for two months prior to surgery would not seem to make any sense.
What is the long term difference between removing the entire right lobe compared to a wedge or chip of the tumor? E.g. the liver regenerates if wedged/chipped but an entire lobe removal would not result in regeneration?
9) Due to our very busy schedules (we go away every Columbus Day weekend for our anniversary, I have depositions in NYC, etc), we would like to lock down a specific timetable, please. For example:
• What is the specific recommended plan?
• When would that start?
• How many rounds?
• What surveillance, bloodwork, etc will be needed? (I know that CT is a preferred method but none of M----’s CTs have ever detected any of his liver masses. We would really prefer a NON-TOXIC method, e.g. ultrasounds; what about blood draws for AFP (alpha-fetoprotein), a biomarker for metastatic cancers of the liver?
• Who would do this monitoring?
• Since travel to Boston is a huge burden, what can our local oncologist do besides administer the chemo?
10) Since chemo wreaks havoc on the immune system and the healing process, if we go with Plan A, wouldn't that increase M----'s risks of infection and other complications concomitant with open surgery? Similarly, since Ox- can cause blood clots and heart problems, what heart/vascular monitoring should his cardiologist do?
11)Dr. Qadan referred to the right and left lobe masses as “tiny spots” numerous times in our phone conversations and during the consultation appointment which I participated by phone. I distinctly recall him speaking about the efficacy of RFA on spots that are less than .5 cm diameter. However, the liver MRI report indicates that the right lobe spot, the one that had been planned to be ablated, is 1.5 cm diameter. ???
12)Is it possible that the liver mass that Dr. Qadan could not chip August 21st had grown since the June 30th MRI and could that growth be related to what I suspect to be his metabolic syndrome? He was eating significantly more beef lately and late night snacking, so much so that he has put on weight in the past few weeks prior to the August 21st surgery.
13)Would the left lobe mass (one up against blood vessel) at the size seen August 21st be able to be removed without taking the entire lobe or does it have to shrink to gain some margin between it and the blood vessel?
14)We would like the images from the intra-operative ultrasound done on August 21st, please, if any were taken.