Possibly unnecessary open liver surgery

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mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Sun Feb 11, 2018 3:25 pm

https://www.nccn.org/professionals/phys ... fault.aspx

find NCCN Guidelines Version 1.2017
Colon Cancer
NCCN Evidence Blocks

p 45 PRINCIPLES OF SURVIVORSHIP - Colorectal Long-term Follow-up Care

...Maintain a healthy body weight throughout life.
• Adopt a physically active lifestyle (at least 30 minutes of
moderate intensity activity on most days of the week). Activity
recommendations may require modification based on treatment
sequelae (ie, ostomy, neuropathy).
• Consume a healthy diet with emphasis on plant sources. Diet
recommendations may be modified based on severity of bowel
dysfunction.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

heiders33
Posts: 247
Joined: Sat Nov 04, 2017 11:08 am

Re: Possibly unnecessary open liver surgery

Postby heiders33 » Sun Feb 11, 2018 3:26 pm

This seems like a good recommendation for anyone, regardless of CRC diagnosis.

On the recommendation of an integrative care doctor, I’m going to start taking baby aspirin and curcumin tablets daily to reduce risk of recurrence.
36 year-old female
May 2017: Dx rectal cancer at T3N2M0
MSS, no genetic mutations
June-July 2017: 28 days of chemo/radiation
September 2017: laparoscopic LAR surgery with loop ileostomy
October 2017 - February 2018: six rounds of mop-up XELOX
March 12, 2018: reversal
April 16, 2018: CEA 2.1, all blood counts within normal ranges
May 2018: CT scan showed liver spot, MRI inconclusive
August 2018: PET

mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Sun Feb 11, 2018 3:49 pm

What does your doctor think about long term aspirin use? I have been using it for years (reversed heart disease with supplements, diet, and exercise) and husband has been on it ever since his heart catheterization last spring. I am wary about very long term use.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

heiders33
Posts: 247
Joined: Sat Nov 04, 2017 11:08 am

Re: Possibly unnecessary open liver surgery

Postby heiders33 » Sun Feb 11, 2018 4:50 pm

I don’t know, I will have to ask him. I’m thinking at least two years is OK.
36 year-old female
May 2017: Dx rectal cancer at T3N2M0
MSS, no genetic mutations
June-July 2017: 28 days of chemo/radiation
September 2017: laparoscopic LAR surgery with loop ileostomy
October 2017 - February 2018: six rounds of mop-up XELOX
March 12, 2018: reversal
April 16, 2018: CEA 2.1, all blood counts within normal ranges
May 2018: CT scan showed liver spot, MRI inconclusive
August 2018: PET

NHMike
Posts: 1537
Joined: Fri Jul 21, 2017 3:43 am

Re: Possibly unnecessary open liver surgery

Postby NHMike » Sun Feb 11, 2018 6:05 pm

mpbser wrote:What does your doctor think about long term aspirin use? I have been using it for years (reversed heart disease with supplements, diet, and exercise) and husband has been on it ever since his heart catheterization last spring. I am wary about very long term use.


I think that there's research on the benefits of:

Aspirin, Vitamin D3, Exercise and Tree Nuts for preventing recurrence of CRC.

About the only thing that I'm getting right now is the D3. I have been deficient in the other three.

I don't think that Aspirin is a good idea on chemo and there are a number of things killing my exercise. Tree Nuts go straight into the bag for me too unless it's in a butter and I need to get back to that.
6/17: ER rectal bleeding; Colonoscopy
7/17: Stage 3B rectal. T3N1bM0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda +radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8
MSS, KRAS G12D
10/17: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx 8 cycles 12/17-6/18

User avatar
LeonW
Posts: 345
Joined: Sun May 03, 2015 4:59 pm
Location: Amsterdam, Netherlands

Re: Possibly unnecessary open liver surgery

Postby LeonW » Sun Feb 11, 2018 6:38 pm

Utwo wrote: . . . considering diminished liver capacity, it probably still makes sense to adjust his diet . . .


No need to worry about liver capacity. Mine lost some 75% and we've seen it grow back to original size and capacity within weeks. Most of the work done within the first month. My docs said that they really can see it grow every day until capacity is restored.

to mpbser: congrats on the recent achievements.
Leon
Dec 2012 - Colon Cancer MM @65yrs, 2 unresect liver mets, CEA 41.8
Jan 2013 - colectomy @ spleen 2/26 nodes (IVa T3N1bM1a) MSI-low
Feb-Aug - 1x Xelox-7x Xelox/Avastin, shrinkage from #3
Sept - 2x failed Portal Vein embolization
Oct 2013 - R liver resect 28 hosp days (liver failure, delirium, emboli, encephalopathy) pCR - cancer gone
2014/15 - recovery/benign polyp
Apr 2016 - new town, new life
clean CTs and (1.3-1.4) CEAs: 4x2014, 6x2015-17, 1x2018
June 2018 - 2 polyps, 5yr survivor

mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Mon Feb 12, 2018 1:39 pm

Husband was not told to suspend the aspirin while he was on chemo. Thanks for the heads up. I will look into that. Husband probably has 2 - 4 more rounds. He's leaning towards 2, but we'll see what the docs say Feb 23rd.

I'm glad he's doing well. I really am. But I am just wiped out. I have my own health concerns that I have put on hold for months now while dealing with his. The next couple of months are completely filled with my work which is unfortunately the burden of my career. I work at home and he is often working at his company downstairs (or else in a nearby city at other business locations). So he is in and out all day while I need to concentrate. I need to get my carotid IMT (intima media thickness) measured by sonogram as soon as I get a break in my schedule. I was supposed to have it done in December. My lifestyle (not nearly exercising enough or eating well enough lately and last year's results showed a huge reversal in all the gains I made prior to meeting husband) tells me that I am not going to get good results.

I fear there is going to be a point in the not too distant future where I need to separate for my health and well being. My mother died at an age about a year or so from my age right now of massive stroke from blood clot that broke off from her left carotid. I have her inherited genetic mutation that predisposes me to hypercoagulation (sp?). If the IMT results show that the plaque has reached "vulnerable" territory, then something absolutely has to change. It will literally be a matter of life or death.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

NHMike
Posts: 1537
Joined: Fri Jul 21, 2017 3:43 am

Re: Possibly unnecessary open liver surgery

Postby NHMike » Mon Feb 12, 2018 1:45 pm

mpbser wrote:Husband was not told to suspend the aspirin while he was on chemo. Thanks for the heads up. I will look into that. Husband probably has 2 - 4 more rounds. He's leaning towards 2, but we'll see what the docs say Feb 23rd.

I'm glad he's doing well. I really am. But I am just wiped out. I have my own health concerns that I have put on hold for months now while dealing with his. The next couple of months are completely filled with my work which is unfortunately the burden of my career. I work at home and he is often working at his company downstairs (or else in a nearby city at other business locations). So he is in and out all day while I need to concentrate. I need to get my carotid IMT (intima media thickness) measured by sonogram as soon as I get a break in my schedule. I was supposed to have it done in December. My lifestyle (not nearly exercising enough or eating well enough lately and last year's results showed a huge reversal in all the gains I made prior to meeting husband) tells me that I am not going to get good results.

I fear there is going to be a point in the not too distant future where I need to separate for my health and well being. My mother died at an age about a year or so from my age right now of massive stroke from blood clot that broke off from her left carotid. I have her inherited genetic mutation that predisposes me to hypercoagulation (sp?). If the IMT results show that the plaque has reached "vulnerable" territory, then something absolutely has to change. It will literally be a matter of life or death.


I know you and others are doing the long-term support thing and that's rough on your health and you have to be around for him at some level.

My wife is in Singapore for seven weeks. She sent me a picture a few days ago and she looks a lot better. She told me that all of her skin issues have gone away and I imagine that she's getting in a lot of walking as it's a city environment. She is taking care of some business matters and meeting with friends and relatives. My daughter is helping me out with care in her absence, and, my wife may not have said so but I think that she likes the break from care and a warm, change of scenery, and some amount of freedom. I wouldn't mind being there right now myself.

I'm trying to keep up with my work or even get ahead because I certainly need the insurance. So I know about the work treadmill. We have much better drugs and treatments but the best treatments are the ones that you never need. I do get a little help from friends as well but I try to use favors sparingly. It is surprising on the number of offers to help though. I hope that you get some break time soon.
6/17: ER rectal bleeding; Colonoscopy
7/17: Stage 3B rectal. T3N1bM0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda +radiation
7/5: CEA 2.7; 8/16: 1.9; 9/8: 1.8; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8
MSS, KRAS G12D
10/17: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx 8 cycles 12/17-6/18

mpbser
Posts: 429
Joined: Wed Apr 19, 2017 11:52 am

Re: Possibly unnecessary open liver surgery

Postby mpbser » Mon Feb 12, 2018 2:35 pm

Thanks, NHmike.

I made my IMT sonogram appointment after my last post. I have to wait until April 23rd!
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

heiders33
Posts: 247
Joined: Sat Nov 04, 2017 11:08 am

Re: Possibly unnecessary open liver surgery

Postby heiders33 » Mon Feb 12, 2018 4:26 pm

NHMike, I don’t mean to butt in, but you should use those “favors” more often! Don’t think of them as favors, but rather as people offering to do what you would do for them in the same situation. When I read about you clearing snow off the roof after Oxaliplatin, I almost can’t believe it. I’ve had to accept help a lot more than I’m used to, but I’m learning how. Just my two cents!
36 year-old female
May 2017: Dx rectal cancer at T3N2M0
MSS, no genetic mutations
June-July 2017: 28 days of chemo/radiation
September 2017: laparoscopic LAR surgery with loop ileostomy
October 2017 - February 2018: six rounds of mop-up XELOX
March 12, 2018: reversal
April 16, 2018: CEA 2.1, all blood counts within normal ranges
May 2018: CT scan showed liver spot, MRI inconclusive
August 2018: PET


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