Stage 4a, chemo to start after removal of partial colon+liver met.

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andelib
Posts: 6
Joined: Fri Dec 15, 2017 1:13 pm
Location: Turkey

Stage 4a, chemo to start after removal of partial colon+liver met.

Postby andelib » Thu Jan 25, 2018 3:51 pm

Hi everyone,

I am writing from Istanbul, Turkey. I am very glad to find this forum which is full of first-hand and real experiences. Thank you to all contributors that help me understand what is waiting my family and that we are not alone.

My father was diagnosed with colon cancer two months ago. He is 61, with no other chronic illness. When a routine blood check showed anemiea, his doctor was suspicious and asked for some other tests and a colonoscopy and they found a tumor which turned out to be adenocarcinom after a biopsy. MRI and PET showed no mets, but a lesion on liver. So, the doc insisted on a liver biopsy and found out that it really spread to liver. When his anemiea got better, he underwent a laparoscopic surgery for removing part of his colon and the lymph nodes, together with a synchroneous surgery to remove part of the liver (open surgery, 15% of the liver was removed). No colostomy was needed, all affected parts were removed. He was discharged after a week, 3 out of all removed lymph nodes turned out to be cancerous. After two weeks, he was able to drive, go to work and return to his daily routine.

It's been almost a month since the surgery and now it is time to decide on the adjuvant chemotherapy, and we know it is a must in order to destroy the remaining cancer cells so he will have a longer time before it is back in his colons or elsewhere. Still, he looks and feels so healthy and optimistic that I am concerned about how the chemo will affect his overall health and mood. We don't know if it will be COPOX or FOLFOX, or another combination, and how many cycles... Our appointment is next Wednesday. I am trying to make as much research as possible so I can ask the doc about all of our choices. I'd appreciate any feedback.

mpbser
Posts: 372
Joined: Wed Apr 19, 2017 11:52 am

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby mpbser » Fri Jan 26, 2018 8:02 am

My husband has stage IVa as well with a liver met. He had the colectomy done but the liver surgery will be separate (next week). In between the surgeries, he did four rounds of CAPOX. Each cycle was 3 weeks with 2 weeks on, 1 week off. It was very effective for him. The liver tumor shrank (not sure if that is a word!) by more than 1/2. He didn't experience many side effects. He managed the ones he had very well once he figured out effective timing for anti-nausea med and cimetidine at night with his evening chemo dose. After his Ox infusions, he had some mild side effects but nothing like what he feared he would experience.
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 Pre-op; 2.1 2 days Post-op; ~2.2 ave
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

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LPL
Posts: 343
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby LPL » Fri Jan 26, 2018 4:51 pm

Hi andelib,
You can see in my signature below the treatment that my husband has had. Where we live the recommended treatment for >1 liver met is chemo, 4-6 treatments before surgery and 6-8 after - in total 12. The chemo after liver mets resection was not fun of course but he got through it without any remaining side effects. The worst ’side effect’ my husband had was his reaktion to the steroids, it caused bad hyperglycemia and that was a bad period before it was diagnosed and after with insuline and lots of tests. So if I were you I would make sure they check your father’s blood glucos.
Good Luck!
P.S. You are not mentioning any tests done on the tumors removed. It is of importance to know about any mutations like for example KRAS and if your father is MSS or MSI. You can search this forum to find more info about that.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

andelib
Posts: 6
Joined: Fri Dec 15, 2017 1:13 pm
Location: Turkey

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby andelib » Mon Feb 05, 2018 1:22 pm

Thank you both for your replies. I hope your husbands will be successfully treated and have a long disease-free time.

The tests showed that my dad has MSI High tumors. For now, the doc is planning to use a standard 12 cyles of Oxiplatin and 5FU for adjuvant chemotherapy after putting a port under skin. He will have a dihydropyrimidine dehydrogenase deficiency test tomorrow to rule out any possibility of severe fluorouracil toxicity. If it turns out that he has DPD deficiency, they will only use oxiplatin.

At the end of the treatment he will have a PET scan and if the cancer is back we are planning to try immunotherapy drugs. Currently they are not paid by the goverment (contrary to chemo and surgeries), so it will be our second choice.

Currently all his blood levels including blood glucos seem normal. We will see how the chemo will affect it though...
Dad Dx CC, Age 61, no chronic illness
Late Nov 2017: Anemia led to Colonoscopy + CT + PET + Ultrasound + Biopsy
Stage IV, Liver lesions
Jan 2018: Lap colon res and open liver res (15%)
No colostomy, 3 affected left nodes out of 30+
All clear margin, MSI High
Feb 2018: recovering, DPD Deficiency: Negative
March 2018: Started chemo (FOLFOX) via port (2-day pouch)
April 2018:(4/12 cycles completed)
Working full time, CEA 1.8, HMG 13.1
thrombocyte lower than normal, AST-ALT higher than normal

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DBF
Posts: 293
Joined: Fri Jun 07, 2013 1:44 pm
Facebook Username: https://www.facebook.com/#!/profile.php?id=1000008
Location: New York

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby DBF » Mon Feb 05, 2018 6:10 pm

Good luck to your dad. I hope he handles the chemo well. I also had my colon and liver surgery before chemo. I did 12 rounds of FOLFOX after my liver resection. You can see by my signature I have been NED since 2013. I am not MSI high, so immunology was never discussed.
My marker went up initially after I finished FOLFOX, and I chose to do ADAPT protocol, which is low dose Xeloda plus Celebrex. Some say it has no positive effect in keeping people disease free. I don't know what I think, but I am disease free, so I choose not to disparage it. :wink:
Best,
Donna
6/13 Dx @ 29 Wks pregnant, 42 yo
Adenocarcinoma, mucinous features
7/13 C-sec/col resec/part. hysterectomy
8/13 Pulm embolism
8/13 Liv met
9/13 Liv resect
FOLFOX
CEA UP
ADAPT: Xeloda/Celebrex
2/14 oopherectomy
10/15 obstruction surg
10/17 Scar tissue removal/vsg surg
NED :D
Mom to 3 boys: 19, 8 & 4

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LPL
Posts: 343
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby LPL » Mon Feb 05, 2018 6:13 pm

Hi andelib,
Thank you for your kind words.
I’m surprised and happy to hear that your father, in Turkey, will have a ”dihydropyrimidine dehydrogenase deficiency test” before starting chemo. That is to my knowledge not done in France (where I am) or in USA where most members on this Forum live. I tried the best I could to look at hubby’s 23andme gene test (that we had done before his diagnosis) to find signs if 5-FU would be a problem for him. I did not find huge potencial problems but I could not check everything like in this kind of specific test that your father will be doing.
Best of Luck with the test and with the chemo treatment.
Please come back and let us know how your farher is doing.
Kind regards /L
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

Yegana
Posts: 3
Joined: Fri Jan 05, 2018 8:19 am
Facebook Username: flower76

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby Yegana » Thu Feb 08, 2018 5:25 am

Hi.
I wish your father get well very soon. Could I ask you in what hospital he has his treatment?. And what is best ranking hospital for cancer treatment in İstanbul? Thank you.

andelib
Posts: 6
Joined: Fri Dec 15, 2017 1:13 pm
Location: Turkey

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby andelib » Thu Feb 08, 2018 5:20 pm

LPL wrote:Hi andelib,
Thank you for your kind words.
I’m surprised and happy to hear that your father, in Turkey, will have a ”dihydropyrimidine dehydrogenase deficiency test” before starting chemo. That is to my knowledge not done in France (where I am) or in USA where most members on this Forum live. I tried the best I could to look at hubby’s 23andme gene test (that we had done before his diagnosis) to find signs if 5-FU would be a problem for him. I did not find huge potencial problems but I could not check everything like in this kind of specific test that your father will be doing.
Best of Luck with the test and with the chemo treatment.
Please come back and let us know how your farher is doing.
Kind regards /L


Actually DPD test is not a standard procedure but our doctor strongly advised. There are several labs in Istanbul who can do this analysis by a small tube of blood. We will get the result next week and plan accordingly. The health care is quite advanced compared to past years, especially in Istanbul. Doctors are closely following the latest researchs and hospitals are equipped with the latest equipment. The only setback is immunotherapy drugs, since they are very expensive and not reimbursed by health insurance.
Dad Dx CC, Age 61, no chronic illness
Late Nov 2017: Anemia led to Colonoscopy + CT + PET + Ultrasound + Biopsy
Stage IV, Liver lesions
Jan 2018: Lap colon res and open liver res (15%)
No colostomy, 3 affected left nodes out of 30+
All clear margin, MSI High
Feb 2018: recovering, DPD Deficiency: Negative
March 2018: Started chemo (FOLFOX) via port (2-day pouch)
April 2018:(4/12 cycles completed)
Working full time, CEA 1.8, HMG 13.1
thrombocyte lower than normal, AST-ALT higher than normal

andelib
Posts: 6
Joined: Fri Dec 15, 2017 1:13 pm
Location: Turkey

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby andelib » Thu Feb 08, 2018 5:37 pm

Yegana wrote:Hi.
I wish your father get well very soon. Could I ask you in what hospital he has his treatment?. And what is best ranking hospital for cancer treatment in İstanbul? Thank you.


Hi Yegana. Thanks for your good wishes. He had the surgery at Medipol University Hospital (http://www.internationalmedipol.com/Medipol-University-Hospital), he will continue chemo at Istanbul Oncology Hospital (http://istanbulonkoloji.com/EN) since it is closer to home.

Other than these two, there are several high ranking hospitals in Istanbul, best three are:

http://www.americanhospitalistanbul.org/
http://www.acibadem.com/en/
https://www.memorial.com.tr/en/
Dad Dx CC, Age 61, no chronic illness
Late Nov 2017: Anemia led to Colonoscopy + CT + PET + Ultrasound + Biopsy
Stage IV, Liver lesions
Jan 2018: Lap colon res and open liver res (15%)
No colostomy, 3 affected left nodes out of 30+
All clear margin, MSI High
Feb 2018: recovering, DPD Deficiency: Negative
March 2018: Started chemo (FOLFOX) via port (2-day pouch)
April 2018:(4/12 cycles completed)
Working full time, CEA 1.8, HMG 13.1
thrombocyte lower than normal, AST-ALT higher than normal

andelib
Posts: 6
Joined: Fri Dec 15, 2017 1:13 pm
Location: Turkey

Re: Stage 4a, chemo to start after removal of partial colon+liver met.

Postby andelib » Thu Feb 08, 2018 5:41 pm

DBF wrote:Good luck to your dad. I hope he handles the chemo well. I also had my colon and liver surgery before chemo. I did 12 rounds of FOLFOX after my liver resection. You can see by my signature I have been NED since 2013. I am not MSI high, so immunology was never discussed.
My marker went up initially after I finished FOLFOX, and I chose to do ADAPT protocol, which is low dose Xeloda plus Celebrex. Some say it has no positive effect in keeping people disease free. I don't know what I think, but I am disease free, so I choose not to disparage it. :wink:
Best,
Donna


Hi Donna, that's great to hear. Thanks for sharing. I hope you will never get it back and live a healthy and long life with your sons :)
Dad Dx CC, Age 61, no chronic illness
Late Nov 2017: Anemia led to Colonoscopy + CT + PET + Ultrasound + Biopsy
Stage IV, Liver lesions
Jan 2018: Lap colon res and open liver res (15%)
No colostomy, 3 affected left nodes out of 30+
All clear margin, MSI High
Feb 2018: recovering, DPD Deficiency: Negative
March 2018: Started chemo (FOLFOX) via port (2-day pouch)
April 2018:(4/12 cycles completed)
Working full time, CEA 1.8, HMG 13.1
thrombocyte lower than normal, AST-ALT higher than normal


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