Delaying treatment?

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AmyG
Posts: 157
Joined: Tue Dec 25, 2018 8:08 pm

Delaying treatment?

Postby AmyG » Mon Dec 31, 2018 10:38 am

I'll be seeing my team next week to discuss all my options and get a general idea of a timeline, but until then I have no one to bounce ideas off of!

So. Currently 27 weeks pregnant. It's been suggested that we induce at 32 weeks, leave the baby in the NICU two hours away from home and begin treatment for me. The thought behind that is if I need a c section that I'd be recovered within 2 weeks or so and able to begin chemo at what would have been 34 weeks gestation.

32 weeks is early. Looking at needing breathing support, several week stay in the hospital, etc.

My question is this: this liver met has been there since at least August. Will delaying chemo a few more weeks truly impact my prognosis? I'm not sure if there's any way of knowing an answer, but I'm going to ask anyway. What I'd like to do is wait until 35w6d and induce at the hospital 35 minutes away from home. We'd be a lot closer and be facing a much shorter hospital stay for the baby. And he'd likely have less challenges or health issues.

Is that ridiculous? Should I be ready to deliver at 32 weeks and get started on chemo asap? In the grand scheme of things, will a few extra weeks not matter to my long term survival? If it were you, what would you do?


UPDATE 1/9/19

So, was seen by my CRC surgeon today. He's totally okay with waiting until 34 weeks to deliver. He said the only thing that would change his mind was if the tumor in my liver had grown substantially. I asked if we could get an ultrasound of it and he thought that was a great idea. MRI while pregnant is okay, but would take forever to get in at our hospital. Neither of us are interested in waiting.

Provided this stupid thing hasn't eaten the majority of my liver and it's still just the one spot, I'll be delivering after 2/17 and will start everything at some point after that.

That also means I can do the half marathon on 2/10. I told him I had that on the books, that it wasn't my first one nor first while pregnant. He told me to have fun. :lol: Glad I have his blessing.
Last edited by AmyG on Wed Jan 09, 2019 4:58 pm, edited 1 time in total.
42 dx @ 9wks pregnant w/baby #8 8/18
Originally thought to be stage 2, no lymphnodes involved 9/18
Spot on liver found prior to bowel resection 9/18
Liver biopsy, it's malignant 12/18
Stage IV, 1 liver met 4.7cm
2019 plan is to deliver baby early and start FOLFOX w/Avastin

stu
Posts: 1103
Joined: Sat Aug 17, 2013 5:46 pm

Re: Delaying treatment?

Postby stu » Mon Dec 31, 2018 1:12 pm

Only because you asked !! Here are my thoughts . My mum’s oncologist actively encouraged her to go on holiday before starting treatment but I think you have a bit more to consider than a month or so delay . Right now you are 27 weeks so in 5 weeks the bady is delivered and wait another two weeks to commence treatment . That’s 7 weeks away ! If you delay that another three weeks you are also assuming you have no complications and can start in ten weeks time . That’s nearly three months away . Honestly I think you have to consider that as too long . Micro disease spread and increase in tumour size . I think your Team has made a sound safe calculation in the circumstances. It’s far from ideal but one that serves both of you as best they can . I get the travel side is a problem . But not sure if anything can be done .
I would trust their judgement but in the full knowledge medicine is a judgement call as is life .
Holding out for good news for you both .
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

KimT
Posts: 661
Joined: Sat Feb 20, 2010 8:53 pm

Re: Delaying treatment?

Postby KimT » Mon Dec 31, 2018 1:15 pm

That’s a really tough choice. There really is no way to predict the outcome of delaying chemo for a few weeks. All I can say is what I would do. I would give my baby every possible second before birth to improve his life. I have a 14 year old son. I would not hesitate to give my own life for him. You are already a stage 4. Treatment is going to be the same whether you wait an extra 4 weeks or not. A 2 hour drive to the hospital is going to be very taxing while on chemo.
2/10 dx colon cancer
right hemicolectomy 3/19/10
Stage 2a 0/43 nodes
Lynch syndrome
3/14/10 colon resection/ removal of metal clips
Nov 11 dx ovarian cancer

AmyG
Posts: 157
Joined: Tue Dec 25, 2018 8:08 pm

Re: Delaying treatment?

Postby AmyG » Mon Dec 31, 2018 4:15 pm

I do trust my doctors to help me pick out the best treatment plan. I know if they have to take the baby at 32 weeks, he'll have fabulous care and they will get him through any medical hurdles he might face. In the end, he'll be fine. If there's a safe way for me to be able to bake him longer, then that's what I'd rather do!

My case is just so complicated, I wish there was just a very simple "this is what is going to happen so you don't die" kind of plan that I knew was going to work. Why can't cancer be easier? :lol:

Last year at this time, I'd lost both my mom and dad unexpectedly. 2017 sucked, 2018 had to be better. Well 2018 can go kick rocks. 2019, I'm counting on you!
42 dx @ 9wks pregnant w/baby #8 8/18
Originally thought to be stage 2, no lymphnodes involved 9/18
Spot on liver found prior to bowel resection 9/18
Liver biopsy, it's malignant 12/18
Stage IV, 1 liver met 4.7cm
2019 plan is to deliver baby early and start FOLFOX w/Avastin

ashima2016
Posts: 36
Joined: Thu Dec 01, 2016 10:56 am

Re: Delaying treatment?

Postby ashima2016 » Mon Dec 31, 2018 6:59 pm

I was induced and ended up with c-section. So you never know what's gonna happen. 4 weeks would make a bigger difference for you than you unborn child. If you are not sure, trust the doctor.

debb
Posts: 171
Joined: Sun Dec 21, 2008 9:03 pm
Location: NJ

Re: Delaying treatment?

Postby debb » Mon Dec 31, 2018 11:12 pm

AmyG: I’m sorry for this unimaginable crisis you are facing. I’ve read your previous posts and you sound like an amazing and strong woman. As a fellow mom, I know our first inclination is always to put our children first. It seems like the doctors have a good plan in place to ensure all of your well-being. Maybe explain your reasons to your docs as to why you think it would be beneficial to delay treatment at this time. Many of us have put off a treatment for one reason or another...vacation, illness, graduations, weddings, etc. But like you said, you are a complicated case and the doctors are caring for two patients. Also, you said you were diagnosed at 9 weeks pregnant, which has already allowed a lot of time between diagnosis and your earliest future treatment start day. It sounds like their plan is very prudent.
We are supporting you here and it sounds like you have a team of docs that are on top of things. Sending positive energy and love to you and your kiddos!
(also, maybe search this forum for other pregnant moms who face your same situation. Other women have shared their journeys here.) good luck!
Stage 3C, Dx at 42, mom of 4
Colon resection 7/08
Folfox 9/08-2/09
Met to right ovary, both ovaries removed 7/10
HIPEC 8/10
VATS 7/12, 2 nodes, right lung
10/14 3 lung nodes, Stivarga clinical trial
3/15-7/15 Folfiri & avastin for lung things
Break! One+ year of freedom
8/16 Folfiri & avastin..lung things again
Break! 10 months of freedom
1/18 rib mets, radiation, folfiri & avastin
1/19 rib mets again, radiation, folfiri & avastin

AmyG
Posts: 157
Joined: Tue Dec 25, 2018 8:08 pm

Re: Delaying treatment?

Postby AmyG » Tue Jan 01, 2019 8:36 pm

Appointment is a week from tomorrow, so hopefully I'll have a much better idea of what I need to do and when to do it to get me healthy.

Since this is all so very new to us, we don't really have any idea if a few weeks matters, if I've pushed the envelope further than I should have already or something in between. But that's what the doctors are for!

For all I know, my liver could have exploded with multiple mets instead of just the 1, could be in my lungs or it could just be the one spot that's just waiting to be shrunk and resected. This not knowing stuff is obnoxious, but I guess I'm going to just have to get used to it. :roll:
42 dx @ 9wks pregnant w/baby #8 8/18
Originally thought to be stage 2, no lymphnodes involved 9/18
Spot on liver found prior to bowel resection 9/18
Liver biopsy, it's malignant 12/18
Stage IV, 1 liver met 4.7cm
2019 plan is to deliver baby early and start FOLFOX w/Avastin

Lee
Posts: 5938
Joined: Sun Apr 16, 2006 4:09 pm

Re: Delaying treatment?

Postby Lee » Tue Jan 01, 2019 9:43 pm

I am sorry I do not have an answer for you. You really need to rely on the experts regarding your situation.

If this helps, when I was diagnosed (almost 15 yrs ago), a good friend"s niece was diagnosed with stage IV colon cancer, a few months after giving birth to her first child (she had issues during pregancy, but decided to wait to address them until after giving birth). She too had a liver met, this was just OVER 15 yrs ago. She got 2nd opinion at major cancer hospitals like Sloan Kettering Memorial in NYC and MD Anderson in Houston when all other local hospitals told her there was nothing they could do other then chemo for life. These major cancer hospitals said YES, we can address this. Please understand there has been a lot of advancements since then!!

The cancer hospital that put her in NEDville I believe was MD Anderson, and about 6 yrs later, she gave birth to her 2nd child. This was "after" some local Dr.(s) early on told her that first child was it. Somewhere in the last few years, she has been told she is "cured" like me a few yrs back.

Moral of story, "Do Not Give Up the Hope"!! And if you are not getting the answers you want to hear, pls get a 2nd opinion at a major cancer hospital or treatment center. When you hang out here long enough, 2nd opinions are always a good idea, especially when dealing with a stage IV diagnoses or unique situation like your self.

I know you have received some info that has since been removed, my advice regarding that, Follow Your Heart. You know in your heart where your path lies!!

All the best,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

stu
Posts: 1103
Joined: Sat Aug 17, 2013 5:46 pm

Re: Delaying treatment?

Postby stu » Thu Jan 03, 2019 5:19 pm

Thinking of you Amy .
Hope your keeping well X
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

sailbd
Posts: 53
Joined: Thu Jan 27, 2011 10:58 am

Re: Delaying treatment?

Postby sailbd » Fri Jan 04, 2019 9:31 am

Hi Amy:

Sorry you are in this position. My wife was diagnosed Stage 4 with multiple mets to the liver at age 42. It will be almost 9 years from diagnoses and she has been NED since her one and only surgery to remove her primary and liver mets. After surgery, she did typical chemo and submitted to a clinical trial. The best advice we ever received was to go to a major cancer center (NCI designated) for surgical and medical care - you can take chemo at a practice closest to your home but the surgical advise should come from those best qualified and they are found at NCI designated institutions with some that stand out more than others as you will note from reading this board (Sloan, Anderson, Hopkins). Arguably, surgical resurrection of the liver met(s) is the only known path to prevent a recurrence. You must act as your own best advocate regardless of your provider. Wishing you well.

AmyG
Posts: 157
Joined: Tue Dec 25, 2018 8:08 pm

Re: Delaying treatment?

Postby AmyG » Wed Jan 09, 2019 5:39 pm

It's so nice to leave the hospital feeling positive. Added an update to the original post!

Thanks yall for all your feedback.

I'm totally going to kick this cancer's ass. It's going to be too scared to come back. :lol:
42 dx @ 9wks pregnant w/baby #8 8/18
Originally thought to be stage 2, no lymphnodes involved 9/18
Spot on liver found prior to bowel resection 9/18
Liver biopsy, it's malignant 12/18
Stage IV, 1 liver met 4.7cm
2019 plan is to deliver baby early and start FOLFOX w/Avastin

stu
Posts: 1103
Joined: Sat Aug 17, 2013 5:46 pm

Re: Delaying treatment?

Postby stu » Wed Jan 09, 2019 6:37 pm

That’s fantastic news . Always reassuring to hear you have the Docs on board .
Enjoy your marathon .
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

lakeswim
Posts: 209
Joined: Sat Mar 31, 2018 9:37 am

Re: Delaying treatment?

Postby lakeswim » Wed Jan 09, 2019 8:07 pm

Hi AmyG. I am coming in late to your discussion (so haven't read all early posts yet) but I want to tell you how much I admire your courage and positive can-do attitude. I often get so caught up with anxiety about my situation that I can't think straight. You have so much on your plate and you seem very clear-headed and as calm as one can be.

I will be rooting for you and your baby BIG time.

And, MARATHON, may I ask what that is about? (I've run one, so very curious! Good luck with that too.)

You are one formidable woman, Amy. Hang in there....

Best,
Lakeswim
50 - F - Mom
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18
Capecetabine + Radiation - 28 sessions - Oct - Nov 2018
Jan 19 - MRI & flex sig show tumor gone
Mid-Feb 19 - MRI & flex sig show tumor gone
W&W

AmyG
Posts: 157
Joined: Tue Dec 25, 2018 8:08 pm

Re: Delaying treatment?

Postby AmyG » Wed Jan 09, 2019 8:27 pm

lakeswim wrote:
And, MARATHON, may I ask what that is about? (I've run one, so very curious! Good luck with that too.)

You are one formidable woman, Amy. Hang in there....

Best,
Lakeswim



Oh, it's just a half!! 13.1 isn't that big of a deal. It's just one foot in front of the other until you're finished!

I might have a very small finisher's medal obsession :shock: Any race within driving distance that has a neat medal, oh yeah, I'm registered. Kids 1-3 all ran cross country, #4 will be next school year. Depending on the race, I usually have a kid with me. Last season, I carried the littlest one on me (soft sided carrier) in my first 4 races. She was super popular, but then it just got too hot!
42 dx @ 9wks pregnant w/baby #8 8/18
Originally thought to be stage 2, no lymphnodes involved 9/18
Spot on liver found prior to bowel resection 9/18
Liver biopsy, it's malignant 12/18
Stage IV, 1 liver met 4.7cm
2019 plan is to deliver baby early and start FOLFOX w/Avastin

lakeswim
Posts: 209
Joined: Sat Mar 31, 2018 9:37 am

Re: Delaying treatment?

Postby lakeswim » Wed Jan 09, 2019 8:37 pm

AmyG wrote:
lakeswim wrote:
And, MARATHON, may I ask what that is about? (I've run one, so very curious! Good luck with that too.)

You are one formidable woman, Amy. Hang in there....

Best,
Lakeswim



Oh, it's just a half!! 13.1 isn't that big of a deal. It's just one foot in front of the other until you're finished!

I might have a very small finisher's medal obsession :shock: Any race within driving distance that has a neat medal, oh yeah, I'm registered. Kids 1-3 all ran cross country, #4 will be next school year. Depending on the race, I usually have a kid with me. Last season, I carried the littlest one on me (soft sided carrier) in my first 4 races. She was super popular, but then it just got too hot!


Like I said - you are one strong woman. (And I love the half distance. I miss running! I had plans to get my bunions done and get back to running right before I was diagnosed.) GOOD LUCK on the run and thinking of you..... and please keep us posted.
50 - F - Mom
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18
Capecetabine + Radiation - 28 sessions - Oct - Nov 2018
Jan 19 - MRI & flex sig show tumor gone
Mid-Feb 19 - MRI & flex sig show tumor gone
W&W


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