Waiting for PET results & HAI pump issue

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mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Fri Jan 18, 2019 4:19 pm

Oncologist and liver surgeon at Mass General recommended biopsy. My husband said why not ablate just in just when you are in there biopsying. Interventional radiologist agreed. Procedure was scheduled for January 22nd. We postponed it to February 26th to get the second opinion from MSK. We had originally hoped to have some more definitive diagnosis by MSK at this point, but they are doing all the right scans, and this is all fine by us.

Will get MSK's recommendation on Monday. The biggest irony will be if we stick with Mass General and go for the biopsy/ablation there as originally planned!
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Fri Jan 18, 2019 4:48 pm

Or, come to think of it, just a biopsy. One concern originally was risk of spread via the percutaneous biopsy needle if indeed it is cancerous. That was one of the reasons we sought a second opinion at MSK. However, if he goes for the biopsy (without ablation), and it does come back positive for cancer, then the resection & HAI pump would most likely be the route he will choose to go, now that that is an option being in MSK's system.

Having surgery and HAI pump implanted without such a confirmation would be foolish. The MSK surgeon hopefully will not advise thus on Monday.

I don't care what the doctors say, I just care about them not making mistakes like misinterpreting the measurements on the MRI.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

User avatar
LPL
Posts: 651
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Waiting for PET results & HAI pump issue

Postby LPL » Fri Jan 18, 2019 5:51 pm

mpbser wrote:Or, come to think of it, just a biopsy. One concern originally was risk of spread via the percutaneous biopsy needle if indeed it is cancerous. That was one of the reasons we sought a second opinion at MSK. However, if he goes for the biopsy (without ablation), and it does come back positive for cancer, then the resection & HAI pump would most likely be the route he will choose to go, now that that is an option being in MSK's system.
...
I don't care what the doctors say, I just care about them not making mistakes like misinterpreting the measurements on the MRI.

I know nothing about biopsies. My husband has never had one. But a possible lung biopsi is mentioned now and I have read about risk of seeding. As I understand it when they see something in the lungs, one reason for biopsi is checking for possible New(!) cancer. I have not read that is the case with biopsi on liver?
Having surgery and HAI pump implanted without such a confirmation would be foolish. The MSK surgeon hopefully will not advise thus on Monday.

If MSK recommend/do the surgery and the pathology says it is not cancer - I presume that is it and they will not implant the HAI pump?
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a 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->Jan-19 mets to lung NED again Oct-19 :)
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb & Oct lung mets

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Fri Jan 18, 2019 6:43 pm

Yes, there is the same risk with biopsy of the liver. You call it "seeding", here we call is "spreading." That is why I wrote, "One concern originally was risk of spread via the percutaneous biopsy needle if indeed it is cancerous."

"If MSK recommend/do the surgery and the pathology says it is not cancer - I presume that is it and they will not implant the HAI pump?"

I don't know, although I am not sure I understood your question. I can't see MSK recommending surgery without implanting the pump at the same time as the surgery.

Another option that Mass General had suggested was to watch and wait. Given the seriousness of possible metastasis, my husband and I were rather surprised by such a suggestion. But now, going through all this, we get it. That's something we plan on asking on Monday. Once we hear the doctor out, we will definitely ask about alternatives.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED


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