Hai pump leak into lymph nodes

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mpbser
Posts: 934
Joined: Wed Apr 19, 2017 11:52 am

Hai pump leak into lymph nodes

Postby mpbser » Wed Mar 13, 2019 1:45 pm

So the flow scan test that was done yesterday showed leakage into liver lymph nodes. Dr. D’Angelica did not seem overly concerned but said that it is Dr. Kemeny’s call whether or not HAI pump chemo can be given with it as is. We don’t know if this is something that can be “repaired” as in removing the nodes and thus removing the condition that will lead to leakage. (For those unfamiliar with our story, he just had surgery last Thursday to implant the pump. Chemo scheduled to begin in April.) We don’t know what risks there may be if FUDR gets into these nodes. Any ideas?
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

radnyc
Posts: 404
Joined: Tue Apr 06, 2010 6:32 pm

Re: Hai pump leak into lymph nodes

Postby radnyc » Wed Mar 13, 2019 6:07 pm

DX Jan '10, at 47
Feb - colon resection - 2/17 nodes
April - liver mets - Stage 4
3 months Folfox chemotherapy
August '10 liver resection and HAI pump
7 months chemo FUDR HAI and Folfiri systemic
NED since August 2010
Last treatment April '11
HAI Pump removed Dec '15

mpbser
Posts: 934
Joined: Wed Apr 19, 2017 11:52 am

Re: Hai pump leak into lymph nodes

Postby mpbser » Wed Mar 13, 2019 7:36 pm

Thanks for sharing that.
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

boxhill
Posts: 388
Joined: Fri Apr 06, 2018 11:40 am

Re: Hai pump leak into lymph nodes

Postby boxhill » Thu Mar 14, 2019 10:46 pm

My eye was drawn to this because I've been trying to figure out whether the HAI pump would work on my 2 enlarged lymph nodes in the porta hepatis in addition to my tiny liver met, if keytruda doesn't work for me. I've been having a hard time finding information pertaining directly to treatment of such nodes. My oncologist considers them to be very risky to try to remove due to their location with no curative benefit in doing so, at least at this point. I am concerned that if they grow they will put pressure on the arteries/veins and bile ducts in the porta hepatis structure with obviously negative results. I know that stenting is possible, but finding some way to attack them directly the way HAI attacks liver mets would be awfully nice.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED
11/20/18 CT NED. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met? and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LN and spleen normal, Liver node stable
6/28/19 Pause Keytruda, predisone for joint pain
7/31/19 Restart Keytruda
9/10/19 CT stable

mpbser
Posts: 934
Joined: Wed Apr 19, 2017 11:52 am

Re: Hai pump leak into lymph nodes

Postby mpbser » Sat Mar 16, 2019 9:26 am

I will keep you posted, boxhill. What we learn at our next appointment with his oncologist may be useful.
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: 934
Joined: Wed Apr 19, 2017 11:52 am

Re: Hai pump leak into lymph nodes

Postby mpbser » Fri Mar 22, 2019 3:07 pm

So, Dr. Kemeny is not convinced that there is a leak into the two nodes that the radiologist says has extrahepatic tracer activity: portocaval node and periportal node. She thinks that it may just be the slice/angle of the particular images they are looking at. She said that the radiologists reading the flow scans have tended to over-report to be overly cautious. She further stated that my husband is one of a number of patients that have been said to have leakage into these nodes but it turns out that it is not the case. Apparently, the procedure to "correct" this problem, ligating the nodes, is extremely tricky and often "fails." Her recommendation is that we simply proceed with HAI treatment, recognizing the potential risk as leakage into the nodes would cause a toxicity that would need to be very carefully watched out for and monitored. My husband accepts the risk and agrees with moving ahead.

Another MRI and CT scan will be done March 31st and his first HAI treatment will be the following day, April 1st.
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

jep
Posts: 178
Joined: Sun Jun 11, 2017 7:45 pm

Re: Hai pump leak into lymph nodes

Postby jep » Fri Mar 22, 2019 4:47 pm

Sounds like you all have a good plan in place! Hoping it's not a leak and that your hubby keeps moving forward and fighting this s*#t....as you know, our husbands' surgeries were basically at the same time....my man is facing a potential second surgery soon....praying that both men stay strong and beat this!!
Wife of DH (47) Stage IV CC on 5/16/17
T Loc: recto-sigmoid
T type: Adenocarcinoma
T size: 7.4 cm
T grade: G3
TNM code: T3N2M1
Pos LNs: 8 out of 20
Baseline CEA value: .9
LVI: present
Perineural invasion: present
LAR margins: clear (w/in microns)
Folfox (8/17-1/18)
Scope 6/18 - CLEAR! - 2 polyps removed
PET 10/17/18: 3 pos LNs
Irinotecan + Vectobix (started in 11/18)
CEA: 1.7 (2/19)
Xeloda + radiation (5/19)
Surgery scheduled: 8/21/19 (surgery aborted)

mpbser
Posts: 934
Joined: Wed Apr 19, 2017 11:52 am

Re: Hai pump leak into lymph nodes

Postby mpbser » Sat Mar 23, 2019 5:07 am

jep, would that surgery be for the nodes mentioned in your signature? Where are they located? Abdomen?

EDITED: I just saw your thread about this and see, yes, they are abdominal. Good luck with the surgery and everything! Please keep me/us posted!
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

kandj
Posts: 263
Joined: Sun Sep 27, 2015 11:29 am

Re: Hai pump leak into lymph nodes

Postby kandj » Tue Mar 26, 2019 12:55 pm

I would trust Dr. K on that. She has seen thousands of these pumps (well, more the old ones, but hundreds of the new ones as well) and is pretty good at eyeballing things. And she will watch your husbands numbers. This is the reason she only wants the chemo done in NYC, because she controls it. I pray the HAI pump is the key to your husbands cure.
wife to DH, dx 8/15 stage IV @36, numerous unresectable liver Mets
resection and HAI placed 12/15
Liver resection 5/19/2016 15-20 mets removed (surgeon lost count, but it hopeful he got it all!)
Recurrence 7/2017 4 Liver mets and one possible lung met
Radiation on liver Mets 12/17
Lung met 10/18
VATS on lung met 11/18 started xeloda
Chemo break 6/19-11/19
New spot seen in lungs and adrenal gland 11/2019

mpbser
Posts: 934
Joined: Wed Apr 19, 2017 11:52 am

Re: Hai pump leak into lymph nodes

Postby mpbser » Tue Mar 26, 2019 2:11 pm

Thanks, kandj. I am sure she has seen many hundreds of pump flow scans, so we are comfortable with the decision.

However, I'm a bit of a stickler for facts (the attorney in me) so I must say that I doubt she has seen hundreds of the new pump adaptation as only 60 had been implanted at MSK as of the end of February.
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: Hai pump leak into lymph nodes

Postby LPL » Tue Mar 26, 2019 3:58 pm

mbpser wrote: I'm a bit of a stickler for facts (the attorney in me)

Thank you for pointing that out. I’m dealing with a law suite and an attorney and that really makes sense to me :wink:
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


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