The Colon Club

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?

Here's what MSK says about this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113257/

Thanks for sharing that.

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.

I will keep you posted, boxhill. What we learn at our next appointment with his oncologist may be useful.

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.

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!!

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!

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.

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.

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