Removing small liver met?

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boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Removing small liver met?

Postby boxhill » Thu Jun 27, 2019 4:22 pm

I thought I would put this question in a separate thread from my other one, since the topics are really different.

So I had one 5mm subcapsular liver met removed for biopsy during my initial surgery. (It was in the 7th sector.) On FOLFOX, I grew a subcapsular 5mm met in the 8th sector. I also developed two enlarged lymph nodes in the porta hepatis. None of these were biopsied, but the radiologist and my onc were pretty confident that they were cancerous. I've been on Keytruda since 12/31/198, and as of my recent scan the two nodes shrank back to normal size, but the liver lesion is apparently still the same size.

It is my understanding that they can't really tell what the composition of it is from scans. It could be necrotic tissue. It could still be alive. It may be too small to biopsy but leave in situ, I think. I feel pretty strongly that I would like to have it removed. Then we'll know for sure. My onc said something about maybe leaving it there like the canary in a coal mine. I said I don't want a canary, I want to be N E D NED! He decided to take it to the tumor board, which hopefully was yesterday. (He also said I should read about SBRT.)

So, I'm constantly reading about people having liver met resections. Has anyone had one this small? Laparoscopic? Or did you have SBRT, and if so what was left afterward? Side effects?

I'm seeing him tomorrow afternoon. Any input would be helpful.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

kandj
Posts: 314
Joined: Sun Sep 27, 2015 11:29 am

Re: Removing small liver met?

Postby kandj » Fri Jun 28, 2019 2:56 pm

DH had SBRT on 4 lesions after a recurrence. That was in Dec 2017. The spots show up still on the CT and MRI (MRI is a much better view for him) but they don't have any uptake of contrast and show other post radiation changes that has led to them being declared dead. His radiation oncologist was very happy with his results.
wife to DH, dx 8/15 stage IV @36, 12+ liver Mets
HAI placed 12/15
Liver resect 5/19/2016 15-20 mets (surgeon lost count)
Liver Recurrence 7/2017-radiation
Lung met 10/18 VATS
lung/adrenal gland recurrence 11/19
Adrenal ablation 2/20 VATS 3/20
Radiation: 9/20 adrenal gland, 2/21 pancreatic node
9/2021 liver, 4/22 esophageal node
7/2023 proton therapy: liver
140+ rounds of chemo and counting
Chest nodes, lung nodules, and esophageal nodes currently.

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Removing small liver met?

Postby boxhill » Fri Jun 28, 2019 5:17 pm

Well, the tumor board said no surgery: I'm responding well to keytruda, so just watch it. Some of them apparently said that it might not be a met at all. Scan in 3 months or so.

Not only that, but due to my pretty extreme joint situation, he is going to continue to postpone Keytruda infusions for a while, saying that the effects keep on working for a while. He'll consider giving me more down the road. Keeping a watch on my numbers and so on. Another blood draw and appt in 2 weeks.

As he correctly noted, given the way I am, this is probably going to be harder for me than surgery.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

Pyro70
Posts: 156
Joined: Mon Jan 21, 2019 4:25 pm

Re: Removing small liver met?

Postby Pyro70 » Fri Jun 28, 2019 8:20 pm

boxhill wrote:Well, the tumor board said no surgery: I'm responding well to keytruda, so just watch it. Some of them apparently said that it might not be a met at all. Scan in 3 months or so.

Not only that, but due to my pretty extreme joint situation, he is going to continue to postpone Keytruda infusions for a while, saying that the effects keep on working for a while. He'll consider giving me more down the road. Keeping a watch on my numbers and so on. Another blood draw and appt in 2 weeks.

As he correctly noted, given the way I am, this is probably going to be harder for me than surgery.


All surgeries carry risks. Doesn’t seem like this one has a definitive benefit so the tumor board’s decision seems sensible for now. Scans are really not that accurate. It’s easy to mistake something for a lesion and even more easier to miss lesions. I apparently have many small lesions in my pleura that don’t show on any scans. So even if you remove this lesion it’s quite possible there are still other occult ones.

Congrats on success with Keytruda! Many of us would love to be in that boat. But I’m not sure what you mean by “probably going to be harder than surgery”.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Removing small liver met?

Postby boxhill » Sat Jun 29, 2019 1:23 pm

I mean that it is very, very hard for me, tempermentally, to "do nothing." I would find it easier, mentally, so prepare for a laparoscopic surgery, have it, and recover, thus *knowing* what this lesion is and being rid of it.

I was also envisioning months of hanging around the house unable to walk at anything beyond a hobble due to my knee, hand aching constantly with the occasional stabbing pain (spreading to the left one in progress), painful stiff neck, impossible to get comfortable, waking up with splitting headache. Watching our glorious but brief summer go by completely unable to garden, hike, do yoga, walk the dog, fix peeling paint, you name it. Nothing constructive to occupy myself with.

BUTT, as some are wont to say, I started on the descending prednisone pack yesterday and I woke up feeling a solid 50% better. Woohee! If this continues it will be fine.

I totally agree with you that the tumor board made a very rational risk-benefit analysis. As my onc often says to me, "If we do that, will it affect treatment afterwards?" And of course the answer is no. I also agree regarding the possibility that there is other stuff that the scan can't see. My first met wasn't seen on CT. This one wasn't seen until I had an MRI, to start with. In reality, it could have been there all along, but not visible to the surgeon like the other one. Anything is possible.

Despite the whining above, believe me, I know I am incredibly lucky to be in this position. Especially if I am able to go back on Keytruda. So, so many of us have it much, much worse.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED


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