Liver and lung mets

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Rock_Robster
Posts: 341
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Liver and lung mets

Postby Rock_Robster » Sat Sep 14, 2019 6:54 pm

That’s great news Alexandra! Thanks for sharing. Really pleased to hear about the liver and glad you’re now prioritising a surgical opinion.

Indeed below 2cm then ablation can become an option, depending on the position of the tumour. Ablation doesn’t work so well near major blood vessels. Below 2cm, ablation has been shown to about 90% as good as surgical resection (above 3cm, it’s about 10% as good). If there are several mets in one segment then they must just prefer to do an anatomical resection of that segment, but if there is a “rogue” small lesion elsewhere, or if it is very deep (which would mean losing a lot of healthy liver too), then they may prefer to ablate. If it is near the surface then a ‘wedge’ resection is also possible to avoid losing the whole segment. Often they combine ablation with resection if there are multiple mets to try to preserve as much liver as possible. Lots of tools in the arsenal, anyway.

Enjoy the chemo break and hoping you guys get some great news from the surgeon :D
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

AlexandraZ
Posts: 48
Joined: Fri Aug 23, 2019 8:25 am

Re: Liver and lung mets

Postby AlexandraZ » Sun Sep 15, 2019 7:10 am

Rock_Robster wrote:That’s great news Alexandra! Thanks for sharing. Really pleased to hear about the liver and glad you’re now prioritising a surgical opinion.

Indeed below 2cm then ablation can become an option, depending on the position of the tumour. Ablation doesn’t work so well near major blood vessels. Below 2cm, ablation has been shown to about 90% as good as surgical resection (above 3cm, it’s about 10% as good). If there are several mets in one segment then they must just prefer to do an anatomical resection of that segment, but if there is a “rogue” small lesion elsewhere, or if it is very deep (which would mean losing a lot of healthy liver too), then they may prefer to ablate. If it is near the surface then a ‘wedge’ resection is also possible to avoid losing the whole segment. Often they combine ablation with resection if there are multiple mets to try to preserve as much liver as possible. Lots of tools in the arsenal, anyway.

Enjoy the chemo break and hoping you guys get some great news from the surgeon :D


Thanks! You seem extremely knowledgeable regarding surgeries. I believe it was one of your posts where I originally read the datum about 2cm and ablation. That's cool and exciting! I've done tons of research on chemo and cancer in general, but I don't know much about surgery at all. So that's very helpful. Following the threads on this forum I've realized what a big difference there is between doctors and surgeons. I'm pretty sure the Danish hospital is very rigid in following their official guidelines, so I think we HAVE to search elsewhere and pay out of our pockets. I've heard a lot about Dr. Vogel in Germany and I'm considering contacting him also, as he has a great reputation as a liver surgeon and we are just north of Germany. But I'll go over all our options and all my questions with our oncologist on Tuesday. He seems pretty up-to-date and open, so I don't think he'll be offended if we decide to go somewhere else. (Not that anyone necessarily would be offended, but he seems more open-minded than other oncologists we've met).

I also want to ask how many mets he has in his liver. At diagnosis 7 of 8 segments were affected, but he had big 5-6cm mets that may have covered several segments. Now that they have all shrunk, I'm pretty sure it's looking a lot better. His records just say "multiple" mets in the liver, but I don't know if that means 10, 12, 7 or 15?? It's not like he has countless tiny mets, I know that for sure. Would be good to get more details now that we might have more options.
Boyfriend 28yo dx February 2019, CEA 70,480
Stage 4 CRC with multiple mets to liver & lungs
KRAS, NRAS, BRAF wild type, MSS
12x FOLFIRI + Vectibix
September 2019 CEA 210, 60% reduction in size, chemo break!

Rock_Robster
Posts: 341
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Liver and lung mets

Postby Rock_Robster » Sun Sep 15, 2019 8:15 am

No problem at all, after lining up for my 2nd one of these I’ve done a fair bit of reading. I also have some modest paramedical training, and I like to bug my surgeon a lot too :D

Great idea re getting multiple surgical opinions. Surgery is the one area that I’ve observed the most variation between approaches. One surgeon’s “inoperable” can be another surgeon’s “Tuesday”. And the range of techniques and approaches used can vary wildly too - there’s other possibilities like portal vein embolisation and multi-stage surgeries that probably haven’t really come up yet in your discussions. No such thing as too many opinions, in my view!

Indeed it will be great to get more data now you know he’s had a great response! Liver mets are a bit like real estate - it’s all about location, location, location. You could have 20 mets but if they’re in one or two adjacent segments, then happy days for a resection. I’ve been lucky so far that mine have popped up in fairly friendly locations, though this latest one is a little more tricky as it’s deeper and near a blood vessel we’d rather keep.

Indeed there are some very reputable surgeons in Germany, so I can understand the interest there. It’s definitely one of the places people head to (outside of the US) when looking for novel ideas for more complex cases.

Keep in touch!
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Claudine
Posts: 131
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Liver and lung mets

Postby Claudine » Mon Sep 16, 2019 11:48 am

Those are great news Alexandraz!!
Wife of Dx 04/2018 (51 yo). MSS, KRAS mutated G12A
No primary, lytic tumor L4 vertebrae, CEA 10
Radiation 04/2018
Resection small intestine 05/18 (no cancer found - Crohn's)
Xelox * 6, 05/2018 to 10/2018
6.7 cm left adrenal mass 03/14/2019, 4.4 cm 05/21, 4.1 cm 09/16
SBRT L4 02/2019
Folfiri + Avastin
CEA since 03/15: 58, 17, 10, 6.4, 5, 4.8, 4.2, 3.6, 3.2, 3.3, 3.2, 3.7, 4.3, 4.2, 4.2, 5.0
Scan 03/14: Multiple small lung nodules
Scan 05/21: shrinking
Scan 09/16: lungs show no abnormalities (YAY!!!)

User avatar
juliej
Posts: 3048
Joined: Thu Aug 05, 2010 12:59 pm

Re: Liver and lung mets

Postby juliej » Mon Sep 16, 2019 5:35 pm

AlexandraZ wrote:Just checking in to mention that Jesper's new scan came in after his 12th round of FOLFIRI. His lung mets are stable (biggest met is 1cm) and his liver mets have shrunk further. At diagnosis, the biggest mets were 5-6 cm. Now they are 1.8-2cm! That's over a 60% decrease in size! We're very pleased and will definitely get a second opinion to see if there is someone who thinks his liver is resectable now.
He is getting a much-needed chemo break and during the break I'll send his scans around and see what other surgeons (and what the people at MSK) think! I think I heard something about that if tumors are under 2cm you have more treatment options. Maybe RFA or something, I don't know. Anyway, just wanted to share the good news!

This is FANTASTIC news, Alexandra!!! :D :D :D Sixty percent decrease is absolutely amazing! Folfiri is definitely working for him.

Lung mets are slower to react to chemo so you won't see changes there as quickly. It's more important to see whether or not they are growing or if there are any new nodules. It's a really good sign that his lung mets are stable.

You're right about having more treatment options when liver mets are smaller. RFA is a good possibility for some of the smaller ones, maybe combined with wedge resections for the larger ones. It's all up to the surgeon. The main thing is that Jesper should be able to get a surgical opinion now, considering his wonderful response to chemo.

I'm so happy for both of you!
Juliej
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 9/23/2019, CEA<1

AlexandraZ
Posts: 48
Joined: Fri Aug 23, 2019 8:25 am

Re: Liver and lung mets

Postby AlexandraZ » Tue Sep 17, 2019 11:15 am

Thank you so much everyone! We're definitely pleased, and SO HAPPY to be getting a chemo break too. The 12th infusion hit him the hardest, and even now, two weeks later, his skin is still a mess from the Vectibix. He deserves this break!

We met with his oncologist today who said he would send the new scan to the multi-disciplinary team or whatever it's called. The board of surgeons and specialists. However, he did say he didn't expect them to be able to operate. So we absolutely need a second opinion. I really get the idea that as soon as they see the lung mets, they're like, "Thank you, next". We requested all his CT scans and all the things MSK asked for, and I just need to translate his medical file. I found out a second opinion there is 5000 USD, yikes! But it's some kind of deposit that goes toward your treatment if they accept you, and otherwise you get back what's left after they have charged you for the consultation and any bloodworm or anything else they may need. So I want to make it happen.

We asked how many liver mets there were, and he said no one has counted them. We then got a chance to look at his first scan compared to the most recent one and HOLY MOLY what a difference!!! On the first scan there was practically more cancer than liver, and now there are just some scattered mets here and there, and they are SO MUCH SMALLER!! It's just a totally different view.

We talked a bit about the differences between the US approach vs the DK approach, and our oncologist said they are more "loose" in the US, whereas in Denmark they only want to do things that have been proven, etc. I much prefer the sound of the US way! Much less robotic and more handling each patient as a separate case. Ok I'm just rambling now. But I just think Jesper is SUCH a trooper to have made it through all 12 cycles and even as I'm writing this, he's at the gym working on regaining some muscle mass. We're definitely not giving up!! I think we can find someone who can scoop out those little mets. (if only it were that easy!! But you know what I mean)

In other news, Jesper signed me up for the X factor auditions over here. :lol: Yikes. Whatever makes him happy, I'll do it I guess! I got through the first two rounds of pre-casting, and tomorrow I get to meet the judges. HAHA! I'm sure it'll be a laugh, whatever happens.
Boyfriend 28yo dx February 2019, CEA 70,480
Stage 4 CRC with multiple mets to liver & lungs
KRAS, NRAS, BRAF wild type, MSS
12x FOLFIRI + Vectibix
September 2019 CEA 210, 60% reduction in size, chemo break!


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