Is surgery a option if it is metastatic to different location?

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Suniva
Posts: 15
Joined: Mon Sep 30, 2019 4:03 pm

Is surgery a option if it is metastatic to different location?

Postby Suniva » Fri Feb 28, 2020 10:33 am

Hi all, as you know that last ct, pet scan , colonoscopy and ultrasound endoscopic confirmed that tumor is metastatic to perirectal and assuming at peritoneal too. As per your experience, can we do surgery on these places as well as one spot at lung rather getting chemo. Last visit it was told that if boispy of perirectal was confirmed, doc told to go with chemo rather than lung surgery but now they are discussing about doing surgery as chemo can only shrink the tumor. And all the tumor is less than 1 cm. All your suggestions are really valuable.
Thank you
Suniva
DT 41yrs 10/18 on 3C, and small nod r/l lungs
11 lap surg
12/1805/2019 CAPOX total 8cyc (inc and dec tumor)
09 thoracotomy at right lung took two nodules, still left at left lung.metastatic to lung
10-Started CAPOX again
10/31/19-2nd cycle Allergic to OX taking CAP oral chemo alone for 1 cycle, CT scan showed left nodule inc. from 5to6mm
12/19 ct scan ndoc visit 7mm. Doc want to do 3 cycles of CAP
2/18 pet n ultrasound endo confirmed metastatic to perirectal 4mm
3/16 CT new nods at r/l lungs, inc pelvis

Claudine
Posts: 385
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Is surgery a option if it is metastatic to different location?

Postby Claudine » Fri Feb 28, 2020 10:44 am

Hi Suniva,
I have no experience with your met locations, but in our case we were told that surgery would only be considered after cancer was stabilized/under control, so DH did 18 rounds of Folfiri before getting his adrenal gland removed. It had shrunk by about 50% and his lungs mets were pretty much all gone (or at least not detectable). My understanding is that in the case of multiple met locations, doctors are reluctant to do surgery if cancer is still actively progressing/spreading so they want chemo to knock it down before operating.
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT 04/18, SBRT 02/19
Resect small intestine 05/18 (no cancer - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin 03/19 to 01/20
6.7 cm left adrenal mass 03/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 4.4
Scan 03/19: Multiple small lung nodules up to 5mm
Scan 12/19: one 1mm stable nodule
PET 04/20 uptake by L4
L3-L4-L5 fusion surgery and residual tumor removal 05/20

Suniva
Posts: 15
Joined: Mon Sep 30, 2019 4:03 pm

Re: Is surgery a option if it is metastatic to different location?

Postby Suniva » Fri Feb 28, 2020 10:52 am

Thank you for your reply Claudine, recently found are at perirectal and pelvis both of them are around 4mm. Previous one at left lung, at right lung surgery is already done.
DT 41yrs 10/18 on 3C, and small nod r/l lungs
11 lap surg
12/1805/2019 CAPOX total 8cyc (inc and dec tumor)
09 thoracotomy at right lung took two nodules, still left at left lung.metastatic to lung
10-Started CAPOX again
10/31/19-2nd cycle Allergic to OX taking CAP oral chemo alone for 1 cycle, CT scan showed left nodule inc. from 5to6mm
12/19 ct scan ndoc visit 7mm. Doc want to do 3 cycles of CAP
2/18 pet n ultrasound endo confirmed metastatic to perirectal 4mm
3/16 CT new nods at r/l lungs, inc pelvis

Lee
Posts: 6048
Joined: Sun Apr 16, 2006 4:09 pm

Re: Is surgery a option if it is metastatic to different location?

Postby Lee » Fri Feb 28, 2020 8:31 pm

Are you in the USA? If you are, get a 2nd opinion at a major cancer hospital. You want a team of aggressive doctors dealing with your current situation. Major cancer hospitals tend to be on the leading edge of today of what is deemed tomorrow standard of care.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!

Rock_Robster
Posts: 507
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Is surgery a option if it is metastatic to different location?

Postby Rock_Robster » Sat Feb 29, 2020 12:22 am

Lee wrote:Are you in the USA? If you are, get a 2nd opinion at a major cancer hospital. You want a team of aggressive doctors dealing with your current situation. Major cancer hospitals tend to be on the leading edge of today of what is deemed tomorrow standard of care.

Lee

Completely agree with this - re-resections (aka ‘salvage’ resections) of the (peri-)rectum and pelvis/peritoneum are definitely done but usually only by specialist colorectal / peritoneal surgeons in this area. I’d suggest doing some research for names, and considering travelling for a direct consult if necessary.

Good luck,
Rob
38M Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm high
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2, May-20=1.9, Jun-20=2.1
11/18 FOLFOX x6
3/19 Liver resect
5/19 25x pelvic VMAT radiation; complete met. response
07/19 Robot ULAR w ileo, 1/27 LN+
08/19 Found liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resect #2
02/20 Ileo reversed
03/20 NED (PET+MRI)
06/20 NED (CT+MRI)
07/20 Clear scope

Suniva
Posts: 15
Joined: Mon Sep 30, 2019 4:03 pm

Re: Is surgery a option if it is metastatic to different location?

Postby Suniva » Wed Mar 11, 2020 10:59 am

Yes we are from MN, our local oncology is from U, with long discussion with team they want to do open surgery at perirectal and peritoneal if possible. They want to hold chemo as my husband is getting lot of bowel movements everyday, like he is chemo break since end of Jan and still have abdominal pain and frequent bowel movements. As per your suggestion, we are going to get second opinion from Mayo about it.
DT 41yrs 10/18 on 3C, and small nod r/l lungs
11 lap surg
12/1805/2019 CAPOX total 8cyc (inc and dec tumor)
09 thoracotomy at right lung took two nodules, still left at left lung.metastatic to lung
10-Started CAPOX again
10/31/19-2nd cycle Allergic to OX taking CAP oral chemo alone for 1 cycle, CT scan showed left nodule inc. from 5to6mm
12/19 ct scan ndoc visit 7mm. Doc want to do 3 cycles of CAP
2/18 pet n ultrasound endo confirmed metastatic to perirectal 4mm
3/16 CT new nods at r/l lungs, inc pelvis


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