Need help!! Ablation or No ablation??

[ilovemyfrenchie]

What are your opinions on a heat ablation for a 1cm liver met? the oncologist said the ablation will do nothing to prolong anything. He said even though the CT may show one met left there may be some not shown on the CT. The radiologist said he only saw one and said he can do an ablation.

My mom had no surgery and had a lot of liver mets when first diagnosed (which now all shrunk). The oncologist said why put her through the ablation and “aggravating it” when it won’t prolong survival since she’s stage 4.

I was happy she was a candidate for the ablation (anything to help), now I’m back to being stuck on what to do. The main reason I want is to give my mom a break from chemo that she has had for 2 years straight. Chemo for lifer.

[claudine]

I'd definitely get a second opinion/push for ablation. Lots of folks who are stage 4 have benefited from aggressive treatment, several of them on this forum. IMO saying "you're stage 4 so there's nothing to do, it's chemo for life" is an outdated view! Especially given how young your mother is.

[boxhill]

I agree with Claudine. It is ridiculous to lump everyone who is stage 4 into one basket and say they are "incurable" in this day and age.

Yes, it is true that CT scans will not pick up very small masses in the liver: I can testify to that. An MRI is much better for the liver. Has she had one?

I would probably be more concerned about the perimets, actually. They are harder to treat, although there is debulking and HIPEC.

Also look into the HAI pump for multiple liver nodes. There are people right here who have done it. Before doing ablation, I'd check to make sure it doesn't cut her off from other alternatives. Earlier I asked if you the surgeon's report and/or the results of tumor biopsies. You really need that information to make an educated decision about treatment.

Your mother is a young woman. I personally would like to have a doctor who was willing to be more aggressive. Does your mother's oncologist participate in a Tumor Board? I'd push for them to review her case, also.

What does your mother think about all this?

[ilovemyfrenchie]

Thank you for your responses.

I guess the oncologist main concern was “quality of life” vs benefit for doing the ablation. I’m trying to research the reoccurrence rates. He asked us what our main goal was. I told him “some time” anything really, a chemo break?? since we are left with what seems no other option. Chemo either stopped working or is too “strong” for her. I know my moms tired of this all. She’s the type of person to just listen to what the doctor says. But always values my opinion on things. So I’m sort of the one advocating for her care. I know she wants to give up most of the time.

The surgeon who did her colostomy only took a liver biospy. His notes states disease burden everywhere. And we only have a biopsy from the rectal mass from her incomplete colonoscopy (couldn’t advance camera to complete her colonoscopy). So the biospy didn’t show much, but I got this report from the oncologist notes.

Stage IV adenocarcinoma of the rectum, MSI-low, KRAS/NRAS wild-type, BRAF negative,

[boxhill]

Maybe someone here who has had an ablation will pipe up and tell you about how difficult the recovery was.

I would also suggest that you join the private Facebook group Colontown and they join their Liver Lover's Lane (correction) neighborhood. You can get lots of information there.

[Gravelyguy]

I don’t know you mom’s full story, but I would definitely seek a 2nd opinion at a major cancer center.

I had one of my liver Mets ablated But it was in conjunction with a wedge resection and primary tumor removal so I can’t give you any insight into how taxing the procedure is. I very could be wrong, but I thought I remember that it is similar to a biopsy. Again, not at all sure that that is true.

Being on chemo took its toll physically and mentally on me. If there was no end in sight of it, I am sure I would have been in a dark place. I would want to know if there is a chance that I could do something that would give me a break from it. Maybe the ablation could do that. It is worth the 2nd opinion!

Dave

[boxhill]

I just want to circle back to what you told the oncologist when he asked you what your goal was. You said "some time," or "a chemo break." This is not the answer of a person who wants to work towards NED. I'm not criticizing you AT ALL. It is pretty clear that you and your mother had been told that nothing else was possible. And there is no doubt that for many people that is realistic, unfortunately. It is a perfectly reasonable goal, depending on the circumstances.

I think you might want to revisit this with the doctor. Getting at least one additional opinion may be the first step toward having a better idea whether there are other possibilities for your mother. You can tell him that in retrospect you answered without having enough information about the alternatives. Or not, if she wishes.

I admit that I am a little mystified by the absence of your mother's opinions and volition in this. I know you are a loving daughter, but what does SHE think? As a now-67 yr old, I cannot imagine leaving decision-making to my son OR husband. But of course we are all different. Best to you and your mother.

[ilovemyfrenchie]

I appreciate/value any input regarding this “cancer journey”. Yes after hearing a 2nd and 3rd opinion say no and that she is palliative and inoperable, I think she pretty much gave up with NED. She refused to go out of state for a 4th opinion. Here and there she’ll ask me if it “will ever go away”. As into her mindset. English is her second language and I think that makes her feel inferior to a lot of people. She told me herself. She just goes along with what the doctors say. She’s also a genocide survivor from the Khmer Rouge in the 70’s. I think she feels like she already beat death once. She’s tired of all of it, chemo for 2 years straight, all the doctors. She was the type to not even take Tylenol for a headache, never went to the doctors, workaholic. Her first time in the hospital was when she was diagnosed. So she’s a strong woman.

As her daughter, it’s hard. So I have to advocate for her. I am willing to do anything as a long as she’s willing.