Discouraging scans after liver resection, advice needed

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Vana3
Posts: 59
Joined: Tue Aug 13, 2019 11:40 am
Facebook Username: ma

Discouraging scans after liver resection, advice needed

Postby Vana3 » Fri Jun 12, 2020 6:41 pm

Hi everyone
I am in need of advice and and others experience and stories.

8 weeks ago I had a liver resection 3 small tumors were removed (2 small sections) and 3 were ablated (all three were so small no longer seen on scans but found with internal liver ultrasound during surgery). Pathology came back on Tumors removed one was 96% dead and the other two were over 80%dead, this was good news. Today I had my first scans with hope that I would now be NED.

The results came back that there is a 0.6 cm suspicious enhanced area next to one of the ablated spots. We did scans at our new local community clinic (just moved) and plan to send all results to our surgeon and oncologist at MSK but we won't know what they think until sometime next week after they get the hard copies. The community onc. was unsure what to think or what to do... could it be inflammation? My CEA did not go down after surgery it remained at 4.6 but my CEA has not seemed like a good indicator for me since my diagnosis last summer.
Has anyone experienced this? Could it be just inflammation? Could they have missed a spot during the surgery? Could it have grown since surgery?
They did not want me to do mop up chemo because pathology looked so good, so no chemo since beginning of March.
Has anyone had to go back in after a surgery because of a missed spot? If so did you do ablation, another resection, more chemo?
I know that the good news is that there has been no spread any where else, the surgeon visually searched my abdomen and para aortic lymph nodes and all looked clear before proceeding with liver resection. Scans continue to show that.

Last year I was in the emergency room on Father's day. My husband has been my rock during this last year and I wanted so badly for this scan to be clear and just have a nice Father's Day for him.

I need encouragement... but also info so that I don't drive myself mad as I wait to hear from the doctors.
Dx 36 yr, F, 7/19
T4aN2M1 Cea 5
5 cm tumor in cecum removed, 17 + out of 45 LN
Cea 4.2
MSS, KRAS g12d, Braf WT
MT: 10.9
8/20/19 MRI & PET liver spots
9/19 - 3/20 FOLFOX
1/20 CEA 3.6,4.4, 4.6, 4.6
Liver resect 4/15/20
6/20 Ct scan clear
7/20 Cea 8.6
8/20 Cea 12.4, suspicious ovarian cyst
9/20 Hysterectomy SOB CRC
post surgery cea 2.6
11/20 clear scans
2/21 clear scans
4/21 spleen met
5/21 pet scan picks up subtle concerns in liver as well as confirms spleen
Cea 4.6
5/21 to current folfiri
Cea 10

ChiMama
Posts: 34
Joined: Wed Jul 20, 2016 8:41 pm
Location: PHX

Re: Discouraging scans after liver resection, advice needed

Postby ChiMama » Fri Jun 12, 2020 9:48 pm

Hi - I don't have any input except to give you a virtual hug. The uncertainty and waiting is often the hardest part. Hopefully someone will come along soon with some wisdom.
4/21/16 First Colonoscopy @59
DX high grade dysplasia
Fibroid uterus, liver cysts, lung nodules
6/17/16 Open surgery: hysterectomy, X 12.5cm sigmoid, 29 LN
T2N0M0 Stage 1 Mod diff adeno 5.2cm x 4.1. Gyne benign, Lynch neg
CT 7/27/16 Ground Glass & spiculated lung nodules, thyroid nods, watching.
2017/18/19 Scopes: polyps. Scans stable
2019 Endo: hiatal hernia. 2 breast biopsies, benign
5/20 GGN 1.1cm. Biopsy: adenocarcinoma/primary lung cancer. Robotic VATS upper left lobe. 1A
Mama to a rescue Chihuahua

Gravelyguy
Posts: 382
Joined: Thu Jul 05, 2018 6:03 pm

Re: Discouraging scans after liver resection, advice needed

Postby Gravelyguy » Fri Jun 12, 2020 9:50 pm

Hi Vana3,

Sorry you have to go through this. I had a very similar experience with my first post surgery scans. They were done at my local hospital and they were very concerned about recurrence. They sent me back to Mayo because I was scheduled for take down surgery and they don’t mess with liver stuff locally. Mayo did scans and said they were just scar tissue from the surgery.

The moral for me was get all my scans done where the surgery was done. My surgeon did say that there is always a chance for the cancer to come back, that is why they want scans so often, and if it does they will take care of it. That gave me a lot of peace. Been clear ever since. Heading back next week for another round of scans.

Hope this helps,

Dave
6/17 dx mRC t3n1m1 very low rectal tumor 2 liver Mets 1.3 cm and .9 cm

6/17 begin 4 rounds Folfox w/Vectibix
9/17 short course radiation
10/17 rectal and liver resection LAR with coloanal anastomosis (no rectum left)
11/17-3/18 8 rounds Folfox
6/18 still NED!! Takedown
8/28/18 still NED! CEA .8 new low for me
10/18/18 colonoscopy clear
12/12/18 CEA .9 still NED!
6/11/19 CEA 1.0
12/19/19 CEA 1.0 still NED!
6/17/20 CEA 1.1 still NED!
12/15/20 CEA 1.1still NED!
12/16/21 CEA 1.2 still NED!

Vana3
Posts: 59
Joined: Tue Aug 13, 2019 11:40 am
Facebook Username: ma

Re: Discouraging scans after liver resection, advice needed

Postby Vana3 » Fri Jun 12, 2020 10:06 pm

Thank you Chimama, I really appreciate your kind words.
Dx 36 yr, F, 7/19
T4aN2M1 Cea 5
5 cm tumor in cecum removed, 17 + out of 45 LN
Cea 4.2
MSS, KRAS g12d, Braf WT
MT: 10.9
8/20/19 MRI & PET liver spots
9/19 - 3/20 FOLFOX
1/20 CEA 3.6,4.4, 4.6, 4.6
Liver resect 4/15/20
6/20 Ct scan clear
7/20 Cea 8.6
8/20 Cea 12.4, suspicious ovarian cyst
9/20 Hysterectomy SOB CRC
post surgery cea 2.6
11/20 clear scans
2/21 clear scans
4/21 spleen met
5/21 pet scan picks up subtle concerns in liver as well as confirms spleen
Cea 4.6
5/21 to current folfiri
Cea 10

Vana3
Posts: 59
Joined: Tue Aug 13, 2019 11:40 am
Facebook Username: ma

Re: Discouraging scans after liver resection, advice needed

Postby Vana3 » Fri Jun 12, 2020 10:35 pm

Dave,

Thank you, your message gives me hope and made me feel a little more calm.
I think the moral of your story is something I might need to heed as well. The community clinic onc. did not have much to say other than we really needed the surgeons opinion because the suspicious area bordered the ablated area. the waiting for the MSK teams opinions feels terrible when I could have done the scans with them...lesson learned.

Hearing that it was just scar tissue for you, that you have been clear ever since is inspiring... I am grateful you shared.


Wishing you good scans next week
Dx 36 yr, F, 7/19
T4aN2M1 Cea 5
5 cm tumor in cecum removed, 17 + out of 45 LN
Cea 4.2
MSS, KRAS g12d, Braf WT
MT: 10.9
8/20/19 MRI & PET liver spots
9/19 - 3/20 FOLFOX
1/20 CEA 3.6,4.4, 4.6, 4.6
Liver resect 4/15/20
6/20 Ct scan clear
7/20 Cea 8.6
8/20 Cea 12.4, suspicious ovarian cyst
9/20 Hysterectomy SOB CRC
post surgery cea 2.6
11/20 clear scans
2/21 clear scans
4/21 spleen met
5/21 pet scan picks up subtle concerns in liver as well as confirms spleen
Cea 4.6
5/21 to current folfiri
Cea 10

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Discouraging scans after liver resection, advice needed

Postby Rock_Robster » Fri Jun 12, 2020 10:52 pm

I had a small (14mm) spot pop up a few months after my first liver resection; surgeon reckons it was probably there to begin with but too small for scans and hiding in an awkward spot. Unfortunately it was too close to the hepatic vein for ablation to be reliable so they went back in and did another wedge resection. Close margins but went fine. Recovery was much easier than the first time.

Best of luck,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

Vana3
Posts: 59
Joined: Tue Aug 13, 2019 11:40 am
Facebook Username: ma

Re: Discouraging scans after liver resection, advice needed

Postby Vana3 » Fri Jul 03, 2020 11:29 am

Well guys I have an update
My surgeon reviewed the scans and says the spot is post surgical changes and that it will again be watched & evaluated at the next scan in September. We also have our main onc. who is at a major cancer center and she said it was nothing to be concerned about... chemo break continues.
I can’t tell you how grateful I was for both Gravelyguy and Rock_Robster stories around liver resection experiences... it kept me balanced and hopeful despite my big fears as I waited.
Dx 36 yr, F, 7/19
T4aN2M1 Cea 5
5 cm tumor in cecum removed, 17 + out of 45 LN
Cea 4.2
MSS, KRAS g12d, Braf WT
MT: 10.9
8/20/19 MRI & PET liver spots
9/19 - 3/20 FOLFOX
1/20 CEA 3.6,4.4, 4.6, 4.6
Liver resect 4/15/20
6/20 Ct scan clear
7/20 Cea 8.6
8/20 Cea 12.4, suspicious ovarian cyst
9/20 Hysterectomy SOB CRC
post surgery cea 2.6
11/20 clear scans
2/21 clear scans
4/21 spleen met
5/21 pet scan picks up subtle concerns in liver as well as confirms spleen
Cea 4.6
5/21 to current folfiri
Cea 10

User avatar
Jack&KatiesMommy
Posts: 640
Joined: Wed Dec 21, 2011 1:08 pm
Location: Columbus, OH

Re: Discouraging scans after liver resection, advice needed

Postby Jack&KatiesMommy » Fri Jul 03, 2020 3:03 pm

What wonderful news, Vana!!!!!
Cynthi8a
Cynthia
Mommy to Jack (8) now (18) and Katie (4) now (14)
(My Most Precious Things)
Dx 8/11 Stage IV CRC (liver mets) CEA 2,600+
9/11 Folfiri 2/12: Failed Liver Resection
5/12 HAI pump/removed primary
4/13 Liver Resection
8/13-12/15 (10) RFAs lungs
5/17: Upper Left Lobe of lung resected.
02/18: 3 new lymph mets lung
05/18: Keytruda (MSS w/Intermediate TMB): NED CEA: 66.4, 39.2, 23.8, 13, 3.5 1.8, 1.0, 2.8 3.9, 5.0, 5.6, 1.5, .8,

Vana3
Posts: 59
Joined: Tue Aug 13, 2019 11:40 am
Facebook Username: ma

Re: Discouraging scans after liver resection, advice needed

Postby Vana3 » Mon Jul 06, 2020 7:33 am

Thank you Cynthi8a!
Dx 36 yr, F, 7/19
T4aN2M1 Cea 5
5 cm tumor in cecum removed, 17 + out of 45 LN
Cea 4.2
MSS, KRAS g12d, Braf WT
MT: 10.9
8/20/19 MRI & PET liver spots
9/19 - 3/20 FOLFOX
1/20 CEA 3.6,4.4, 4.6, 4.6
Liver resect 4/15/20
6/20 Ct scan clear
7/20 Cea 8.6
8/20 Cea 12.4, suspicious ovarian cyst
9/20 Hysterectomy SOB CRC
post surgery cea 2.6
11/20 clear scans
2/21 clear scans
4/21 spleen met
5/21 pet scan picks up subtle concerns in liver as well as confirms spleen
Cea 4.6
5/21 to current folfiri
Cea 10

Gravelyguy
Posts: 382
Joined: Thu Jul 05, 2018 6:03 pm

Re: Discouraging scans after liver resection, advice needed

Postby Gravelyguy » Mon Jul 06, 2020 8:32 am

I am so thankful for the news you got! I would do all follow up scans with you surgeon’s hospital. They are better prepared to compare new scans with previous one!

Dave
6/17 dx mRC t3n1m1 very low rectal tumor 2 liver Mets 1.3 cm and .9 cm

6/17 begin 4 rounds Folfox w/Vectibix
9/17 short course radiation
10/17 rectal and liver resection LAR with coloanal anastomosis (no rectum left)
11/17-3/18 8 rounds Folfox
6/18 still NED!! Takedown
8/28/18 still NED! CEA .8 new low for me
10/18/18 colonoscopy clear
12/12/18 CEA .9 still NED!
6/11/19 CEA 1.0
12/19/19 CEA 1.0 still NED!
6/17/20 CEA 1.1 still NED!
12/15/20 CEA 1.1still NED!
12/16/21 CEA 1.2 still NED!

Vana3
Posts: 59
Joined: Tue Aug 13, 2019 11:40 am
Facebook Username: ma

Re: Discouraging scans after liver resection, advice needed

Postby Vana3 » Sun Jul 12, 2020 10:14 am

Thanks Dave! Your advice was right on...

Now I am figuring out a crazy CEA spike from 4.6 to 8.6
MSK thinks it’s nothing and have blood work done again in 4 weeks. But our onc. at big cancer center wants another CT scan. (Going in on Tuesday)
My Cea has never been reliable indicator 4.6 pre liver resection 4.6 after surgery....
Anyone else deal with a spike 12 weeks after liver surgery?
During Chemo my Cea spiked to 8.1 during same time that scans showed shrinkage, which was weird.
We are waiting for CA19 and CA 125 blood results from same day.
I also have hypothyroidism and am dealing with some PCOS stuff.
Dx 36 yr, F, 7/19
T4aN2M1 Cea 5
5 cm tumor in cecum removed, 17 + out of 45 LN
Cea 4.2
MSS, KRAS g12d, Braf WT
MT: 10.9
8/20/19 MRI & PET liver spots
9/19 - 3/20 FOLFOX
1/20 CEA 3.6,4.4, 4.6, 4.6
Liver resect 4/15/20
6/20 Ct scan clear
7/20 Cea 8.6
8/20 Cea 12.4, suspicious ovarian cyst
9/20 Hysterectomy SOB CRC
post surgery cea 2.6
11/20 clear scans
2/21 clear scans
4/21 spleen met
5/21 pet scan picks up subtle concerns in liver as well as confirms spleen
Cea 4.6
5/21 to current folfiri
Cea 10


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