Possible Liver Met, So Many Questions

[crikklekay]

Man this has been a long tiring road of tests. Long story short, my DH John’s CEA suddenly started going up in February and after a litany of tests we just got the results from his MRI. Good news is they only found one spot, but bad news is his oncologist is pretty sure this is the reason for the CEA increase. He’s getting a biopsy to be sure, and he likes to remind me that it could still possibly be something else. So in that spirit I won’t say he officially has a reoccurrence but we won’t know anything for two weeks and my brain can’t sit still.

She brought up resection, possible further chemo and a bio-something treatment? She was talking off the top of her head so fast that I can’t remember the whole word, I wasn’t sure if anyone here could fill in the gap on what that might be? Was liver resection surgery difficult to recover from? He only has experience from his emergency colon resection and ostomy creation, then they ostomy removal surgery. I’ve read about the HAI pump, is that just for people who have a lot of liver mets or difficult cases? What kind of chemo is usually used, more Folfox and oxalplatin or something else? I think she mentioned the biopsy might show what will work best? Once we have the biopsy results, are there any questions we should be asking?

Sorry for all the questions, I just don’t know what to mentally prepare myself for and I know from experience going to Google for answers would be bad. I wish I could shut my brain up but it keeps trying to plan for the future.

[I_will_fight]

I am not an expert at all, but let me share my understanding. Hopefully those with more experience will chip in soon enough.

CEA is not a good marker for everybody, having said this, CEA is more sensitive to liver mets than it is to lung mets, you did not mention how much your husband´s CEA increased and whether this was a good marker in the past.

One thing that stries me as uncommon is the fact that your husband has been NED for quite a long time, liver mets are typically early occurences, while local recurrences are more common after the 3 year mark. Has your husband had a colonoscopy to discard a local recurrence in colon? SORRY, I realize he had one this year as described in signature.

So the liver lesion might still be a benign and the CEA rise a random occurence, but if it turns out to be a metastasis, then there are several possible routes:

Surgery offers the best outcome, it may be followed up with systemic chemo and additional hepatic chemo. You may want to request a Signatera test for residual disease, to assess the need of post surgical chemo and its effectiveness.

For surgery to be an option a number of requirements need to be met, there is some room for flexibility but in general the requirments are as follow:

-the number of lesions is small.
-the liver that can be left after resection is enough to survive.
-there is no evidence of extra-hepatic disease.

Second best is to first apply chemotherapy to reduce the size and number of lesions (to meet the requirements above) and then go for surgery

A HAI pump is a way to deliver chemo to the liver only, this is often accompanied with systemic chemo

If chemo manages to shrink the lesion then surgery becomes an option.

Here is an excellent video on HAI: https://www.mskcc.org/videos/treating-liver-metastases-hepatic-arterial-infusion-therapy?fbclid=IwAR1J4J8Fehr7FxzSnIR9zIGzXuSeaUCxI2F_8-uTLWWj7f9to5JzKQxGyFU

As I said, I am not an expert, hopefully people with more knowledge will soon contribute.

Good luck.

Javi

[crikklekay]

John's CEA was 12 on diagnosis, and until recently it was around the 1.5-2.2 range when it suddenly shot up to 5.1 in February. From there it has just continued to go up, his most recent reading was 10.5, which is why his oncologist seems to be sure this is most likely a met. I'm not sure what qualifies as a "good marker", it has never been super high but the fact it has been increasing so quickly is terrifying.

He had a clear colonoscopy and CTscan, but his PETscan showed a spot on his liver and the MRI confirmed the spot. The report says "subtle delayed enhancing mass lesion" measured approximately 1.7 x 1.1 cm, I'm not sure if that's considered big? She seems to think it is resectable, but she's referring him to their liver surgeon expert to see if it can be biopsied and to get his opinion on it. Apparently it is in an odd spot, and might be hard to biopsy.

Thank you SO MUCH for that video, it explains a lot! The survivorship data made my heart stop briefly but at least I can intelligently communicate with the doctors now.

[I_will_fight]

Let me give you some statistics that may cheer you up a bit

Your husband had a late recurrence (in fact very late). Late recurrences typically carry a better prognosis than early recurrences.

Additionally If repeated resection is performed the odds of survival are actually very good, and taking into consideration the size of the lesion you mentioned and the fact that it is just one it should hopefully be resectable, I guess this is what your oncologist already told you.

Have a look at this study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994626/