Time to get 4th surgery to remove intestinal obstruction

[crybaby]

This year has been hell of a ride. I don't love thrillers, God now gotta lower the pace so I can revert back to my normal life.
So to recap, dad's pelvic and sacral mets were found in March, 2022. We radiated it with 45Gy, early scan still showed growth in both places. And then dad started having intestinal obstruction and has barely passed any gas in last 3-4 weeks or maybe more

And our most recent scan showed increase in pelvic mass to 5.3 cm and suddenly there is also a liver lesion of 3.6 cm which was never in our June scan. The Onco surgeon suggests to get it operated and gave us a poor prognosis. His current treatment plan is to operate that pelvic mass and then give temporary colostomy. Though he also told us if there are some other little mets in colon that PET Scan might not have caught. If this happens, he told us that he might not be able to operate on it.

Have you guys seen any such case and what was the treatment plan followed for the same? I am really annoyed why is there a hypermetabolic liver lesion now, so suddenly and that too of 3.6 cm (SUV 5.7). Though lytic lesion have shown increased SUV but this time there was not soft tissue component around it (a little win).

[Rock_Robster]

Sorry to hear - this is indeed disappointing and complex.

What was the scan interval between the liver lesion being picked up? Sounds like 4 months, so assuming the lesion was completely absent (which it likely wouldn’t have been) in June then we’re talking <1cm/month growth which is probably not ridiculous if not on any chemo etc. Can anyone see any sign of the lesion if they go back to the June scan and review?

When the surgeon suggests to “get it operated”, does that relate to the pelvic or liver lesion? Or both? I know often surgeons are reluctant to operate on visceral mets in the presence of bony disease.

Where is the liver lesion located? Is it likely to be causing any issues? 3.6cm isn’t small, but if it’s away from major structures and the capsule then it might not be the crocodile closest to the boat. Any idea if it could be targeted with SBRT/SABR? This can often be a good option to control larger liver mets that aren’t suitable for thermal ablation, and if a resection is contraindicated.

Is he on any systemic treatment at the moment? Has anyone suggested trials?

[crybaby]

Previous scan was done in June, now on looking the previous reports. It does say there is a non enhancing spot (simple cyst) but over this interval it has grew out. It is in right lobe (segment VI). The surgeon only told to operate on pelvic mass. Should we discuss with him to operate on that liver lesion as well? I mostly read success stories of people on getting liver lesions ablated.

My family's main concern is that my dad is not that fit for surgery. He been having trouble eating for last couple weeks because of bowel obstruction and especially after that LAR + TME in 2017, he never returned to his past health.

Surgeon has told us that opening up that obstruction is the only goal of the surgery at the moment so he can start eating food again. Only then he will be able to handle the treatment by medical onco.
So our last treatment was radiation in April/May, 2022.