Liver resection?

[Missyw]

Hi Everyone,

I have read with great empathy about new liver mets for some of us. Mine has been hard to take. I have started Navelbine, but I want more; more time with my husband and children. Due to the site of the tumor, I am not a candidate for ablation or Cyberknife (as per Drs. at Georgetown). They can resect though. My onc is pretty dead set against it. I have tried to explain my desperation and need to find some hope. She is willing to "allow" it, but my husband is in agreement that it is a waste (and possibly dangerous). Sisters (and brothers) can you give me any guidance? I am 49 and healthy (except for this little terminal illness). I am ready for the fight. Is it a waste of time to resect?

[StephN]

Hello Missy -

Are you on any other drug along with the Navelbine?? This can be a good drug for liver mets, but works better in combination with at least one other drug.

Check my signature to see what I did.

All the best.

[Lori R]

Dear Dear Missy,
We are VERY much in the same situation. We are the same age and both VERY healthy on than this pesky disease. (the irony isn't lost on us I'm sure)

I urge you to fight!!! I can tell in your post that you are up for it. PLEASE do not allow anyone else tell you when you are through. Who is to say when a procedure is a "waste"? It is your life.

I am not a surgeon and there may be other risks to consider but if you weigh those risks and determine it isn't worth it, than at least it will be your decision.

Hopefully Steph's chemo advice is useful and you can also pursue additional tools in addition to a possible surgical option.

I am just encouraging you to listen to your own heart.

Sending lots of love and support!!! Lori

Missy - please don't give up - I had liver resection in 2005 for two spots and have been cancer free since then (yeah). It's worth it. I was 45 at the time. The surgery wasn't even as bad as I thought it would be. I took good care of myself and did exactly what the drs. said. I thank God everyday that my onc suggested it!!! I say - GO FOR IT.

Nancy

[Shobha]

Missy, I am praying for you to make the right decision and have full success with it and get back to the NED status!

Forge forward...God bless you!

love,
shobha

[Mary Anne in TX]

Hi Missy! I don't know what you should do, but I so support your desire to fight for your life. I'll be cheering for ya. ma

[jml]

Missy~
Eat your Wheaties & pick up those gloves, girl. It's time to fight even harder. And we're in your corner, right behind you to encourage you to keep swinging.
I have been Stage IV since my primary dx in 5/2002. I had a liver resection in 12/05 (55% of liver) & have been NED in my liver ever since.
Don't give up. Leave that doc who doesn't have faith, knowledge or confidence in your survival potential. Find someone that you and your husband can believe in.
Also, can you provide us with more information of your dx & tx history?

Keep the Faith~

Jessica

Dx - 5/17/2002 @33yo ;Stage IV - IDC + liver met;
Lumpectomy, 12/12+ nodes; er/pr-, Her2+++
Tx1 - Navelbine+Herceptin x 8 wks; No response, progression - single liver met to "innumerable/immeasureable"
Tx2 - ISIS 2504 - clinical trial x 6mos
Taxol + ISIS (continuous IV);partial response.
Tx3 - Taxol+Herceptin x 13 weeks
NED
NED 9/11/03-9/17/04, then single liver met recurrence.
9/04-Recurrence 1- Taxol+Herceptin x 4 weeks prior to RFA, but NED again, cxl RFA.
12/04 -Recurrence 2 - single liver met
1/05 - RFA - partial response
2/05 - Abraxane+Herceptin x 9 weeks;No response due to improper dosing(?)
3/05 - Taxol/Carbo/Herceptin to NED again.
11/05 - Recurrence 3 - same single liver met
12/05 - Right hepatectomy-55% liver removed. Success. NED in liver ever since.
2/06 - Recurrence 4 -single lesion in L breast again
3/06 -excisional biopsy. 1cm IDC, extensive high grade DCIS.
No tx due to liver still healing post hepatectomy, follow with Herceptin & scans to keep an eye on DCIS
12/06- L mastectomy w/ reconstruction 3/07 & 8/07
10/07 - Recurrence 5 - Supraclav nodes
Tx4 -Gemzar+Herceptin, til NED 3/08.
9/08 -Recurrence 6 -Supraclav nodes again.Rads1 - x 7wks
10/08 - Acute Renal Failure - ICU x4 days, hospital 1 week,
stents in ureters/kidneys x 4mos.still no known cause???
10/08 - Recurrence 7 -Sternal nodes; supraclav -NED
Tx5 - repeat Gemzar+Herceptin; NED in 1/09; finish GH cycle to 3/09.
4/09 - PET scans shows recurrence 8 in sternal nodes...progression while on GH cycle.
5/09 - Now what? Tykerb/Xeloda/Herceptin...still deciding.

[StephN]

Glad some others chimed in. They have very good points and lots of courage as well.

I did not mention resection - as in my case my liver was "shot through" like "swiss cheese" so that was not an option for me. Even at the end when I was down to one stubborn tumor that had really shrunk, it was too close to a main hepatic vein for surgery. My onc DID check with a surgeon in my case. The chemo finally conquered that last met.

Maybe when your docs see some improvement and are not worried about micromets, the option of resecting any stubborn spots will be useful.

[jones7676]

I sure don't know what is the right decision...but I do understand your desire to keep fighting!

[Darlene Denise]

Miss Missy: I am a liver metster too. I am interested in knowing about your history. It may reveal things to consider from your cancer's behavior that might benefit you in making this decision. Oncs are our quarterbacks but they aren't the whole team and they are not always totally knowledgeable about how other specialists might benefit us. I learned this going through brain mets.

I hope you will share your history so we can give you our best thoughts.

Darlene

[Missyw]

Hi Steph,

I must say your profile is one of the reasons I have sought out something beyond chemo. You are an inspiration. I am only on navelbine with Herceptin right now. I guess thye are saving some big guns for a bigger battle. Thank you so much for everything.

Missy

[Missyw]

Hi Everyone,

I can't thank you enough for all of the words of encouragement. I wish I could tell you all how much you have meant to me in my battle. I never would have made it through without you.

I have tried to edit my signature to provide you with more info. It is obvious that my technical ability is seriously lacking. I'll keep trying and eventually I'll get it out there.

Missy W

[Jackie07]

You've got it! Let's see if there are more liver met girls
around...

Hi Missy,

I don't know the answer to your question. I do know of at least two women in San Francisco who had successful liver resections. In one case, she decided to have the resection because things were looking dire. (I don't know the facts of the other case.) As far as I know, the women in the dire situation has not had significant problems with her liver since the resection, and I think it has been a year or two.

I would seek another opinion to get further information. What would be the down side of trying chemo and seeing if the met goes away? (This is an actual, not rhetorical, question.) With respect to the surgery, I have read that there is a small chance that the surgery would somehow cause metastases to grow. (I don't recall the technical details.)

In terms of other things to look into, I also have heard of people having success with "spheres," but I am not sure what they are technically called. Maybe "theraspheres"?

I had liver mets at the outset, but they went away with chemo/Herceptin.

I note in your signature that you are having both hormonal treatment and chemo. I thought that if one was having chemo, the hormonal therapy would be discontinued.

Sorry, that I could not be of more help. I think Esther, who sometimes posts here, thoroughly researched liver resection, but I could be wrong. She also sometimes posts on bcmets.org.

Good luck!


Jill

[jml]

Hi Missy~
Thanks for including your dx/tx history. It helps us understand your journey a little better & hopefully offer more insightful suggestions & advice.
With a single liver lesion that responded previously to chemo, I think surgical intervention at this point would be premature. Give the chemo a chance to do its job. And in the meantime, you could research the top surg oncs in your area that specialize in hepatectomies.
I'm surprised & disappointed that your onc is "dead set against" a resection. What are his/her reasons? I hope you are able to find a clinical onc + surgical onc that are willing to work collaboratively & cooperatively in your best interest.
After my 1st recurrence, I went back on/off chemo for a year, beating back the lesion to NED. It would resolve, I'd stop chemo, then it would pop back up.
My surgical onc followed my progress closely with my clinical onc. It wasn't until he felt confident that the chemo was simply not going to do the trick AND that there was only a single lesion in the R lobe, that is was worth the risk/benefit of a surgery as invasive as a liver resection.
Most importantly, this was a decision we made together - clinical onc, surgical onc, me and my family. It's important that everyone's on the same page, with a realistic understanding & common goal.
I hope first & foremost that the Navelbine + Herceptin will do the trick for you.Keep us posted, ok?

Keep the Faith~

Jessica

[Joan M]

Missy,

I'm sorry to hear about your subborn liver met.

Why did the doctors tell you that you're not a candidate for radiofrequency ablation?

I had RFA of a tumor in my lung, which is done much, much less frequently than for the liver.

Many times, oncs rule out alternative procedures because the cancer is advanced and not a primary cancer of the lung or liver. That is, they don't like to do these procedures on metastses. They also don't consider them standard of treatment for metastatic bc.

The idea of an RFA for one met in the liver is that the procedure may eradicate the met without you're having to undergo a liver resection. This might well be the case too if it's the same met that went away before, meaning that no others have formed in the meantime.

Generally, a nodule should not be over 3.5 cm.

Many oncs dismiss local procedures in favor of only systemic procedures. Every onc I consulted was against the RFA of the lung. Or they tell you RFAs are reserved for people who are surgically inoperable.

I had the RFA last August and a CT scan last Saturday showed no nodules.

Also, a year prior to having the RFA I had the nodule removed with a wedge resection of the lung, and one year later it recurred, which is why I did the RFA (that is, it wasn't a new nodule, it was a recurrence of the old nodule even though I had clean margins).

Perhaps you can consult a radiation interventionist which is the kind of doctor who does this procedure.

Here are two links:

Radiological society of North American
http://www.radiologyinfo.org/en/info.cfm?PG=rfa

University of Southern California
http://www.surgery.usc.edu/divisions...yablation.html

Joan

[Lori R]

Missy,
I "just" finished a cryosurgery procedure for my liver met. My onc referred me to an interventional radiologist who elected to use cryo (freezing) instead of RFA (heat)

The procedure was performed on an outpatient basis - laproscopically on Wednesday. I was home that evening and was up and around on Thursday.

Could this be investigated as an option for you?

I don't know if this will be the silver bullet for me (certainly hope so), but I will keep everyone apprised on my journey. I'll probably start a separate thread so if anyone is interested they can find the notes.

Next step will be another CT to determine if the procedure actually brought me to NED. I am also beginning another round of Chemo to knock out any remaining cells.

I continue to think of you and wish you all the best.

[Missyw]

Hi Everyone,

You have all been so amazing. Thank you so much for all of the suggestions. Unfortunately, the tumor is laying against the vena cava (sp?). This makes it impossible to freeze or heat without too much residual damage to the vein. At least so I am told. I am so grateful to you all for all of the wonderful and heartfelt advice. I'll keep you posted after my surgical consult this week.

Missy

[jml]

Hi Missy~
Sending you prayers that the Navelbine/Herceptin combo will finish off that stubborn met.
I was in a similar situation - single, stubborn recurring met, close to main portal vein. That's the reason the RFA was only partially successful & only for a few months.
When we decided to go ahead w/the liver resection, I had a consulted with a vascular surgeon who was on stand by to resect that part of the main portal vein if needed. Fortunately, we didn't need his services, but that couldn't be ascertained until they were "in there looking around".
Keeping fingers crossed for that Navelbine, but if it doesn't do the trick, you still have many combos in your medicine cabinet.
Keep fighting.
Keep the Faith~

Jml

[Joan M]

Missy,

It's good to know that you're on top of the situation.

Yes, a tumor is too close to a major artery can cause a problem.

At least I'm glad you were given a sound medical reason.

Joan