Mass in liver

[Lauriesh]

Well, I had the biopsy yesterday, and it went as good as can be expected.

I am starting to contemplate my treatment choices, so when I meet with my onc on Mon, I'm well informed of and have an idea of how I want to approach the liver mets (if that's what they are)

I see that the "super herceptin" trial is at Mayo, which is only about an hour from where I live. I am wondering if I shoud first try Herceptin combined with other chemos that are already approved? Or has anyone just tried Herceptin alone first? That is appealing to me because of the lack of side effects. I want to keep things as normal as possible for my kids, and herceptin alone was so easy last time, it wouldn't be a big disruption for my kids.

I am also interested in cyberknife. For those of you that have had it for liver mets, were you on chemo while you had the cyberknife? I read that surgery is required, is that true? Did you have to stop chemo/ herceptin while recovering from the surgery?

I don't know how to add my diagnosis/treatment details in my signature, so here goes. Diag. 3/05- Stage 2 4.5 cm and 2+ lymph nodes. Did AC, then taxol/ herceptin, then herceptin for a year. Also did radiation. Finished Herceptin 6/06 and have been NED since then.

Thanks for any advice that you can give.

Laurie

[Lori R]

Laurie,
I am glad that the biopsy procedure is complete and went well. Ugh...A weekend of waiting.

I have more questions than answers but hope this generates some thoughts for your meeting with your Dr.

#1 "Surgical" Options
Cyberknife - My onc (somewhat conservative and I question that at times) is not a proponent of Cyberknife to the liver. The liver can be very reactive (in a bad way) to the radiation. Felt this wasn't a tried/true option. Yet there are a few on the web site that have had great success.

RFA - JML has had RFA on her liver met and had success. This process uses heat and has been used for a long time. See note below on size limitation

Cryo - This is the procedure that I've had once and will have again. Concerned that due to the size of the met, that Cryo is not going to be an option. for you My interventional radiologist prefers the met to be 3 - 5 c.m. or less. After the cryo procedure, a 2-3 week recovery period is required and my medical team follows up with "insurance" chemo.

Liver Resection - I've started to make phone calls on this option. JML (jessica) and KK1 have used this option.



#2 Available Drugs
Here is my humble opinion. I will be heading into by 3rd round of "traditional" chemo. (Taxotere, Abraxane, soon Navelbine) These traditional chemos bought me a very stable home life for my daughter. At the time I was diagnosed, she was a freshman in highschool and I prayed to be there for her graduation.

But.....the TDM-1 trials weren't in my backyard. I would have had to travel and it would have been very disruptive. Now...due to previous chemos, I am not an ideal trial participant.

Hmmmm...I think I am suggesting that you push for access to the TDM-1 trial. Others on the site can chime in, but it appears to be very tolerable and hopefully would be the silver bullet that it has been for many.

I SOOOO hope that all of this is just precautionary and the mass is not BC.

One last word of hope....I worked with a woman who was a BC survivor and she had a mass that was NOT cancer. She simply had it removed. It is NOT guaranteed to be cancer.

Sending positive thoughts for a wonderful weekend with your family.

[Diane H]

I'm sorry Laurie - am hoping still that it's not what they think.
If it is will be in there with prayers for you. Wishing you strength and peace and healing.
Hugs,
Diane

[jml]

Laurie~
Hoping the biopsy results will come back quickly and that it's not positive for mets.
You've gotten a lot of great advice re: options, if you need them.
Let me add what I know/experienced with local, liver targeted therapies...
RFA - most effective on single lesions of a certain small size, unfortunately, under 11cm's. location of the lesion also influences whether or not RFA would be an effective/curative option.
Liver Resection - likely not your first option. my docs had me beat back the disease with chemo for a year before they agreed to go forward with this surgery.
ChemoEmbolization - using adriamycin beads and shooting them into the blood vessels that feed the tumor in the liver. via femoral artery to liver- sort of like an angiogram.I had this done 4 weeks ago with good success. We were going to repeat the procedure to clean up residual stuff last week, but I had to cxl as we're prepping me to screen for TDM1 and the procedure would have been a conflict. Full of beans had this procedure x 3 and had great success with staying NED in her liver ever since.
SIRTEX - like chemoembo, but using radioactive beads/pellets inserted in the blood vessels feeding the tumor instead of chemo.
I guess one of the questions would be is the priority to address the met with just localized liver directed therapy, or should you hit the whole system with chemo again?
There is no good answer, just a matter of what works best for you, your family and your docs.
I just hope that you don't need any of these options and you'll report back to us with news that it's not what they think.
In the meantime, hope you're able to push the stress of this aside, enjoy your weekend and your family and know that you have much strength and prayers coming your way from your friends here on the boards.

Keep the Faith~
Jessica

[chrisy]

Sorry the news was not what you wanted to hear. While I am still hoping, along with you, that the final report will be better, I hope you can see from the earlier posts that there are many options for you. And that even liver mets need not be an immediate death sentence! There is much reason to be hopeful.

If it is a single lesion, even of that size, I would explore options for local control (such as jessica was discussing) as that could help you quickly gain control and possibly set you up for a long term "NED".

It willl really just depend on what options are feasible, and how you respond to that.

When I was diagnosed with liver mets (numerous, throughout my liver), my doctor advised me to "go with the sure thing" (being chemo) and maybe do a clinical trial later. Note, in my case RFA, resect etc. was not an option because of the widespread nature of the disease.

At the time, I think that was the best advice and that's what I did. That strategy worked well for me and subsequently I have participated in clinical trials including one of the early TDM1 studies. But if I was facing that initial diagnosis now, I would seriously consider getting into a TDM1 study as my first line of attack. You would be followed very closely on study, so would know how it's going and could still switch to a more chemo based regimen if necessary.

The one thing I would not do is try Herceptin alone...while Herceptin is our miracle drug, it mainly acts to stop/slow tumor growth vs. killl it; and usually in conjunction with chemo. You really don't want to mess around with liver mets - it's important to get control of that. Once you have control, you can switch to herceptin as a maintenance thing.

You are doing the right thing by exploring all your options. As you learn more, you will make the right decisions for you.

do not lose heart.

Chris

[Joan M]

Laurie,

I'm sorry to hear about your liver lesion. But before you start chemo, I would check with a surgeon on whether you would be eligible for a liver resection. That procedure would just remove the recurrence. If you don't have cancer anywhere else, you could then only stay on Herceptin.

I think several women on this board have had liver resections.

Joan

[Joan M]

PS, I believe the tumor is too large for radiofrequency ablation (burning the tumor with radiowaves). Cryoablation (freezing the tumor) may also be an option. I'm not sure about those parameters. But both procedures are worth checking into. A few women on this board have had these procedures for the liver.

Joan