Liver mets. Am I wrong to want them zapped?

[michka]

Hi, it's me again with my liver mets! As I explained in a post, although I had surgery early December for what I thought was one met, a mid January MRI showed I had 2 liver mets that were already visible on the original MRI I had in November prior to the operation. My onc agrees I should try to have them taken out since I have (at this moment...) no other met. I started Herceptin and Tykerb end of December. Of course I do not want to go back to the surgeon who did such a bad job. I discovered that even the one tumor he took out did not have clear margins.
My onc sent me to see a very good team of digestive surgeons. I was waiting for their answer by the phone for days. They refuse to operate! They say it's not worth it. I asked if it was not doable. They said it was but not "in the standards"!!! Not for breast cancer!
What do you think? Am I wrong to want to zap these 2 tumors which are 20mm? In my mind I also need to add chemo but I want to start after the zap. (I would like Navelbine). I am fighting to find a surgeon to zap them. Any suggestion of a place in the States is welcome. I already contacted Sloan in NY. I am waiting for their opinion. I have an appointment next week in another place in Paris thanks to Joan. It seems logical to me: if you can zap a tumor, zap it. Like in the brain or in the lungs. But maybe I am stupid and the liver is not the same although it grows back!
At first, I was very depressed and had complications from the first operation (what a surgeon!) . Now, I want to fight. You gave me hope and strength.
Michka

[KDR]

Michka,
I was told the same thing.
I think it's expected the regimen will do its work.
As always, feel good,

[michka]

Hi KDR. How many mets did you have? You are on fist line treatment and I keep my fingers crossed, it seems to be working! I love to read that your markers going down! The worry I have is that I know Taxol and Herceptin did not work as first line treatment for me since I had it before my mastectomy. So my belief in chemo for me is not too strong although, the pathology of the met showed a change in the er/pr levels. Hi hope to see you NED soon KDR! Hugs. Michka

[krisvell]

Michka;
It's so good to see your fighting spirit is back. I'll follow your lead. I can't render any advice on the zapping but logically, I would want to do the same.
Good luck with you pursuing other opinions.
Sending prayers and positive support your way.
Kris...

[KDR]

Hi, Michka,
I had three pesky (to use Courtney's word...love you, Courtney!) mets. They went down by more than half and we'll find out how much more they've shrunk or diminished this week.
Keep the faith, ok? Just read that Stage IV sisters thread!

[Ellie F]

Hi Michka
I am no expert on liver mets but am always encouraged by posts like Lori R's. It seems to me that if you can reduce the disease load by surgery or some other modality like cryo etc then follow up with drug treatment to eradicate any cells that got away this may be a good plan?

Have you considered getting a second opinion from one of the u.k. centres of excellence? It would be closer than the States and probably not as costly.I know that resection and other treatment options are available privately here.
Hope this helps.
Ellie

[chrisy]

Michka,
True, that type of localized treatment is not "standard of care" for breast cancer mets, but there is growing evidence that it can be effective, even sometimes curative in certain situations. In my case it was not an option because I was dealing with extensive widespread liver mets. But if it had been one or two small ones, I would have wanted it seriously considered.

It may be worth a try compiling some of that data, with the help of your oncologist, supporting that position - and get another opinion. Here in the states many oncs are resistant to the idea because there is not a LOT of data, but that thinking is beginning to change.

You could also consider a radiological approach (like RFA) which is less invasive than surgery.

Good luck, keep us posted.

[Lori R]

Michka,
HI....Lori R checking with a few insights (for what they are worth) I sure wish I had a crystal ball because I have obsessed over which option is best, cryo+chemo, Liver resection????

I ultimately opted to have cryosurgery twice for liver mets. In both instances, I only had a single tumor approx 3 cm. in size. (somewhat frightening because I am scanned every 3 - 6 months and the tumor manages to grow that quickly)

Some of the factors that influenced my decision included;
*Onc and Interventional Radiologist (Dr. who performs Cryo...not a surgeon) are not supportive of liver resection. They too say the current standard of care does not support it. Based on all of the smart, aggressive members of this board, if the time was right I am confident that I could find a quality location to perform a resection. If I was to go that route, I'd ask the wise members of the team who they used and would need to travel from Denver, Colorado possibly down to MD Anderson down in Houston.

**A major personal factor was trying to not disrupt my daughter's senior year of High School. By using cryosurgery (it has been a very easy procedure with almost not recovery time ...at least for me) I've been able to have the procedure and be up and about the very next day. I have another detailed post on the site that explains the procedure in great (boring) detail.

**Wishful thinking....I had read that there was some evidence that the process of freezing cells and the associated healing might trigger an immune system response. Honestly, was keeping my fingers crossed that some magic would occur. So far, no magic.

So, Michka..although everyone is different I can blaze a few trails for you. My latest course of treatment involved cryosurgery + Navelbine. Both were very very tolerable. I didn't even lose my few strands of post taxotere hair. I have a scan in mid-february. I would love to come back and post that the Cryo+Navelbine worked.

The question that I've asked my Drs over and over (without a good response) is....am I passing up an opportunity to not just remove that portion of the liver with the met? Are we messing around here? My Onc did say that if there ever was a patient that she would support for a liver resection, it would be me. We'll see what the Feb scan brings. If it comes back AGAIN in the liver and no where else, I think I will be done with the zap approach and will pursue a resection. (YIKES....now that has me scared)

All the best to you for these tough decisions. Hope this input helps you sift through all the conflicting data and emotions.

Love...Lori

[Rich66]

Were the liver mets in the same lobe?

[Joan M]

Hi Michka,

Glad you have an appointment soon with an IR doc in Paris who can explain both RFA and cryoablation, or freezing the tumor.

Most medical oncologists look down on these procedures for metastatic cancer, and such procedures are certainly not standard of care for advanced breast cancer. Some of that makes sense, since metastatic disease is a systemic problem. So, it would be a good idea to add chemo afterward. I regret not doing that when I had the option. If a person has a limited number of mets in a single location, interventional radiology can be a choice.

I'm wondering what Sloan and the doctor in France will say about whether an RFA or cryoablation can be done. Sometimes it's not feasible due to the locations of the tumors, and surgeons sometimes ignore these procedures.

Both of these procedures have been used for primary liver cancer for a long time, but resection is generally performed. Using the procedures for lung cancer is relatively new. In general surgeons are heavy weights in the medical world, and interventional radiology is the little guy. Surgeons are reluctant to give over even small tumors of 3 cm and under to IR.

I'm glad you're checking out everything and can come to a decision soon.

Joan

[Lori R]

Rich,
The met did return to the same lobe, it was the upper left.

So...that is good news I think. Originally, the interventional radiologist used one probe to freeze the tumor. The 2nd treatment used 2 probes and he tried to freeze a large margin.

Rich, you are always so knowledgeable and have insights to the latest statistics....any thoughts you have regarding the zap a met vs resection would be appreciated.

Thanks...Lori

[Rich66]

Hmm..I'm not the best resource regarding stats...
But it being limited to one lobe seems to give you lobectomy or partial lobectomy option. (might want a circulating tumor test (http://her2support.org/vbulletin/showthread.php?t=41709) to inform your decisions)

Some bits on liver met options here:
http://her2support.org/vbulletin/showthread.php?p=221053#post221053

If you go surgery route, consider:
Opiates/Opioids (accelerates cancer?, alternatives)
http://her2support.org/vbulletin/showthread.php?t=42074


If you really want a "targeted treatment", consider a biopsy and chemosensitivity testing (http://her2support.org/vbulletin/showthread.php?p=222355#post222355)

[Joan M]

Just one other note on interventional radiology. Memorial Sloan-Kettering Cancer Center will soon be undertaking a trial for testing how RFA works for breast tumors, according to Dr. Larry Norton who is a medical oncologist there, during a lecture.

MSKCC just opened a multi-million-dollar facility, Center for Image-Guided Intervention (CIGI), which indicates that minimally invasive procedures are the way of the future. CIGI is headed up by co-directors, one from IR and one from surgery (which is like forcing them to play nicely).

MSKCC also just opened the Evelyn Lauder Breast Center, which is a separate, brand new facility that looks like an office building. The lobby of the building is dedicated to Dr. Norton. These projects occurred during the reign of Dr. Harold Varmus, the former 10-year president of MSKCC who stepped down in 2010 to become the director of the National Cancer Institute. Dr. Varmus was a 1989 Nobel Prize winner for his discovery of cancer genes and also headed up the Cancer Biology and Genetics Program at MSKCC.

[Ellie F]

Just a quick chime in here. Resection seems to be gaining popularity here in the UK. I am aware of a number of bc patients who have had this done. It also seems to be an option for bowel cancer. A friend of mine had bowel cancer 5 years ago with stage 4 due to liver mets at diagnosis. He had surgery, chemo then a liver resection.It has never come back!! Interestingly (one for Rich) he takes metformin for diabetes!! Wonder if this has had any impact?

Ellie

[Joan M]

Ellie,

You raised an excellent point. Why not remove the cancer and also administer chemo afterward? A double whammy.

My initial lung lesion in January 2007, which was 9 mm in the apex of my left lung was removed by video-assisted thoracic surgery (VATS), which is a minimally invasive procedure performed by a surgeon, in April 2007. I never followed up with chemo. A year later the tumor recurred. Again 9 mm, at which point I decided on the RFA.

First, I'm sorry I didn't do the RFA initially (but I'd never say that to a breast oncologist or surgeon. They'd accuse me of blasphemy). After all, a wedge resection is really like doing a lumpectomy without radiation. Right? And second, I should have followed up with a course of chemotherapy, even after the RFA.

Most of the regulars on this board know that a fungal ball developed in my lung in the cavity created by the RFA, which is a rare occurrence. The fungus, aspergillus, is a common fungus in the soil. The RFA was in August 2008, and I was doing a lot of gardening. Eleven months after the fungus developed, I had to have a thoracotomy to remove that section of my lung, in July 2009. But, there was no cancer, only the fungus.

Third, I think that most recurrences that are even eradicated with chemo come back in the same spot and then other spots. So why not get rid of the first spot? Perhaps the bottom line is that many docs still view metastatic cancer in a poor light. That is, a ditch effort.

I have had all three procedures: from the thoracotomy, a 10 inch scar down my back. from the VATS, three two-inch slits (two for the instruments and one for the camera). From the RFA, a half-inch slit where the probe was inserted. If one procedure can be shown to be as good as another, why opt for one that leaves a 10 inch scar, an elevated hemi-diaphram, a rib cage that sticks out more on the left, and ribs that had to be fractured, and a long, long recovery?

Joan