Liver Mets - Need Advice Please!

[Helen]

I completed 6 rounds of chemo combination of carboplatin and taxotere given once every three weeks last Nov 2, 2005. I am still on weekly Herceptin. I had one spot (3.4 cm) in my liver when I was originally diagnosed in June 2005 and it is at the tip of the right lobe. The lesion had decreased in size to 1.8 cm based on the last CT scan last Nov 14. My oncologist is suggesting that I could have 2 more rounds of chemo. I have also made an appointment on Dec 13 with a liver cancer surgeon at Stanford whom I have already met back in August for a second opinion. He said he can do a liver resection but wanted me to complete the chemo first because I already completed 2 rounds at that time in case the tumor can be treated with it.
Should I go for the additional rounds of chemo? Is liver resection necessary in my case? Should I just wait and hope that Herceptin will wipe it out without the 2 options? As always, thank you all for your input.
Helen
_______________________________
Her2 +++, ER/PR-, Left modified radical mastectomy, 1.7 cm tumor with no lymph nodes involvement,
Originally diagnosed at stage 1 but immediately restaged in one month after all CT/PET scans were performed to stage 4 due to liver mets.

[al from Canada]

Hi Helen,
Ask mentioned in the previous post on liver mets; the gold standard for this is resection. The advantage of taking chemo BEFORE surgery is that it will shrink the tumor and improve the chances for clear margins AFTER surgery. Chemo curing liver mets..... The problem is that once you have any mets the disease is officially stage 4, therefore systemic. To cure liver mets (suggesting that this particular tumor is history and will not grow), resection will do it before chemo will so I would finish the chemo and have the surgeon remove what is left. Unfortunately, although you may have a cured "liver" it can come back anywhere, anytime.
The good news is that many on this board have been living with minimal relapses where the prognosis is no longer "terminal" but one of living with chronic disease, and doing it with an excellent quality of life. The other good news is that there is a tremendous amount of money and energy being put into this "cure" and I think that most of us are more optimistic that one will be found than ever before.

Good luck,
Al

[kk1]

Hi Helen;

I experienced exactly the same scenerio. Thought I was stage 1 with a small lesion in my breast only to find a 3 cm liver met. I did weekly chemo with herceptin (taxotere and xeloda) for 25 weeks (~ equivalent to 8 rounds) and the liver met eventually dissappeared competely. Since the chemo you were on appears to be working I would continue with the additional 2 rounds before I opted for a surgical or other method of removal.

I should also mention that for awhile my liver met was just "stable" and did not continue to shrink. It also showed no activity on a PET scan so we stopped the harsh chemo and I remained on herceptin only every 3-week. For several months we all wondered if it was scar tissue or dormant cells. Just when I finally decided to have a liver resection it totally dissapeared. It must have in the end been scar tissue and took a few monhts for my body to reabsorb the dead cells.

Also at stage IV it is best to try and avoid surgery unless it is really needed. There is some evidence, athough weak, that growth factors present in wound healing can possibly "wake" up sleeping micro mets. This is one of Al's favorite topics . I am not really convinced by most of the science articles on this topic but on the other hand I don't want to find out the hard way they are right.

take care
kk1

[Kim in CA]

Hi Helen,


I too was diagnosed with liver mets in 2001(original BC diagnosed 1997). I had 8+ months of Taxotere and Herceptin weekly and then had to stop the Taxotere because the side effects were adding up. My scans had improved tremendously, but I still had a small suspicious spot on my left lobe. I continued on with just Herceptin and went to UCSF for a consultation with a surgeon. RFA was not an option because the spot was too close to the left portal vein. He said the only way to be sure we got it all was to have resection. I decided to wait and watch for awhile because it was the beginning of summer and I wanted to take a vacation with my family to Grand Cayman. I finally decided to have the surgery in November, because I knew that I would never rest until I knew for sure that we got it all. They removed the entire left lobe and it turned out there was no cancer to be found, just scar tissue. They said my left lobe looked like a shriveled up prune!

The surgery was tough, but I felt I needed to do it. It would have been wonderful if there had been some way to know for sure that what they were seeing on the scans was just scar tissue. I think because we are still in pretty uncharted territory when it comes to having metastatic disease that actually disapears with the Herceptin/chemo combo, they want to do everything they can to insure success. It is so hard to make these decisions, but the fact that I am still here 4 years out from my recurrence, makes me feel I did the right thing. You just have to do whatever you can for now to keep this disease at bay until they find a cure. I am positve we will be here to see it!

Love Kim