Liver mets: resection, ablation, SBRT, Y-90, anything else?
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I had the liopiodol procedure today. So easy, no pain or discomfort. Just nice rest with propofal. Three down, one to go. December 2 here I come ready or not.
Very sleepy and ready to be in my nice soft bed. Good night ladies.💞
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rest easy Grannex.
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My MWA is Wednesday. It's for two lesions in my right lobe. I'm praying hard that I will not get as much pain this time. I definitely don't want to get post ablation syndrome this time. I have special weekend plans with my family this coming weekend. I'll keep you updated.
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Grannax,
I'm writing this on Thursday and hoping that you see it and hoping that you are doing better this time after your second MWA. Please let us know how you are doing when you get a chance.
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Question for those of you who have had local liver treatments done, if your MO uses tumor markers:
I had my liver microwave ablation on Oct. 19th (the one that I have to have repeated on Dec. 11th). So I know for sure that there is still some tumor in there. Additionally, in my mind, after an ablation procedure is done, it seems like there must be some open scarring in the liver until the darn thing heals over.
So here's my crazy story: I had labs this past Tuesday. My TMs (my MO uses CA27-29) jumped an HUGE amount from last month and the month before. Has anyone had a weird TM reading on labs during the month after doing a local liver treatment? My MO isn't that worried -- says it just means that cancer cells are putting out more markers (I assume that means mucin?) and that once I scan again later in December, we can look at that and see if we should change treatments. She hasn't acknowledged at all that it could have anything to do with the partially failed liver ablation (or with any local liver treatment.)
I can't answer this myself because my MO didn't start doing markers until after my first ablation in 2019 -- so no valid info there.
Thanks for anyone who has any info on this. I appreciate it.
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BevJen, I did see elevated tumor marker numbers yesterday but it correlates to the progression seen in the liver and bone mets on my PET scan. So I guess, this is not a big help in answering your question! Hopefully someone else in the group will have a better response.
My MO doesn't pay attention to the TM numbers since they were elevated even when Piqray was working and kept everything stable.
Grannax, thinking of you. Hope everything went well yesterday.
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S3K5,
Thanks for responding. I guess I'll just have to wait and see. I think I'm just getting anxious because of the incomplete MWA and wondering what the hell is swirling around in my body due to that. Oh, well, just one more week until that is repeated. Then we wait.
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Has anyone heard from Grannax? She was supposed to have her second liver ablation this week, I think.
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Grannax, I hope you are having a wonderful time with your family this weekend. Whenever you get a chance, please let us know how you are doing and how did the ablation go on Wednesday. Thinking of you.
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Hi ladies...so I will be going in for my Mapping for Y90 on Monday...can you all give me the good, bad and the ugly on what to expect? I am having 3 TINY tumors done. 1 is 2.0cm. the other 2 have no uptake and are 1.0 or less.
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Nicolerod
I did both the mapping and procedure unsedated so I was awake. It is a very carefully planned procedure where they put a wire up my groin, used dye and fluoroscope and CT scan to check out the vascularity of the liver. The goal is to get the beads to the tumors, but not let them escape to the lungs or other areas. That is why I had bland embolization to one tumor- the IR was not comfortable with that vein. FYI- the bland embolization worked well to reduce the size and PET uptake. The mapping uses beads that have no radiation .
I believe Grannax had her wire inserted in her arm. After my procedure I had to lay still for a few hours so the plug they installed in my groin would not come loose (bed pan was no fun) 😉
I was in minimal pain during the procedure (they gave me fentanyl) and afterward. I went home the same day for the mapping. My BP was wonky after the Y-90 so I spent the night for that one. (I deal with wonky BP occasionally)
Hope this helps.
DEE
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Thanks Dee.... I will be doing it with no pain meds...so I am hoping the pain is tolerable. That is my choice due to constipation issues... The twilight they give constipates me enough (yes, thats how prone I am to consitpation)....
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Ladies...is there risk of Acites with Y90? I don't know why but I am so scared of that...and scared of what happens if they put in too much of the Y90 and it goes to my lung or stomach
. I guess I am just getting cold feet... I just didn't feel this way with the cryoblation (but thats probably bc its less risk for problems) I cant even talk to the IR she is out this week and doesn't return until Monday (day of my procedure)...any words of wisdom will be apprectiated...0 -
NicoleRod,
Can you call the IR department in the morning and ask for a PA to call you back to answer pre-procedure questions. I did that at MDACC.
I don’t know about ascites risk. But one purpose of mapping is to test and prevent the beads from going anywhere but to the tumor.
Ask the IR doc after the procedure how the mapping went and if he feels good about the beads staying where they belong. Mine talked to me so I would know why he chose bland embolization for the one tumor.
You sound anxious. I hope you can get a peace about it all. Y-90 has been one thing that worked great for me!!!
Dee
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Thanks so much Dee... I will definitely ask her about how it went after and definitely tell her about my worries before hand. Thanks for the advice
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Nicole, hope the Y-90 procedure goes well for you. I think Grannax had this too prior to microwave ablation.
Please keep us posted about how things go. You and others who opt to go through any procedure without sedation are very brave. Personally, I like to be knocked out! I can deal with constipation later! But that’s just me being a chicken!
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S3K5. I will be getting twilight... and it WILL consitipate me...
. I just do not and will not take pain meds. Thank you so much for you well wishes I will keep you in my pocket! I will definitely keep you all updated.0 -
Ok Ladies my procedure is on the 22nd...for the Y90. I am not really nervous about the actual procedure but more so about how my liver will react to these radioactive beads...
. I was wondering if anyone had any procedures to their C7 Cervical?? Specifically Cryoblation?
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Ladies....can anyone tell me about their recovery from Y90 to the liver?? I had it done 5 days ago...first 3 days I felt fine...then yesterday and today i can feel my liver swollen...and very sore
. How long does it take to start feeling better? I am on a 5 days steroid pack..and nexium...0 -
Nicole,
I hope someone who has had y90 responds, but having had three procedures now to the liver (as you know, all microwave ablation) I think the recovery from procedures to the liver can be longer than you might anticipate. I had my last procedure on Dec. 11th, and have done fairly well on it. But I will say, two weeks out, there are days when I don't feel so great and I still get waves of tiredness and nausea. My advice to anyone doing anything with their liver is to hold tight, and get as much rest as your body demands and eat what you can tolerate. Hope that helps.
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Thanks Bev! I guess I just thought it would get better..not start out good then get rough...lol I will wait it out.
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Nicole, for my right lobe which is much bigger than left lobe, I felt good after Y90 until I finished the prednisone and then the fatigue hit me. I was fatigued for a few weeks and my chemo at the time (Doxil) had a lot more harsh side effects that cycle. My feet were totally blistered from the inside out on Doxil. For my left lobe, the symptoms were much milder. It really depends on the tumor load. My right liver had a lot of mets to attack with Y90 and was hit hard. The left lobe was also filled full with mets but it is just so much smaller than the right lobe that the right lobe can function fine on its own. You may only have mild symptoms because you have a relatively tiny tumor load in comparison.
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JFL I feel stupid bc I do not know which lobe my stuff was in...I just know it was only 2 tumors. 1 of them was about 2.4cm and the other just over 1.6cm...they are both right next to eachother and they are located down by my bottom rib...(right next to the colon wall). my liver is definitely swollen now bc its sore if I press on that area from mid ribs to down by the bottom rib.
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JFL,
So good to see you pop in here! I hope you are doing okay.
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Two questions please:
1. For those of you who have had Y90 treatments, was it in the setting of progressive disease?
***Nicole, it seems that your therapy (Havelen) was working and shrinking tumors but they still did Y90? Was this a decision for local as well as systemic approach?
2. If you were on therapy, how long did you have to stop? Was it during a chemo break or did you delay chemo? If daily oral meds, could you keep taking or did you have to stop? For how long? What's the rationale for stopping? I can understand chemo because it can already have weakening effects, but oral targeted therapies?
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Hi Hope!
So I contacted the IR after my July 2020 scan with progression....I made the appt but didn't actually meet with the her until I was on the Halaven for 2 months. It was not my MO's idea it was mine..but I did ask my MO if she would go "off the record" and recommend an IR...because my IR at John Hopkins even though he was the Chief of IR and very good I didn't want to do that drive there again (the traffic here in NOVA is so bad). Turns out my MO's Father and Brother are IR's...so she called them and asked if they knew anyone good..and they recommended my IR. So my MO was ok with me going bc again, I had progression but she was adament that we needed a systemic therapy to work (and she was right).
As far as the treatment being "wanted bc of systemic/local" etc... it kind of was...but really she made it clear that we need both.
For the Y90 my IR wants you off chemo 10 days prior to procedure and 10 days after...so I will be off almost a month...by the time I get chemo again...then...I will get this again Jan 26th... so I will only get 1 more cycle of chemo before that Jan 26th one. The reason for stopping is the Y90 can put a lot of stress on your liver (I am experiencing this right now) so they do not want your liver to have to filter out this stuff and then chemo on top of that...that is a LOT for the liver.
Just my experience and info
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Thsnks Nicole! Hope you are feeling well now after the procedure
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Hi HopeandGratitude, Y90 only targets active tumors that are currently highjacking a large supply of the the hepatic vein blood supply before it can get to normal cells, which vascular-based tumors (most BC tumors in the liver) all do. If a tumor is inactive/hybernating metabolically or is not present on a scan or has little to no vascular activity (rare), it will not be helped by Y90. The IR tests for vascular activity during the mapping procedure a week or several weeks before the actual Y90. Y90 was a good treatment and did help me feel like I got ahead of my liver mets for a while but it doesn't prevent new mets from growing. So, having actively progressing mets is the right time to have the procedure. I know that some people on these boards have stayed on hormone or targeted therapies while doing Y90. Chemo is treated differently but daily pill hormone therapies and targeted therapies do not always require a treatment break. I didn't take a break from chemo when I had my right lobe done but was on Doxil, which is only administered every 28 days anyway, and is much more tolerable than most chemos (worst side effects are foot tissue issues in the skin and deeper layers below the skin and body rashes). It was easier to handle due to the long treatment cycle. That being said, I had a tough time with Doxil side effects on my right lobe and for the second Y90 on my left lobe, I opted to take an additional week break on top of the 28 day chemo cycle. Each MO and IR may have a different recommendation depending on how harsh the systemic therapy is, how the patient is tolerating the systemic medication, overall health and performance status of the patient and their own personal preferences/experiences. I think both my MO and IR wanted me to take a bit more time off but didn't object when I decided not to do so for my first Y90. It is possible the IR didn't even know but my MO was certainly aware.
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HopeandGratitude,
I've not had y90 but have now had three microwave ablation procedures on my liver. You asked about stopping oral meds on y90, but I thought my experience with MWA might also be informative. For my first, I hadn't started Ibrance yet so was only on faslodex. I was told to hold the Ibrance until they gave me the okay. I think it was about a month after the MWA, once I had checked in with the MO at an appointment. For the second, I was told to stop the Ibrance a week before the procedure. Then I had an appointment with the MO maybe two weeks after. She actually said, based on how I was feeling, that I should hold for a few more days until I felt a little bit better from the MWA. With my third, I was on my off week from Ibrance just before the procedure. Again, she said to hold and not restart before the procedure. After the procedure, I waited about 5 days because I was feeling okay, but in reality I probably should have waited a bit longer. Faslodex continued throughout all.
As JFL said, ask your MO about this. I think the idea with the targeted therapies is that they mess with your blood counts, and you probably want to go into any procedure with as good a blood profile as you can get so your body can fight off any infection, etc. that could occur with any procedure.
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Well another thing...I was told by an IR in NY when first diagnosed that Y90 is for those that have more "than a few" tumors in the liver...I believe this is because IF the tumors are connected by a linking vessel it can get a few at the same time??, However when I went in last week for the Y90 I technically had 3 tumors that needed to go and had the Y90 and NONE of them are connected at all...and I still had the Y90 done... and now I am going back in for 1 single tumor and for the marginal area around where I had the cryoblation done in Oct 2019(also not connected or even near each other) ...so I do not think I fit the "common" status of what Y90 is used on...but it's definitely my new IR's prffered method and after she gave me all her reasons why she feels it is most times the best most effective treatment in Liver tumors..I tend to agree.
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