Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Thanks for the heads-up on nausea, BabyRuth. I'll make sure to ask them to give me something. I wish they would make better notes for us.
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Grannax - I'll be honest, I could not read your complete post because I started to feel the blood draining from my head ... I actually began to pass out. This is my greatest fear in dealing with these procedures ... I can't be present so I can't fight for myself. The other one is that my body is just going to throw in the towel rather than go through the procedure ... some primordial fear will take over and cause a catastrophic failure.
In any case, from where I sit, you are incredibly tough and incredibly brave. What you deserve is a long period of peace and quiet with no cancer drama. Please keep us in the loop.
>Z<
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Zarovka, you can employ your considerable self-advocacy skills in the planning phase, and get reassurance from the medical people that they have heard you and will be looking after you well. Don't be shy about saying what you need. Maybe there is even a social worker or nurse who could provide moral support, like a doula, for times when your usual support people are not allowed to be present. Years ago I had a medical friend very kindly attend a procedure with me because I was afraid to be alone and unconscious with the doctor I did not know well. (I had some PTSD going on at that time in my life.) It occurs to me that cognitive behavioral therapy with a good psychologist might be helpful if you are interested in that, to help with your reaction to medical stuff. Please don't read that suggestion as criticism in any way. You are very kind and brave and I feel for you.
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Today, reading my post, it feels like I went down the rabbit hole and had a very strange experience. Hardly believable. I will get my medical records. After reading yours, BabyRuth, I have to wonder if all of what was told to me will be in writing. It should be, for my safety. My close friend owns a medical transcription company. She is very aware of how many mistakes are made in our medical records. It's dangerous for all of us. Her goal is to help make changes that will benefit all patients.
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Day 3 post y90. I have not had the same SE I had with the last one. Because of all the meds they gave me this time, I have been constipated.
My doc did talk to my daughter about my allergic reaction to iodine. So, I think it will be in my records. They gave me a lot of steroids to help keep that from happening again. They also used dilauted, versed, fentanyl and zofran.
I'm still recuperating. Hopefully in a few more days I'll feel better.
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Eicats. You should finish your systemic treatment first. Your diagnosis is like mine. After I was done taxotere and on Herceptin and perjeta it was discussed. SBRT or RFA is used for oligometastatic patients. You must have less then three mets to qualify for the NRG BR002 trial or two liver mets... keep it in mind. When you are done chemotherapy and on HP you could qualify if your mets are still visible on CT scan (SBRT) or ultrasound (RFA). Y90 is not for you at this time, hopefully never. I had SBRT which was easy and successful so far!
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I'm one week out from y90. My biggest problem from this one that all the meds and zero stool softener s caused what ended up being rectal prolapse. I saw my PCP today and now I have to go to colorectal surgeon. OMG, the things that happen while we're trying to fight cancer. I'm also probably anemic from blood loss from RP. Maybe by next week I'll have a more upbeat post,
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Oh Grannax, rats and double rats. The first one went so well and the second started out so well. Honestly the things that happen are just hard to fathom sometimes...I'm sorry you have yet another situation to deal with right now. You are in my thoughts and yes please let us know how you are doing soon. I guess the only good thing in this situation is the fact that we have these surgeons who can patch us back up as we go.
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Oh, Grannax, I'm sorry for this complication. Let's hope they can help you quickly and with very little trouble to you.
As some of you know, my onc is switching me to Xeloda. She says she wants to see that systemic treatment is working before we talk more about liver radioembolization. That makes sense.
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I'm 10 days out from y90. I started feeling a little better on Thursday. The complication from this one, rectal prolapse, is not resolved but better. I go to the colorectal surgeon next week. I don't think I'll need surgery but there will some sort of procedure to help with healing.
I'm still planning on driving down to see Aubrie's play. She'll be in Jungle Book. Her part is one the coils on the snake, Ka. Evidently, Ka is huge. I can't wait to see my granddaughter transform into a snake. Sure to be fun entertainment for this Granna.
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thinking of you. thanks for the update. it's not over but getting better ... go grannax.
>Z<
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Thanks Z.
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Yes hang in there Grannax, funny how we get used to those "procedures" although never desired nor fun. I'm glad to hear you are feeling somewhat better. That play sounds pretty entertaining.
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I went to the surgeon and he said I do not need surgery. Sure glad that visit is over. What a relief to know that it's healing itself and there is no need for further treatment or tests.
Now, I'm looking forward to being entertained by my granddaughter this weekend. And, to no more complications.
I guess I won't be posting much here anymore since I'm done with y90's. But, I will check back in when I have my scans done. From what I've heard, the results of my July PET won't show true results for the liver mets. It usually takes six months post y90 to show accurate results. So that would be October-ish.
I'm so appreciative of the support and encouragement I've had here.
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We'll be here. This post/record of your experience will help many women. THANK YOU.
>Z<
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Yes, I will be very curious to hear as well. Live well Grannax!
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I did find out one bit of information you might find interesting. After my first y90, my doc told my family that the second one would be more difficult. It wasn't clear what he meant by that. He did the left lobe of my liver first. That was the easier, technically, to "get to the tumors". The right lobe was more challenging "to get to the tumors". I guess because of their location in that lobe. One of the nurses told my daughter all this info after my second y90 was over. They told her they felt like they were successful, even though it was more difficult. So, mystery solved.
I did get to see my granddaughter in the play. A good friend drove me down there and we had a great time together. Of course Aubrie was the cutest snake 🐍 ever. The play was adorable.
I saw my MO yesterday. When I told her my y90 story her eyes got big as she listened. But, I had her laughing by the end of the visit. We are both happy that's over and that I'm feeling so good on 125 of Ibrance. I'll start my sixth cycle on Friday.
Unfortunately, my next big event is a sad one. On June 24th, I'm going to Oklahoma for my brother's memorial service. I'm not looking forever to that, of course. As we all know life does not stop while we are fighting MBC.
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Thanks for the update Grannax. I am very glad that you are living life fully and able to be there for both your granddaughter and your brother.
>Z<
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Yes Grannax, I'm so glad to hear you are feeling so much better and the procedure helped. I'm so sorry to hear of your brothers passing....
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I finished my SBRT April 17 and will have my first scan June 28...I have been super anxious for this scan...I know Grannax that it will take a few more months to get accurate results. I'm just wondering what it will indicate/show. Tried researching to heck out of this topic to no real concrete results. I'll let you know what it says when I find out (July 4 😔). Can't wait to hear your scan result Grannax
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The interventional radiologist wants to check in with me next week. I think we are to talk about the timing window for radioembolization. He has to coordinate with my onc. My onc said she wants to know that the systemic treatment is working before doing local treatment. I just finished my first 2 weeks of Xeloda. Good chance it is working because I felt a flare. I'll get TMs next week, and they are reliable for me. Normally I would be due for a scan in July or August. My onc likes PET/CT for her purposes, and the radiologist likes CT with contrast for his purposes. Will they have to duke it out? What should I ask these doctors? I feel like we should all meet together at the same time, but realize that could be complicated to schedule. Beating up cancer (without beating up me) is of course the priority, but in addition, important summer plans are riding on what gets decided, and when things do or don't happen, so I hope they can give me a timeline soon. How would we decide whether to go ahead with radio or to wait and see if Xeloda can get me to NEAD? Any thoughts or comments will be appreciated.
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Bstein, will you have a PET scan?
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Shetland, after scanning that shows any shrinking/responds to xeloda (making MO happy) zap those buggers! PET scans are rarely ordered in Canada. The interventional radiologist I saw wanted MRI follow-up but that would look at liver only so CT with contrast it is...although I only have liver mets we should at least scan the rest of me every so often. I couldn't have RFA last year after chemo because the mets could not be seen on ultrasound (I thought that this meant that maybe it was just scar tissue but now 1 year later the met looked 3mm bigger on CT and is still not seen on ultrasound...never heard of this before...so SBRT instead) If this CT is vague I will ask for a PET scan! My IR said that SBRT and RFA are equally effective. Hoping you get the RFA and we can compare in 10 years!
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Hi all - I have a question here for my wife who is has mets to her liver. Back in January of this year, routine CT scan found 10+ small lesions in her liver. She was put on Xeloda and started responding to the drug. Her TMs started falling. A CT on 6th June showed that out of the 10 lesions, all are stable but 1 has grown from 1.2 to 1.6 cm. Also now there is a new 1cm x 1cm lesion. A PET was ordered to confirm the CT findings. The PET showed no uptake on the liver mets except on the one that grew bigger and the new one.
The onc now considers it as progression and wants my wife to move off of Xeloda. She does not recommend local resection (surgery) of the 2 rogue lesions but agrees to give a referral for the radiation oncologist to discuss localized radiation treatment.
It will be great if I can get some advice here on whether localized treatment is appropriate for her and whether or not it is premature to get her off of Xeloda which worked on rest of the mets.
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I don't know for sure about these questions but I wonder why can't you stay on Xeloda during y90 procedures? I stayed on Ibrance/femara during the 2 months while I was having procedures.
I wish I could remember the reasons IR said 3 month scans are not reliable. I guess in my mind I think the mets might still be "mad" about being zapped. Therefore there might be inflammation or dead cancer cells making them look larger. I promise I will let you know about my July scan as well as October.
My IR was fine with CT but I had already had PET that showed one growing liver met. I will always get PET because I'm SO allergic to iodine contrast. Also, all the other liver mets showed minimal response if any.
I think there is a window of when it's best to do it. I know he checked bilirubin and other labs that liver is functioning well. I don't think the numbers have to be perfect, though. He did tell me that he just did y90 that morning on someone who had lots more tumors than I did, and I had about 8, I think.
I hope some of this is helpful. If not, I wonder if he does some type if consultation on line. His name is Travis Van Meter, MD, Dallas, Texas.
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Letmywife, I had two liver mets that I spoke to a RO about. He said the safest and easiest procedure for just 2 would be microwave ablation. He said it was so much easier that SIRT or Y90. This appointment was right before Thanksgiving and I agreed I wanted to do this. Because of the holidays...Thanksgiving, Christmas, New years....they drug there feet. So when I went back in January, they wanted to do another MRI of liver to make sure everything looked the same. Much to my surprise, a third small tumor had popped up and they said I was no longer a candidate for microwave ablation. They said I could do SIRT, but my MO wanted me to work on shrinking them first hoping we could at least get back to just 2, so I could do the microwave. Things went downhill from there and no treatments are working for me at this time and now I don't even know if I qualify for SIRT. I am so frustrated how I missed this opportunity, so my advice to you would be act fast!!!! You just don't know how quick things can change so quickly.
Praying she gets an easy procedure and she can stay on Xeloda, since it is obviously doing a good job on the mets!!
Best Wishes,
Roibn
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letmywifelive- I already spoke up about saying I think the Xeloda is working on all but the two new lesions. I am not sure about Y90 and Xeloda together as they are both chemotherapy agents. Good question to ask- can you do both?
I think RFA would be a good option fir the two new tumors depending on their location. If the are near blood vessels this procedure won't work. There is also a procedure to freeze local tumors. Someone will have to help me out with the name of it
As your wife still has several other lesions, I would guess they woukd not suggest surgical resection.
So I think there are lots of options available for your wife to try and treat these new lesions before you have to start all over with a new treatment.
Of course, I am not s doctor so this is all opinion based on my experience as a cancer patient.
Hope you get answers soon.
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Robin. I'm sorry you missed that window and that you are having trouble finding an effective treatment. I hope they find something that will bring you back to a stable or better point soon and then you can get a local procedure,,,,,thinking of you.
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Thanks Artist, It's been a rough six months with nothing working. I have a Bard1 mutation which is closely related to BRCA (which I did not have) so they are trying to treat me now as BRCA pos. I started Carbo last Friday and will do 3 weeks on and 1 off. My MO already has me a slot on a PARP trial with a WEE1 inhibitor, but doesn't want to pull me off Carbo if it starts to work. I am fine with that plan because there are many PARP trials out there and I could also get Oliparb off label.
I am praying this is my magic bullet for a while. For the first time in 2 1/2 years of Stage 4, I am actually scared to death. The ups and downs of this disease is so very emotionally draining.
Best wishes to everyone!
Robin
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That's for sure Robin. It's was to coast along when you are feeling OK and things are stable. But as soon as a bad jag comes along it is terrifying. Snaps us right out of the state of denial I guess. Crossing our fingers and saying a prayer that carbo is the ticket for you. Hang in there Robin!
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