Hi PCL,

I have consulted 2docs in BRussels. The 1st in oct last year did not offer anything new but about 15 days back I had 2 sessions with a 'digestive oncologist ' who said that resection should be attempted. we are awaiting the result of two more rounds of chemo to decide.

Sorry for the trouble with the spelling and thanks for all the effort. Will keep you posted.

Thanks, Marion. Will wait for your reply.

Hi PCL and Marion,

Her latest blood report of 7th February before starting 5 fu are
Haematology

EDTA found
Rbc 3.34
Haemoglobin 9.4
PVC 30.8

RBC indices.  MTV 92.2. Mch. 28.1 mchc.  30.5
                    Total WBC count 7070000000
                    Platelet 120000

Differential counts within limits

Creatinine 0.8 -has been within the normal range since the start..

sGPT 47 - within 9-52range since the start of treatment in June l

CEA 53.8 ca19.9. 990 ca-125 307 latest values as already mentioned

The latest ct scan report on the liver is

'Again noted are heterogenously.  Enhancing mass lesion involving the segment  v, viii and vii now measuring  11.1 by 7.8 cm (9.7 by 5.2 cm previously )
Again noted is another enhancing focal lesion in the segment ii now measuring 1.7 by 1.0 cm(same size since oct 2011). CApsular retraction is noted adjacent to mass. Small peri portal lymph nodes are again noted. The porta hepatitis is normal. The intrahepatic portal venous radicals are normal. No evidence of intrahepatic biliary radicular dilatation. The hepatic veins and intrahepatic portion of inferior venacava are normal.'

PCl, I did not understand the meaning of ' myelosuppression depression'. My mother  is tolerating the 2nd cycle of 5fu better . Initially the opinion of the assisting doc was to go for a 3 week cycle in view of her age and that we are now in the third line of treatment but in view of my mother. 's reasonable tolerance to chemo by the Grace of GOD, our oncologist insisted on a 2week cycle with the neurogen given right after the 48 hour infusion.

I don't know if this is the right forum to ask but I wanted feedback on radioembolization, PDT, cyber knife facilities within India.

Thanks

Hi PCL and Marion,

Her latest blood report of 7th February before starting 5 fu are
Haematology

EDTA found
Rbc 3.34
Haemoglobin 9.4
PVC 30.8

RBC indices.  MTV 92.2. Mch. 28.1 mchc.  30.5
                    Total WBC count 7070000000
                    Platelet 120000

Differential counts within limits

Creatinine 0.8 has been within the normal range since the start..

sGPT 47 within 9-52range since the start of treatment in June l

CEA 53.8 ca19.9. 990 ca-125 307 latest values as already mentioned

The latest ct scan report on the liver is

'Again noted are heterogenously.  Enhancing mass lesion involving the segment  v, viii and vii now measuring  11.1 by 7.8 cm (9.7 by 5.2 cm previously )
Again noted is another enhancing focal lesion in the segment ii now measuring 1.7 by 1.0 cm(same size since oct 2011). CApsular retraction is noted adjacent to mass. Small peri portal lymph nodes are again noted. The ports hepatitis is normal. The intrahepatic portal venous radicals are normal. No evidence of intrahepatic biliary radicular dilatation. The hepatic veins and intrahepatic portion of inferior venacava are normal.'

PCl, I did not understand the meaning of ' myelosuppression depression'. My mother  is tolerating the 2nd cycle of 5fu better . Initially the opinion of the assisting doc was to go for a 3 week cycle in view of her age and that we are now in the third line of treatment but in view of my mother. 's reasonable tolerance to chemo by the Grace of GOD, our oncologist insisted on a 2week cycle with the neurogen given right after the 48 hour infusion.

I don't know if this is the right forum to ask but I wanted feedback on radioembolization, PDT, cyber knife facilities within India.

Thanks

Thanks PCL and Marion. My mother is being treated in India and we are consulting a reputed medical oncologist referred to us by a liver specialist.  we have obtained opinions from oncologists at major hospitals within the country. The unanimous opinion was that inview of large size of liverlesions chemo should be immediately started.

No other procedure except biopsy has been performed. Of course colonoscopy and normal upper hi endoscopy we're done. The biopsy report of June 2011 is under-

'neoplasticism cells express ck7, ca19.9, wt-1,CDC-2, vocally weak positive and negative for ck20, CEA, ck19, ttf-1, ER, PR, synaptophysin,chromogranin, ck5/6,,mesothelioma,mammoglobin. Controls are satisfactory'

She has no jaundice and her sgpt tests done before every chemo are satisfactory till date. But in the last 2to 3months she has had to take injections to boost WBC counts twice and now with the 5 fu combo is taking the injection for neutrophils as already mentioned.
Her last ct scan on 7th feb 2012 ( oral,rectal and IV contrast) is under-

Summary

Marginal increase in the size of right lobe conglomerate hepatic focal lesion.
Relatively stable left lobe lesion.

Stable size sub centimetre right lung module.

Other incidental and non critical ct findings.

I didn't know how much is relevant..regarding 2nd opinion as mentioned by PCL what are the modalities?

Thanks.

Hi PCL

our oncologist believed the origin was pancreatic and hence believed gemcytabine was the primary treating drug, thus he replaced the xeloda with oxaliplatin hoping to achieve better result. But now even after 8 months of diagnosis when nothing has been seen in pancreas or gall bladder he has decided to start her on 5 fu immediately with irrinotican and leucovorin as mentioned by me.

Regarding Ca125 the  whole body pet ct report of oct 2011 says
'ovaries and uterus unremarkable. No significant pelvic lymphadonopathy'

Hope it makes sense.

Best wishes

Thanks, Marion. I am glad I found this site.

Thanks, Marion. I am glad I found this site.

marions wrote:

prayersforall...welcome to our site.  Metastases from unknown primary are not uncommon. Physicians take in account the symptoms and test results and based on that make the diagnoses. 
Irinotecan  (Camptosar) can be difficult to tolerate however; it appears that your mother seems to be doing fine.  Chemotherapy is accumulative therefore; you would want to keep a close eye on possible side effects caused by treatments

I am hoping for others to chime in also and share their thoughts with us.

In the meantime I wish for your Mom to respond favorably to the present treatment and for the upcoming scans to reveal a reduction in markers and lesions. 

Hugs
Marion

Introduction -is this cc?

My mother, 65 yrs old was diagnosed with metastatic adenocarcinoma of the liver last June. She had been complaining of apathy for food particularly intolerance to the smell of cooking, itching and bloated feeling in the stomach for 2-3 months and an ultrasound showed the metastatic deposits in the liver.Colonoscopy and endoscopy did not reveal anything. PET/CT results
Right lobe lesion 15 by 8.3 cm
Left lobe lesion 5.7 by 4.8 cm
- multiple, necrotic fdg avid lesions in both lobes of the liver suggest metastatic
Disease
-FDG avid pre vascular nodes suggest metastatic disease
-no other FDG avid lesion is seen elsewhere to suggest a possible primary neoplasm

CEA 19.1 CA19.9 -427 AFP 1.73 CA 125 - 256


Our oncologist started her on gemcytabine and xeloda 3 cycles of 21 days. She tolerated the chemo very well. A review was done in Aug 2011

Shrinkage right lobe  9.7 by 5.2 cm left lobe 1.9 by 2.4 cm
CEA 12.2 ( earlier 19.1)
CA 19.9 88.9 ( earlier 427)
CA 125 56.6 ( earlier 256)

The same chemo gemcytabine 1600 mg and xeloda 4 tabs daily was continued for 3 more cycles of  21 days and review PET CT done in End of Oct 2011-

Right lobe lesion stayed the same at 9.7 by 5.2 cm
Left lobe lesion reduced to 1.7 by. 1 cm( last scan 1.9 by 2.4 cm)

CA 19.9 - 125( earlier 89.9)
CEA 14.2( earlier 12.1)
CA 125 70.8. ( earlier 96.8)

She was given about 45 days of rest from chemo . Her appetite improved and she felt her symptoms had disappeared.

In December 2011 she was started on gemcytabine and oxitan for 4 cycles each of 15 days. But from15 Dec onwards she felt the same symptoms . so a mid term review was done in Feb 2012. CT scan results

Right lobe lesion increased to 11.1 by 7.8( earlier 9.7 by 5.2 cm)
Left lobe 1.7 by 1 cm same as before


CEA 53.8( earlier 14.2 cm)
CA 19.9 990 ( earlier 125)
CA 125 -305( earlier 70.8)

No new sites

Doctor feels it could be cc and not pancreatic but says treatment options are the same  he advises.



Now she has been started on 48hour IV of 5fu, 750 mg -9 hrs each
Irrinotican 240 mg -2hrs
Calciumleucorin 300mg -2hours

1st cycle completed had a neutrophil boosting injection felt very weak had mouth sores, throat infection.
Was treated on antibiotics and improved

2nd cycle over. Much better tolerance.

She has no diabetes, hypertension but has been asthmatic for years but no other known illness.

has been tolerating chemo well except the 1st dose of 5 fu which gave her a fever and she felt weak for 2days.


Sorry for all these details. But just wanted to find out if anyone had a similar experience  - metastaitic adenocarcinoma of liver with unknown primary and can suggest what options are available for her.

Prayersforall