Topic: Surgery or no?

My dad has been diagnosed w intrahepatic liver cancer. He has 1 lg and 1 smaller tumor in the liver. He also is in stage 4 kidney failure due to diabetes and just had a fistula put in. We've gotten 3 different opinions on treatment and are struggling to come to a decision. Robert Packer says no resectomy; only chemo. Geisinger says liver partial liver resection (cut lg tumor, burn off sm), then chemo. Johns Hopkins says chemo for two months, then scan, then reevaluate and possibly remove tumors via radiation/ablation. Surgeons fear the unseen cancer that could b there. He wants surgery. But there are so many unknowns to each approach especially with the kidney issues and the harshness of the chemo. Any thots/experiences/suggestions ?  Thx much!!

Re: Surgery or no?

karwehavehope.....welcome to our site - so sorry to hear of the difficulties your Dad is experiencing. 
I must admit that a decision on how to move forward with the situation is very difficult to make.  Have you asked the physicians at either, Geisinger and Robert Packer as to how many CC patients are treated in their facility?  Is it possible for you to obtain one (or more) additional professional opinions from a large center treating large amounts of CC patients?  What type of chemo had been recommended by the John Hopkins physicians considering that your Dad's kidneys are failing due to diabetes?  What is your Dad's opinion?  Is he willing to undergo treatments albeit the failing of his health?
My heart goes out to you.  There are no easy answers, but I am sure that after much consideration and discussions amongst each other and with the physicians, you will come up with the answer right for your Dad.  I hope for others to chime in and share their thoughts with you as well.


Re: Surgery or no?

Dear karwehavehope, welcome to our wonderful family but so sorry to read about your Dad. I was wondering your Dad's age. This is such a difficult decision and really there is no right or wrong, what ever you all decide will be the right one. When my husband was told there was nothing they could do but Palliative chemo he said no. He was then 78 and fought for 5 years then was told he had 5 months and he asked the ONC, " how much time the chemo would buy him" and the ONC said a month. So Teddy opted out. To me the bottom line is how long the ONC predicts with and without treatment. Now we all know we really can't give a time limit but it helped in making our decision. I sure don't envy you and am sending good vibes and lots of hugs. Please keep us updated on Dad's progress as we truly care.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Surgery or no?


How old is your dad?
How long has your dad been a diabetic? on kidney dialysis ever before?
Need to know size of the tumors-- how large in [cmxcm ] is the large one and how small is the smaller one?
Need to know the location of the tumors--Are both tumors are located on the same lobe of the liver (ie: both on the left or right side of the liver)?
Basically, the treatment plan from John Hopkins and Robert Packer are the same at this point in time for your dad. chemotherapy for 2 months and then scan for evaluation is a conservative but logical approach.
Until I know the size and the locations;then I may have some more ideas on the  Geisinger  liver partial liver resection (cut lg tumor, burn off sm), then chemo.suggestion for you.

he wants to have surgery is he means your dad wants to have surgery .(ie:as his first choice of treatment option.) ?
PET scan before surgery has had a 30% chance to  change the decision making of having surgery or not due to the PET scan has the ability to detect metastasis in other parts of the body.

BTW, I am only a patient of intrahepatic CCA for 58 months and I am not a doctor either.

God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.