Topic: Need Advice! RadioEmbo and Resection...

My sister got news yesterday (she was diag. in early Aug; had about 5 cycles of Gem/Cis so far and recently had a CT scan).  From this, they determined that the chemo has shrunk the liver tumor some, but that the tumor thrombus in the main portal vein (at the Y-shaped branch where it goes into the left and right lobes of the liver) has grown, invading both branches just at the junction.  Earlier, it was mainly on the right side, (right portal vein) bulging into the main portal vein and left branch at the Y shaped split.  Yesterday, there was a discussion about trying chemoembolization very soon to shrink that thrombus, with the goal still resection of right side of liver.  The Dr's conferred today and decided that was not an option; that the next step would instead be to use radioembolization on that tumor BUT.... they said that any radiation to that area would completely close the door to the possiblilty of resection forever.  Very heavy words.  I wonder why radioembo of a tumor thrombus in the vein would "close the door to resection"?  Is it because there is not enough vein left undamaged to attach to the remaining liver segment? She has no distant mets ( not sure if this portal vein tumor is considered a met or if the one in the liver is either.  No positive lymph nodes (just lymphadenopathy).  They also think it has charachteristics of both hepatocellular carcinoma and cholangiocarcinoma.  I found a couple posts from patients (Kris?) with perhaps "mixed" type of cancer.  Radiographically, one type of cancer looks more dense and the other more diffuse.  biopsy gave both as differential diagnoses.  Either way, they want to try something different since the chemo is only working for the liver tumor, not the vein thrombus.  Can anyone tell me why radiation might prevent ever having resection (or transplant for that matter)?

Willow

Re: Need Advice! RadioEmbo and Resection...

Hi,
what do you mean tumor thrombus? do you mean the tumor or the thrombus(blood clot) inside the bile duct or the portal vein?
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.

Re: Need Advice! RadioEmbo and Resection...

It's a tumor thrombus.  Not a blood clot.  Thrombus just means blockage of a blood vessel.

Willow

Re: Need Advice! RadioEmbo and Resection...

it's in the portal vein.  Started in the right branch, very near the junction to the main portal vein.  Grew into that junction and up into the left branch, all right at the Y (where the main portal vein splits into the left and right portal veins).

Willow

Re: Need Advice! RadioEmbo and Resection...

Hi,
is it possible for you to send me the CT scan report; (the impression section or the findings) through here or my email.?
I still not get the complete picture.(PS as you know ,I am not a doctor) but the reports is easier  and more specific for me to understand .
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.

Re: Need Advice! RadioEmbo and Resection...

Percy,
Sorry, I don't have the report, but I did ask my sister for it.  She said she would mail (snail mail) me a copy.  I will send it to you via private email (rather than the blog), with her blessing.  Percy, thank you so much just for caring enough to think about this one!  Bless you,  Willow

Willow

Re: Need Advice! RadioEmbo and Resection...

Article on medscape about Portal Vein Tumor thrombosis

http://emedicine.medscape.com/article/373009-overview

Willow

Re: Need Advice! RadioEmbo and Resection...

Willow, sorry I cannot be of any help here, just wanted to let you know I am praying and cheering for your Sister!

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: Need Advice! RadioEmbo and Resection...

from that article:

"Tumor in the portal vein may have an appearance identical to that of thrombosis, but this appearance is far less common than others. Tumor in the portal vein is most frequently related to hepatocellular carcinoma. The thrombus may be partial or complete. It may be mixed with bland thrombus as well."

Willow

Re: Need Advice! RadioEmbo and Resection...

Hi,
At this point  just based on the info. from the message board your put up,
I think chemoembo is safer to use .
Radioembo,based on the last three members that I had close contact with,is not proven its value in treating cholangiocarcinoma. All of them passed away within 6months due to various reasons.
However all of those three patients are older than 50 years ; and it seems younger patients can be of more benefit than the older patients. My guess is that the younger patients can withstand the radiation better and have enough liver vitality to recover after radiation.
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.

11 (edited by Willow Thu, 29 Nov 2012 19:41:33)

Re: Need Advice! RadioEmbo and Resection...

Percy,
Thanks for sharing your experience.  We really wish they gave her a choice of chemoembo rather than radioembo.  My sister just turned 50 and has a young child and so much to live for.  I do hope she will come through and be able to maintain much like Maria in Sweden has!

Willow

Re: Need Advice! RadioEmbo and Resection...

Hi,
Is your sister on any anticoagulant like Coumadin, Lovenox ?
What other meds she is on now beside GEM/CIS?
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.

Re: Need Advice! RadioEmbo and Resection...

This is just a guess and I may be completely wrong:

Radioembolization delivers a very high dose of radiation to a small area. Radiation damages the body tissues. The tissues become "dry" and brittle. It is possible that the damage to the surrounding tissues is bad enough that the surgeon might not be able to make the new surgical connections.

My wife had external beam radiation after her surgery.  Compared to radioembolization, external beam radiation delivers a much smaller dose to a much larger area. I don't recall who told us this - either radiation oncologist or the surgeon - but the message was that any subsequent surgery would be very difficult technically due to radiation damage.

Re: Need Advice! RadioEmbo and Resection...

No blood thinners.  No talk of blood clots (though I can see why thinning the blood may help if the vessel is narrowed, just to improve flow). 

She is only on the standard Gem/Cis and the meds they give concurrent with that:
IV Zofran day of chemo, a neulasta shot day after chemo, ativan. 

She's had chemo every other week.  Chemo has definitely caused low blood counts from the very first tx (wbc's early on and platelets last week) which have deferred chemo a couple times.

She hasn't had problems with severe nausea or vomiting, so hasn't had to take the meds given for home use for that.

Willow

Re: Need Advice! RadioEmbo and Resection...

Eli,
That does make sense.  We were wondering why they couldn't just do a blood vessel bypass and cut out the damaged tissue, but the Dr said something to the effect that there wouldn't be any appropriate tissue to reattach the healthy part of the portal vein to at the left lobe of the liver (the left lobe of the liver has no tumors).

They could have done the resection right off the bat, before the tumor grew into the left branch of the portal vein, but he said it was likely that  "cancer seed cells"  may have been carried into the left "healthy" lobe of the liver already since the tumor was within a blood vessel.  The goal of chemo was to kill these seed cells as well as to shrink the tumor thrombus away from the left branch of the portal vein.  I think the surgeon wanted to preserve the left branch of the portal vein along with the left lobe of the liver.  Now they say that won't be an option.  We are really, really disappointed (that's an understatement!).

Willow

Re: Need Advice! RadioEmbo and Resection...

Hi,
Ok,
then I just wait for your email . I don't want to guess without the CT report.
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.

Re: Need Advice! RadioEmbo and Resection...

Percy,

Thanks!  Hopefully she will follow through with mailing it to me.
Yes, we are blessed.
Willow

Willow