Intro – Intrahepatic CCA found by coincidence
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Hi,
I am Hatice’s daughter and just wanted to give an update regarding her. She decided to have the second surgery which happened last Saturday (July 13). In the CT scan, there were 2 and 1 suspicious masses in her liver. During the operation, the doctors saw that one is actually three small tumors next to each other. Overall, they were able to resect all 6 tumors and sent them to pathology. We still haven’t heard about the pathology result. She is still in the hospital and they plan to discharge her tomorrow. She is very tired and having some pain. Also her appetite is too low. She is saying that I am very hungry but I cannot eat. Has anyone had the same complaint? If so, what did you do to overcome that?
Best regards.
-Derya
Hi Hatice,
The decision you are being asked to make is very specific to the geography of your liver (namely, where the tumors are located relative to other features such as bile ducts, veins, other organs, etc.) so it is not possible to generalize. But here are some thoughts:
It is definitely possible to have a second resection. I have read a few medical studies reporting results from second resections, and they seem to be in general similar to results from initial resections in terms of patient outcomes. But it would take an experienced surgeon to give an opinion as to how this would work for you.
If surgery is not possible, both RFA and Cyberknife are also effective in defeating tumors, especially if they are small. You are fortunate that your cancer is only in your liver because, as you are seeing, there are more treatment options than if the cancer has spread.
Recommendations as to whether a proposed treatment is a good choice in part depends on what the doctor feels comfortable with. The surgeries needed for cholangiocarcinoma can be exceptionally complex, and sometimes one surgeon will say it is not feasible but a more experienced or specialized surgeon may be more positive. In my own case, I was initially told I was inoperable, but subsequently a liver transplant surgeon was brought into my case. He thought the surgery was feasible and was able to get the tumor out.
The best path may be just as you are doing – seeking out multiple opinions from experienced doctors, asking a lot of questions including about risks, recovery time, and likely outcome, then choosing the course of action that seems best to you after hearing them out.
I have sent you a private message with some additional information.
Regards, Mary
Hi Mary,
Thank you for your response. Right now, I am in a situation where I need to make a critical decision. The surgeon who did my operation is negative about having another surgery because of these two lesions. He thinks that my cancer is aggressive and if it comes again will they always do an operation? My oncologist recommended me to get other surgical opinion. I saw 3 additional surgeons. Two of them said that surgery could be an option but RFA+CyberKnife could also be tried. The other one strongly suggested surgery. When I spoke with my oncologist he stated all the risks of the options and left the decision to me. I have an appointment for RFA this Thursday and I have to make a decision whether I want surgery or not. How are the others experience who had consecutive liver resection? One part of me does not want surgery, but the other part of me wants to give a chance. I am very confused and don’t know what to decide.
Hatice
Hi Hatice,
Welcome to our community. Thank you for relating your story. It was, as you describe, disappointing to have your happily planned trip turned upside down with your diagnosis. Cholangiocarcinoma can be symptomless initially, and it is a very unwelcome surprise when finally revealing itself through pain or jaundice.
From what you describe, your doctors recommended very aggressive treatment and your results have been generally positive with a few bumps in the road. Folfirinox is a tough chemo regimen, but it got you to surgery. The more recent lesions are going to get zapped, and hopefully the RFA and Cyberknife will do their job for you.
Best wishes as you pursue the next round of treatment. Please let us know how it goes, and send any questions our way.
Take care, regards, Mary
Dear all,
I would like to introduce myself. I am a woman who is 67 years old. In July 2018, I had severe abdominal pain for a few days and the pain went away by itself. In the beginning of September 2018, I was going to US to stay a couple of months with my daughter and take care of my grandson. As I was getting prepared for my travel in the last week of August, my son strongly suggested me to see a doctor and have a check up before such a long travel. Even if I didn’t have any pain or any other clinical symptoms (jaundice etc.) at that time, I saw a doctor and had an ultrasound of my abdominal. They saw multiple tumors (more than 5 spreaded in both lobes and the largest was about 6 cm) in my liver and requested detailed blood work and CT scan due to very likely metastasis. There was also a cyst near my pancreas (which had been discovered a couple of years ago by coincidence and was not cancerous at that time) and the doctors suspected that I have pancreas cancer with liver mets. I had PET scan and biopsy immediately. The pathology report was saying that it is adenocarcinoma. They checked everything in my abdominal including my stomach, colon, etc. They were very sure about multiple tumors in my liver, they couldn’t identify a specific primary cancer, and there was some suspect regarding the cyst next to the pancreas.
I cancelled my travel. It was very devastating. The life is changing very quickly. All of a sudden, I found myself to spend most of my time seeing doctors in the hospitals while I was hoping to spend time with my grandson.
In mid-September 2018, my oncologist immediately started my treatment. It was inoperable and primary unknown with liver mets at that time. I started the Folfirinox regime. I had my worst days in my life. I didn’t believe the treatment will ever work. I had CT scans in every two months. In the first CT scan, the tumors shrank to their half sizes and nothing changed in the cyst near my pancreas. In the second CT scan which was January 2019, there was still some shrinkage (not as the first one though) again no change near the pancreas. After seeing the improvement, my oncologist gave up the idea of pancreatic cancer and started to consider CCA and the possibility of liver resection. I actually had a liver resection on May 5, 2019. There were 3 tumors visible (largest 2 cm) in the CT scan but during the operation they saw 7 tumors (largest 2 cm). I had right hepatectomy and one tumor was taken from the left lobe. The pathology returned that it is indeed intrahepatic CCA. I stayed in the hospital for 5 days. My liver values went normal and went home. After a month, my oncologist told me that I will start low-dose chemo (capecitabine) and will have regular CT scans in every month. In mid-June 2019, I had my first CT scan after the surgery, and they saw two lesions. My doctor thought that it cannot be recurrence in such a short time. The surgeon said that while they saw that the liver was clean after the operation, they cannot see things smaller than 2mm. So possibly there were something not visible and they grew since I was not getting any chemo.
Right now, they have decided to use RFA in one of the tumors (2 cm) and Cyberknife in the other one (9 mm). I don’t know where these things will go. If any of you have/had similar experiences as me after the liver resection, I would like to hear more about it.
I just wanted to share my story with you and I am happy to become a member of such a big support group.
Good luck everyone!
Hatice
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