Neoadjuvant Chemotherapy as a bridge to Surgical Resection

Julie…the short answer to your question is “yes.” Tumor markers are used as baseline at onset of treatment for those that present with the Lewis antigen. Results will be correlated with cytology, imaging, and other clinical findings.
Hugs,
Marion

Aniket,

Thank you for the additional info about your dad’s case….medical places involved and your thoughts. I understand what you are saying…and I have to agree that I would also be worried about losing that window of opportunity for a resection. As I indicated…I haven’t looked at some of the issues involved in your dad’s type of CC, but I think I would personally take the risk of positive margins myself…IF it were my decision to be made and I was given the choice. The issue seems to be that we are not given that choice. The surgeon decides whether they are willing to to proceed with surgery or not…and under what circumstances.

Someone may have to chime in here…but I thought CA 19-9 levels stayed elevated until either the tumor started to die through chemo…or it was surgically removed. Is that right?

Julie T.

Aniket,

When I was first diagnosed with intrahepatic CC (5 cm tumor) late Jan 2014, and went to Mayo Clinic Rochester Feb 27th, they said that they were having some success with neoadjuvant chemo. However, I wanted the tumor OUT…and NOW…..and my surgeon made the decision as well to go ahead with the surgery. I have heard both sides to this question.
1. Doing neoadjuvant chemo could reduce the size of the tumor burdon and thus give better surgical margins.
and the flipside
2. Delaying surgery to do neoadjuvant chemo could result in the cancer suddenly starting to spread and in most cases, they won’t then do surgery.

My thoughts for myself were that:
1. The tumor was resectable….get it out immediately. I didn’t want it in there one minute more. That was the psychological aspect.
2. From the info I gathered, chemo only works on a percentage of CC and thus, the tumor/s could grow in that time or spread making surgery not possible when it was earlier. I saw no point in waiting to find out.

There are times when people have chemo and it is successful in reducing the size the tumor or tumor burdon enough to allow for surgery when it wasn’t possible at all at first diagnosis. In that case though, there really is no question as to whether to go ahead with chemo….as that is the only alternative other than doing nothing. There are some on these boards who have been in this position, had a reduction in the tumor which allowed for surgery.

Again…my case was really kind of a no-brainer. I had no elevated tests…everything was normal…there was no CA 19-9 elevation or bilirubin elevation. (I had no symptoms at all) My PET was negative for anything suspicious anywhere else. The tumor was resectable and that was obvious from the beginning and it was in the outer reaches of the left lobe away from anything, which in surgery allowed for a 2.2 cm clean surgical margin. The decision in my case to go ahead with surgery was the best for “me.” When my oncologist at Mayo saw me again at the end of the consult day, he had spoken with the surgeon….and said to me, “Well, you got the surgery you wanted.” I got the distinct impression that maybe making my wishes known to the oncologist had a little bit of a push toward forgoing the neoadjuvant chemo and just proceeding with surgery immediately. My surgery was the next day at 1 p.m. I am currently 1.5 years post surgery with no reccurrence yet. I was staged at T2b which was a fairly early stage for intrahepatic due to finding the tumor by chance after seeing my GP for something else.

Hilar CC is different than intrahepatic CC and I don’t have any data on Hilar to help you, other than suggesting that you might seek another opinion, but the clock is also ticking during that time as well. You didn’t mention who your father’s doctor is or where, but make sure that they are with a large medical center that has the most experience with CC. There aren’t that many. Second and third opinions are often a good idea when you have doubts and questions or there is a discrepancy in opinion.

Julie T.