My wife has just been diagnosed with secondary Breast cancer in the liver. About 9 months ago she found what everyone thought was a small lump. Her GP was surprised she'd even found it. She was asked to see a specialist who thought it would be OK but did a biopsy anyway. The biopsy showed up cancer cells but still everyone thought it had been caught early. A Mastectomy and removal of 4 lymph nodes showed that the tumour was bigger that thought and the lymph nodes were not clear. The rest of the lymph nodes were removed (20 odd) and these were all clear so we thought we'd established a starting point. Chemo followed (believe it was 4 x "EC" and 3 x Taxoterre (Was meant to be 4th but oncologists decided to stop last one as too drained). Then radiotherapy was to follow and we hoped that that would give us some respite however when doing a routine scan they found something they didn't like the look of on the liver!! A CT scan has shown that there is secondary breast cancer in the liver. They think it may have been there at the start but they don't know because they didn't scan at the time (We wanted an MRI scan but they said to wait until after radiotheraphy).
This experience has dented our confidence in our specialists. (They say that had they found this at the time then they would have followed same treatment).
My wife is on Tamoxifen as the cancer is oestrogen positive (I think is the term). Now we're advised to wait 3 months to see if the secondary tumour grows or not!!
3 months is a long time - should I seek a second opinion?
Has anyone had a similar experience.
I'm advised there's not much that can be done once a tumour is in the liver - is that correct?
We have 2 children, a boy (4) and a girl (9).
My world (which was perfect) has been turned upside down!! Any advice or comments would be much appreciated.
I understand what you are going through.
How many lesions were found in the liver? Metastasectomy (surgical removal of metastasis) can be performed if there is solitary lesion in the liver or if there are multiple lesions confined to one lobe of the liver. Consider also the liver function when this procedure is going to be done.
There are also second-line chemotherapy regimens available for breast cancer, involving the combination of targeted therapy and chemotherapy.
You can always ask for a second opinion from another oncologist.
At time we were given the diagnosis we were too emotional to ask such a simple question. Now we've had chance to think about it we have lots of questions and we've arranged to meet consultant on 21st Feb so will find out then.
By the way I've been keeping up to date with all the discussions on this and other forums and I noted a comment that I'd not seen or even considered before which got me thinking - the comment was along lines
"someone had reported having lesions on the liver which turned out to be NOT cancerous"
This is "clutching at straws" but :-
How does the oncology team etc determine whether it's cancerous or not - can this only be done via biopsy or blood test/tumour markers?
Can a CT scan alone determine whether a "lesion" is malignant or cancerous?
Only biopsy can confirm if the lesion in the liver is malignant or not. In breast cancer, the liver is a common metastatic site.
If there are multiple nodules in the liver, there is a very high probability that it is a metastasis from the primary site. A solitary liver nodule may or may not be malignant until proven by biopsy.
Laboratory examinations like determination of liver enzymes or tumor markers are supportive in the diagnosis.
Please do post your updates.
I've seen references to "lesions", "tumours", "spots" and now "nodules" - are these all the same thing?
Also if there was only one "nodule" visible would you recommend having a biopsy before another course of chemo (If that was suggested)? I'd hate to start further chemo if the "nodule" was benign.
I've heard that oncologists prefer chemical/hormonal treatment to surgical treatment - does this extend to biopsies where in their opinion the %'age chance it's malignant is high (but at end of day is still an assumption)?
The terms you mentioned could mean the same depending on how it was used.
The time interval between the last treatment given and the appearance of nodule/s could help decide whether to undergo biopsy or not. If the nodule/s appear less than 5 years after the last treatment, the patient need not undergo biopsy. If the nodule/s appear 5 years after the last treatment, a biopsy may be warranted. The reason for this difference is that there may be a sufficient time for a patient to develop another primary cancer if the interval is long.
Metastasectomy in the liver is proven to be beneficial only in certain cancers, like in breast and colorectal cancer. But then, there is a need to have an extensive evaluation before the surgery is done, weighing the risks and benefits of doing such procedure.
Tumour markers CA 15 3 = 23
Liver function test normal
CT scan shows "several masses up to 45mm confined to periphery of right lobe"
Oncologist confirmed that without biopsy we can't be 100% certain malgnant but without further information the information to date is indicative of malgnancy and he would suggest he is "95%" certain that it is malignant
Short term plan
Follow up CT scan/blood test in April 2008 to see if any change and to see if Tamoxifen is having any effect.
precautionary bone scan asap to check for further spread (not expected but want to check)
Furthermore oncologist is happy for us to seek second opinion and to speak to a specialist re whether liver resection/RFA is an option (Although our oncologist says that he is not convinced about benefits of resection/RFA as he is yet to see clinical/long term scientific evidence that proves beyond doubt that local liver treatment if beneficial in these circumstances)
Please can you advise
1. Any comments re above?
2. Is there any well founded scientific evidence to suggest that a) RFA and/or b) resection are worthwhile treatments for breast cancer (please advise links to any reports)
Sorry for the late response.
I agree with your oncologist regrading RFA and liver resection in metastatic breast cancer.
In a study by Harrison, et al. (Surgery 1997; 121:625), the 5-year survival in patients undergoing hepatic resection for non-colorectal and non-neuroendocrine metastases is 26% with a median survival of 32 months. In another study by Raab, et al. (Anticancer Res 1998; 18:2231), the 5-year survival in patients undergoing hepatic resection is 18% with a median survival of 27 months. Hepatic resection approach is palliative.
As for radiofrequency ablation (RFA), the success is influenced by the expertise of the treating physician to ensure adequate treatment. There are factors to consider before undergoing the procedure such as the size of the metastatic lesion, possible combination of RFA with additional therapy like arterial embolization, radiotherapy, systemic chemotherapy.
Both procedures are palliative. This means that cure is not the main goal but rather disease control, symptom relief, and improvement of quality of life.
Hope this helps.
You are right. When a portion of the liver is removed, the remaining part will try to compensate in terms of function for the loss of the portion of the liver. Thus, the remaining part will enlarge over time. The same is true for RFA. The remaining portion of the liver will enlarge so as to maintain its function.
First I want to say I am so sorry that you have to be going through this and I send my best to your wife. I too have been diagnosed with stage IV breast cancer that has metastasized to my liver as well as my sacral spine. I am only 28 with a 8 year old son, so I can empathize with you pain. I wanted to let you know that I had a bone scan done, which came back clear, yet 3 weeks later I had a PET scan that showed the bone mets. My doctors advised against any surgery until my cancer started to be a little more controlled and hopefully shrinks from the chemo. I am on Taxol, Herceptin, and Zometa. I am seeing significant shrinkage in the tumor in the breast and am hopeful that the same is happening everywhere else.
I definitely suggest second opinions, and second second opinions. I am having a second second opinion this week, you can never be too cautions. And tests are your friend, even though they are expensive and annoying. I had a liver biopsy, which wasn't too bad, and bone scans, CT scans, brain and breast MRIs, yet if my doctors had not made me get a PET scan I would never have known about the spread to my bones. I have my fingers crossed for you both.
I know what you are going through I was diagnosed with breast cancer that spread to my lymph nodes, liver, and bone stage four. It has been a year now I have had six treatment of chemo, one treatment of radiation on my spine. I have her2 positive cancer and I am on every 3 week treatment of herception. This is hard on the heart and I have to have heart scans every 3 mths. I feel very healthy as I have added alternative supplements. As well I changed my diet to organic No processed foods No perservatives No Sugar unless whole fruits No chemicals No food color. Eat only fresh food No canned. Living food for living bodies, Dead food for dead bodies . Does this make sense. You need to have all your questions answered by your doctors and take your own health and healing in your on hands. A positive attitude also helps. Keep the mind happy helps keep the body healthy. It takes a lot of work to eat healthy but the longer you do it the easier it gets. Try juicing it is a great way to get some nutrients. Hope this helps best to you and your wife
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