Re: [MOL] Secondary Liver Cancer [01739] Medicine On Line


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Re: [MOL] Secondary Liver Cancer



Dear Ms King, I cannot speak to the medical questions you have posed, 
however, it certainly is important to identify the primary source as this is 
what will dictate the treatment options, just as you believe. Personally, I 
think 69 is quite young (my dad lived to 90) and your dad sounds like he'd 
be physically up to a battle. I think you are right to be concerned and have 
found, when it comes to your health, the best guide to follow is your own 
instincts. How does your father feel about the way things are progressing?
Prior to meeting with the Oncologist it is often useful to write down any 
questions you may have (including what you asked in your note to us). It is 
also useful for someone to go with your dad to see the Oncologist. This way 
they can take notes while the Dr. explains things to your father. This 
approach is effective during the entire process. The meetings with the 
medical team are extremely important and there are many books out there (or 
on-line) that will guide you in best preparing for them to take the fullest 
advantage.
I wish both you and your dad all the luck in the world and hope you choose 
to stay in touch and let us know how things are going. I will remember your 
dad in my prayers.
Your friend,
Bridget


>From: "John, Carys" <john@carys62.freeserve.co.uk>
>Reply-To: mol-cancer@lists.meds.com
>To: <mol-cancer@lists.meds.com>
>Subject: [MOL] Secondary Liver Cancer
>Date: Sun, 30 Jul 2000 00:21:22 +0100
>
>Question on liver metastases:  Please help...I have been trying to access a 
>Liver Disease Forum, but have been unable to.
>
>My Dad was diagnosed with liver mets. 2 weeks ago.  This was found 'by 
>accident'.  He had been having fevers, mild jaundice, chills, nausea, loss 
>of appetite etc.  He went for an US and it showed gallstones, but also a 
>'liver shadow'.  He was admitted to hospital, where a gastroenterology 
>surgeon suspected a liver abscess.  There were no markers in his blood, or 
>any clinical/physical indications that my dad had cancer.  He responded 
>well to antibiotics, his nausea, *very* mild jaundice etc disappeared and 
>he is now very well (just a little tired).  Initially he had a raised 
>bilirubin level which is now normal.  The docs said he had a gallbladder 
>infection (due to stones in the gallbladder) but were worried about the 
>possibility of a liver abscess.
>
>Dad had a full CT scan, which indicated their suspicions about the 
>infection were correct (gallbladder wall was slightly thickened and he had 
>multiple stones) but surprisingly it also showed what the surgeon said was 
>'inoperable liver metastases'.  Apparently the surgeons were as shocked as 
>we were...they feel that the discovery of liver mets. wouldn't have 
>happened if Dad had not had the infection and therefore the CT.  What I 
>would like to know is:
>
>a) Dad's LFTs/bloods are normal and he is now asymptomatic.  The surgeon 
>seemed to indicate that the mets. were fairly small but didn't say how many 
>he had.  Surely there is a chance of resection?  There can't be that many 
>mets. if his liver is working perfectly?
>
>b) How accurate is CT in distinguishing between benign growths (e.g.. 
>hepatocellular adenomas, hemangiomas, focal nodular hyperplasia etc) and 
>liver mets?  Given the fact that Dad has no other cancer symptoms or blood 
>'markers' to indicate cancer (plus the primary source is not clear) could 
>benign growths be a possibility?  The surgeon, when I questioned him about 
>this, said that he thought CT was 99% accurate...but he didn't give me any 
>concrete answers and when I raised the questions he said he felt that the 
>radiographers were usually pretty accurate with their diagnosis, but he 
>would check it out again.  I seemed to raise some doubt in his mind but he 
>has not come back with anything else.  Would an MRI be more accurate?  
>Should Dad have a liver biopsy?
>
>c) How can one tell the difference between a metastases and primary liver 
>cancer *just* from a CT? (remember blood tests have indicated nothing).
>
>They are referring him to an oncologist, but I want to be able to have 
>accurate info so that I can ask the right questions when he sees him.  We 
>live in the UK, where I'm afraid, as we have a 'National Health Service' 
>money is always a big issue as far as tests and treatments are concerned.  
>I asked the surgeon if they planned on doing any more tests on Dad (i.e.. 
>to find the primary cancer).  He said 'no' at first, as he said it did not 
>matter.  When I questioned him further about this he agreed with some of my 
>suggestions - i.e.. surely the source *does* matter as far as treatment is 
>concerned?  If he had, for example, colorectal cancer, then I've read that 
>liver mets. are often resectable.  If he had prostate cancer, then a 
>hormone based chemo would help?  If the primary was a germ cell cancer, 
>then isn't a 'cure' a vague possibility? etc.  I may be cynical, but as Dad 
>is 69 years old, (but a very fit and well 69 year old), then he will not be 
>at the top of the list as far as UK National Health Service treatments are 
>concerned.  Surely he should have a biopsy/more investigations?  I fear 
>that they will just leave things as they are, but I'm unhappy with this.  
>He is my dad and I am prepared to sell my home to help him if it takes 
>money to get better treatment.  Are USA treatments more advanced than in 
>the UK?
>
>I know that this is very long and I really apologise for this.  I just want 
>the best for my Dad.  The more info I read on the Net, then the more 
>frustrated I get at the surgeon's lack of concrete answers.  The surgeon 
>seemed pretty grim about the whole thing.  I know liver mets. show advanced 
>disease, but as Dad is very well, then surely there are treatments out 
>there for him?  Maybe the oncologist will be able to help, but until Dad 
>sees him, I am very worried that not enough is being done for him.  Thank 
>you so much for your time.  Ms C King.

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