Just diagnosed--liver mets

curveball

An ultrasound I had back in December to check out a mysterious tender spot on my left ribs (below mx site) revealed two unidentified "focal lesions" on my liver. One is 3.7 cm across, the other 2.4 cm. My oncologist thought they were most likely hemangiomas. After a number of delays, I had a CT scan, which was inconclusive, and a week later, a tagged red blood cell scan, also inconclusive. Reports on both scans said the results were not typical of hemangioma. Last Friday I had a biopsy taken to pin down what these things were.

This afternoon my oncologist called with the biopsy results--liver mets. When first spotted on ultrasound I was five months in to a six month course of CMF chemotherapy. Since their presence wasn't known before I started the chemo, there's no way of knowing whether they grew, shrank or were unaffected. My oncologist says the next step is to have a PET scan to see if I have any other mets, and in the meantime keep taking my anastrozole. If not, it might be possible to remove these surgically, which would mean postponing my DIEP (scheduled at the end of April), but I do hope they can be removed, both because that would mean there are just the two of them, and also I don't know if I can mentally deal with having cancer in my body and not removing it, just leaving it in there where maybe it is spreading further. If I do have other mets, I guess I am in for more chemo. Or maybe it would just be keep on with the anastrozole.

Dr F (onc) says that the good thing is that BC mets can be managed and kept under control for many years. I guess at this point I am wondering what does "many years" mean in this context? I'm 57 now. Or maybe I don't really want to know that. I think I will just ask instead, does the number of sites, or the number of organs affected matter? Or are mets, mets and once the cancer spreads it doesn't make any difference whether there are lots of them or only a few? Does it make sense to hope "maybe there are only the two and maybe they can be removed" or is that just wishful thinking?

bevin

Dear Curvball, I'm very sorry you are facing this and pray that you have strength as you face these next steps. I know there is a stage 4 thread and many women who are very knowledgeable  will be able to help you.

Hugs

Bevin

bestock

Curveball

I just read your letter and I am encouraged about the statement that with mets you can live. I have mets-they believe on my liver(I had a biopsy and will find out for sure on Monday)

I feel so tired and have pain, have multiple lesions on both lobes. What chemos or treatment do they recommend to you. I have not had chemo with BC but 18 mos of taxol/carboplatin with ovarian cancer.

Bevin I will try the thread you suggested too.

I  have a lot of the same questions as Curveball, and would like a few answers, also.

curveball

@bestock, I don't have any specific treatment recommendation yet. My oncologist is currently seeking approval for a PET scan to see whether I have other mets or only the two that are known so far. I think the treatment will be different depending on what is found with that scan. Assuming it is approved, I estimate it will be at least the middle of the month before I get the results. My mets are not causing any symptoms at this time. They were found almost by accident when looking at something else.

I am not certain, but I think if there are no other mets, the two in my liver can possibly be removed surgically, and if so I would continue taking the aromatase inhibitor after that surgery. There is another thread on bco about taking two different kinds of hormone meds simultaneously and I will ask Dr F if I am a candidate for this. If surgery isn't possible but there are no other mets, I think it is the same treatment and then monitor the mets to see if they grow, shrink or what. If there are mets in other organs too, or the mets can't be removed and they grow in spite of hormone treatment, I think that means more chemo, but I don't know what kind. I hope I don't have to go there. I was pretty miserable by the end of the 6 months of CMF and in fact ended up hospitalized for a week with a reaction. But if I need to do chemo, I'll do it. And I also plan to get a second opinion from Seattle Cancer Care Alliance.

I really know hardly anything about treating mets since I only found out I had them 3 days ago.

Actually there is not just a stage 4 thread, there is a whole stage 4 forum. I made another thread in that forum with this same question. You can probably find a lot of information over there. I've decided not to look for that information until I get the results of the PET and find out whether surgery is an option. I don't want to fill my head with information about treatments that might be for forms of mets I don't have. I think I might get it confused with the information I get later on that does deal with my exact situation and make it harder for me to make good decisions about my own treatment.

Moderators

((((curveball)))) We're here for you!

bestock

I am scared because I have pain, I am sure it is liver pain. I just will wait and trust a good outcome of Tomorrows follow up with the dr. I just get fatigued too.

marywh

I dont usually post other than on the stage 4 threads but saw the title and read in.

i was dx last aug. with liver, lung and chest wall mets. Just wanted to let you know there are many treatments out there to try and not to give up hope. I know how scary mets can be, but you can learn to deal with it. I was put on abraxane in aug. My last scans showed no sign of lung mets and the mets on my chest wall have disappeared too. The mets on my liver have shrunk considerably. I feel normal except for being tired, and if I get a nap Im ok then too. Please join us over on the stage4 threads. There are so many women over there that will welcome you and help you through the tough times. It is my life line.

curveball

@marywh, the Mods sent me a PM suggesting the same thing, so I started a thread with this same question in the Stage IV forum. I'm glad to hear the abraxane is working for you!

Pat634

Is pain the only symptom of mets to the liver? What are other symptoms?

jamnstv

I have not posted here but stay in touch.  Finished 6dx of carboplatin/taxotere N0v. 2011.  Had BC mets to Lymph system with ovarian lllc finally being diagnosed 6 mos. after BC mets.  Had my last Petscan last week with a tumor seen in the portal vein of my liver. Going this Thurs. 6/20 for ultrasound.  Not really sure why unless it is to get a better look at size and location (feel like I'm house-hunting).  Any info would really be great on any part of this post.  All of you women are in my prayers always!

anamerty

I too am wondering the same thing as curveball.does it make any difference weather you have 1 mets or several is the tx the same? Does it matter when you find mets is it going to change your prognosis? Even tho stage4 is still stage4

curveball

@anamerty, since I started this thread, I found out I have more mets than I was told about at the time of my stage IV dx. In addition to the two mentioned at that time, there are three smaller ones under 1 cm, plus what I call speckles (too small to measure, too numerous to count). There are also speckles in my lungs but they haven't been biopsied so they may or may not be mets. These were all visible on my scan in Feb, but for whatever reason, not mentioned on the radiologist's report at that time. Finding out in May that I had a lot more metastasis than I had originally thought was an unpleasant surprise, to say the least. I was pretty upset when I found out about the incomplete report., because I'd been pursuing the idea of liver surgery to remove what I thought were my only two mets. I don't like to think what could have happened if I'd had surgery with all that other stuff in my liver--it might even have caused the cancer to spread more rapidly than otherwise, and the surgery and recovery between them would certainly have taken up at least a couple of months of my remaining life (however long that is) with a treatment that would have been futile for me. Surgery would make no sense unless it's possible to remove all of the metastases.

There is some controversy among oncologists about whether "oligometastatic" breast cancer (metastasized to only a few locations in one organ) is sometimes curable with aggressive treatment, or in fact if it even exists as a status distinct from Stage IV with multiple mets and/or multiple organs involved. I believe the majority view is as you describe it: Stage IV is still Stage IV. I think whether the small number of mets changes your treatment depends to a large extent on which side of the controversy your oncologist agrees with. I really don't know about whether it changes your prognosis. I've always assumed that having multiple organ systems affected with large numbers and/or sizes of tumors is a worse prognosis than a few mets, or small mets, in only one organ, but I don't know that for a fact.

In my case, my first treatment was the same as it would have been if I had no mets: an aromatase inhibitor. I had a PET and CT in May--the PET showed "no abnormal uptake of glucose...consistent with treated tumor", but the CT showed slight increase in size, so my oncologist switched me to a different AI and added another medication used to treat neuroendocrine tumors, because there are neuroendocrine cells in with the breast cells in my tumor. I have another CT next week to see how this adjustment is working.

LRM216

Just read this thread in passing, but read an interesting article that was posted on Inspire.com:

http://jco.ascopubs.org/content/20/3/620.full.pdf