› Forums › General Melanoma Community › Bowel obstructions, post-op; new liver tumor, any advice?
- This topic has 26 replies, 7 voices, and was last updated 12 years, 11 months ago by
WalterA.
- Post
-
- May 16, 2011 at 9:31 pm
To the board:
Its been a few months since I posted, but wanted to ask a question to those that have had intestinal surgery. In February, I had a golf ball sized tumor removed from my small intestine via a partial bowel resection. Recovery was pretty quick (3 days in hospital) and all was fine until 4 weeks ago, when I was unable to get to sleep on a sunday night due to extreme abdominal pain. Wound up spending 3 days, 2 nights in hospital as it ultimately corrected itself without any treatment. CT revealed it was a partial obstruction.
To the board:
Its been a few months since I posted, but wanted to ask a question to those that have had intestinal surgery. In February, I had a golf ball sized tumor removed from my small intestine via a partial bowel resection. Recovery was pretty quick (3 days in hospital) and all was fine until 4 weeks ago, when I was unable to get to sleep on a sunday night due to extreme abdominal pain. Wound up spending 3 days, 2 nights in hospital as it ultimately corrected itself without any treatment. CT revealed it was a partial obstruction.
Then, last week, same thing happened. Admitted to Sloan Kettering on Tuesday. CT revealed partial bowel obstruction plus, unfortunately, a small tumor on the liver. Obviously the news about the liver was most heartbreaking, but the pain from obstruction was most important to fix immediately.
My question, has anyone else had to deal with multiple small bowel obstructions? How did they resolve and did u need surgery again to fix? If so, have u had any problems since your corrective surgery?
I had an NG tube for 2 days last week, was uncomfortable, but it worked wonders. I was released on Saturday night, felt great yesterday and this morning, and then about 4 hours ago, have started to have similar pain/cramps. Really would not like to go back to hospital, especially as my doc basically said if I come back, I'm going in for surgery. Does anyone have advice on how these can be avoided? Diet perhaps?
Also, as far as liver goes, mine appears to be resectable, its small at 0.6cm near the base of the liver. The radiologist missed it the first time in fact. The docs at sloan recommended IPI (Yervoy) as I haven't done anything since I was stage 3 and did interferon. Any thoughts on getting it resected? Docs advised against it for now. They did mention possibly post treatment, I get it ablated.
Any and all advice welcome.
Kind regards
Wetterhorn, Stage IV, Liver Met
- Replies
-
-
- May 17, 2011 at 12:45 am
Hi Wetterhorn,
I'm sorry to read about your recent events. I never have had a confirmed bowel obstruction but have taken care of many patients with them (RN). What do they feel is causing the obstructions (I looked at your profile and see they were in different areas)….adhesions/scar tissue from the previous surgery? I can understand you not wanting to go back to the hospital now but I wouldn't wait too long. With the recent frequency of the symptoms, I doubt you will be able to "fix" it at home. As you probably know, the NG tube is usually needed to really rest the bowel. And unfortunately, surgery might be needed in your case. If at all possible, docs try to avoid surgery since it causes more scar tissue/adhesions but sometimes there is no choice.
As far as the liver met, I'm curious as to why your doctors are against a resection. Has it been confirmed to be melanoma? I had a 4.5cm tumor on the right lobe of my liver when I had a resection. My surgeon was very aggressive and removed 70% of my liver and my gall bladder just to give melanoma one less place to go. 70% is the maximum amount of liver that can be removed and the surgeon was very happy to see my NG tube draining bile that first evening…knew my remaining liver was functioning. I believe his aggressiveness is one of the main reasons I am alive today…this was in 2005.
My liver tumor was seen on a routine PET/CT in July (3.3cm) and I had my surgery in September. I know this sounds crazy but I had a planned 30 day road trip prior to the liver met being detected and nothing was stopping me…that was the reason for the delay. However, the surgeon did tell me that if I had consulted with him immediately, he probably would have suggested waiting 30 days for the surgery to make sure I wouldn't be experiencing a "peppering" of little tumors that were still too small to be seen on scans. If that was the case, he would not have operated. Also, my liver met advanced me to Stage IV. I see this is a recurrence for you at Stage IV so maybe that's why the doctors are advising against it and suggesting Ipi. If it were me, I'd want to know the reason since in general, if you can cut it out, go for it.
Keep us posted.
Stay Strong
KingStage IV 7/05 Liver mets
-
- May 17, 2011 at 2:25 am
King
Thanks so much for your reply. The docs believe it is scar tissue or adhesion as you mentioned. They have looked on 2 different CT's for tumors on the intestine and nothing looks suspicious. The problem is that they can't see the scar tissue, but that is exactly what they believe it is. Dr. Ariyan at MSKCC today said I was on a short leash as far as her tolerance was concerned to avoid surgery, however my reluctance to go in is I suppose merely hope that it can correct on its own, as it did 4 weeks ago (minus the IV fluid). Obviously, having this recur so soon after it happened the first time is discouraging, and if surgery is required, then so be it. But as u mentioned, this is happening because of my surgery, hence my reluctance to go in again.
As for the liver met, I don't yet have all the information I need. I found out on Thursday of last week while recovering, and haven't had all the time to process it. I believe that the docs aren't necessarily against surgery, but definitely want me on systemic treatment first to gauge response as I have not done anything since interferon 3 years ago. Its less than 1cm now, so there isn't much urgency to remove it (at least on their end, i'm concerned it will spread obviously). Plus, not sure about labeling indications for Yervoy yet, but think it may require confirmed disease rather than a stage IV patient being NED (feel free to correct if I'm wrong).
I would be inclined to get the ressection, especially since both my surgeon and oncologist said it would be about as easy of a surgery as they can imagine. They also mentioned ablation. Do you know anything about this? It sounded as if they basically would burn/freeze the tumor and surrounding tissue, rather than resect. I'd never heard of this before, but said its a possibility for such a small lesion.
Thanks again for your help, I have seen your posts in the past and am very appreciative.
Regards
Wetterhorn
-
- May 17, 2011 at 4:39 pm
Hi Wettterhorn,
I'm wondering how you are doing today and also wondering if you did have to return to the hospital. You are well informed and I realize that you are still gathering the information about the newly discovered liver met.
I know someone on this Board was considering ablation for a liver met. I can't remember who it was or if they did get it done. Of course, you know to start another thread with that in the topic and someone might respond. I did get a phone consult with one of the melanoma docs at Mass General when I was diagnosed with my liver met…remember this was 2005 so there are a few more systemic options now. However, he said if surgery was an option by all means that would be the best thing to do. Following that would be RFA (radio frequency ablation). He did say with ablation it can not always be determined if margins were obtained and surgery would be preferred over that.
Now, I have to comment on your surgeon's and oncologist's remarks that the liver resection would be as easy of a surgery as they can imagine. Again my surgeon was very aggressive and I do truly believe that it was of the main reasons I am alive today (I did have a recurrence around my pancreas since then). I know of others that had about 40% of their liver resected and within a few short months had recurrences in other parts of their liver. Unfortunately, they did not survive long after that. I don't mean to be negative by any means. I really never heard a liver resection described that way and would have to disagree. Of course, easy or hard, we do what we have to do.
Please keep us posted. We care and are here to support you.
Stay Strong
King -
- May 17, 2011 at 7:42 pm
Hi King
Thanks for the follow -up. I'm feeling a lot better today after not eating anything last night and have not yet gone back to the hospital. Cramps/nausea are gone, had a bowel movement, and things appear to be moving again, so I'm a bit more optimistic right now.
As for the surgery, I think my docs were just trying to be reassuring. The lesion is nearly at the base of the liver and doesn't appear deep inside it, but I will request to meet with a liver surgeon when I go in next week to discuss my options as I think you bring up some good points. Since this journey began, I have used the strategy that surgery is always the best option if it's available. I think since I have recurred 2 times in the last 3 months, they want to get systemic treatment going as soon as possible rather than risk yet another recurrence in 2 months from now. Its time to treat the entire system, I suppose.
Anyway, I will be sure to keep the board posted on my progress. Thanks again for your responses.
Wetterhorn
-
- May 17, 2011 at 7:42 pm
Hi King
Thanks for the follow -up. I'm feeling a lot better today after not eating anything last night and have not yet gone back to the hospital. Cramps/nausea are gone, had a bowel movement, and things appear to be moving again, so I'm a bit more optimistic right now.
As for the surgery, I think my docs were just trying to be reassuring. The lesion is nearly at the base of the liver and doesn't appear deep inside it, but I will request to meet with a liver surgeon when I go in next week to discuss my options as I think you bring up some good points. Since this journey began, I have used the strategy that surgery is always the best option if it's available. I think since I have recurred 2 times in the last 3 months, they want to get systemic treatment going as soon as possible rather than risk yet another recurrence in 2 months from now. Its time to treat the entire system, I suppose.
Anyway, I will be sure to keep the board posted on my progress. Thanks again for your responses.
Wetterhorn
-
- May 17, 2011 at 7:46 pm
I think it was Walter that had the liver ablation a fewe months ago. I e-mail with him and last I heard he is doing well. , Walter doesn't come to the board very often anymore. Do you want me to send him a message to get up with you?
Linda
stage IV since 06
newest surgery being scheduled…..
-
- May 17, 2011 at 7:59 pm
Sure, I suppose it couldn't hurt to touch base with someone who has had this procedure done. Its still a bit premature, but probably wise to gather as much info as possible.
thanks
-
- May 17, 2011 at 7:59 pm
Sure, I suppose it couldn't hurt to touch base with someone who has had this procedure done. Its still a bit premature, but probably wise to gather as much info as possible.
thanks
-
- May 17, 2011 at 7:46 pm
I think it was Walter that had the liver ablation a fewe months ago. I e-mail with him and last I heard he is doing well. , Walter doesn't come to the board very often anymore. Do you want me to send him a message to get up with you?
Linda
stage IV since 06
newest surgery being scheduled…..
-
- May 17, 2011 at 4:39 pm
Hi Wettterhorn,
I'm wondering how you are doing today and also wondering if you did have to return to the hospital. You are well informed and I realize that you are still gathering the information about the newly discovered liver met.
I know someone on this Board was considering ablation for a liver met. I can't remember who it was or if they did get it done. Of course, you know to start another thread with that in the topic and someone might respond. I did get a phone consult with one of the melanoma docs at Mass General when I was diagnosed with my liver met…remember this was 2005 so there are a few more systemic options now. However, he said if surgery was an option by all means that would be the best thing to do. Following that would be RFA (radio frequency ablation). He did say with ablation it can not always be determined if margins were obtained and surgery would be preferred over that.
Now, I have to comment on your surgeon's and oncologist's remarks that the liver resection would be as easy of a surgery as they can imagine. Again my surgeon was very aggressive and I do truly believe that it was of the main reasons I am alive today (I did have a recurrence around my pancreas since then). I know of others that had about 40% of their liver resected and within a few short months had recurrences in other parts of their liver. Unfortunately, they did not survive long after that. I don't mean to be negative by any means. I really never heard a liver resection described that way and would have to disagree. Of course, easy or hard, we do what we have to do.
Please keep us posted. We care and are here to support you.
Stay Strong
King -
- May 17, 2011 at 2:25 am
King
Thanks so much for your reply. The docs believe it is scar tissue or adhesion as you mentioned. They have looked on 2 different CT's for tumors on the intestine and nothing looks suspicious. The problem is that they can't see the scar tissue, but that is exactly what they believe it is. Dr. Ariyan at MSKCC today said I was on a short leash as far as her tolerance was concerned to avoid surgery, however my reluctance to go in is I suppose merely hope that it can correct on its own, as it did 4 weeks ago (minus the IV fluid). Obviously, having this recur so soon after it happened the first time is discouraging, and if surgery is required, then so be it. But as u mentioned, this is happening because of my surgery, hence my reluctance to go in again.
As for the liver met, I don't yet have all the information I need. I found out on Thursday of last week while recovering, and haven't had all the time to process it. I believe that the docs aren't necessarily against surgery, but definitely want me on systemic treatment first to gauge response as I have not done anything since interferon 3 years ago. Its less than 1cm now, so there isn't much urgency to remove it (at least on their end, i'm concerned it will spread obviously). Plus, not sure about labeling indications for Yervoy yet, but think it may require confirmed disease rather than a stage IV patient being NED (feel free to correct if I'm wrong).
I would be inclined to get the ressection, especially since both my surgeon and oncologist said it would be about as easy of a surgery as they can imagine. They also mentioned ablation. Do you know anything about this? It sounded as if they basically would burn/freeze the tumor and surrounding tissue, rather than resect. I'd never heard of this before, but said its a possibility for such a small lesion.
Thanks again for your help, I have seen your posts in the past and am very appreciative.
Regards
Wetterhorn
-
- May 17, 2011 at 12:45 am
Hi Wetterhorn,
I'm sorry to read about your recent events. I never have had a confirmed bowel obstruction but have taken care of many patients with them (RN). What do they feel is causing the obstructions (I looked at your profile and see they were in different areas)….adhesions/scar tissue from the previous surgery? I can understand you not wanting to go back to the hospital now but I wouldn't wait too long. With the recent frequency of the symptoms, I doubt you will be able to "fix" it at home. As you probably know, the NG tube is usually needed to really rest the bowel. And unfortunately, surgery might be needed in your case. If at all possible, docs try to avoid surgery since it causes more scar tissue/adhesions but sometimes there is no choice.
As far as the liver met, I'm curious as to why your doctors are against a resection. Has it been confirmed to be melanoma? I had a 4.5cm tumor on the right lobe of my liver when I had a resection. My surgeon was very aggressive and removed 70% of my liver and my gall bladder just to give melanoma one less place to go. 70% is the maximum amount of liver that can be removed and the surgeon was very happy to see my NG tube draining bile that first evening…knew my remaining liver was functioning. I believe his aggressiveness is one of the main reasons I am alive today…this was in 2005.
My liver tumor was seen on a routine PET/CT in July (3.3cm) and I had my surgery in September. I know this sounds crazy but I had a planned 30 day road trip prior to the liver met being detected and nothing was stopping me…that was the reason for the delay. However, the surgeon did tell me that if I had consulted with him immediately, he probably would have suggested waiting 30 days for the surgery to make sure I wouldn't be experiencing a "peppering" of little tumors that were still too small to be seen on scans. If that was the case, he would not have operated. Also, my liver met advanced me to Stage IV. I see this is a recurrence for you at Stage IV so maybe that's why the doctors are advising against it and suggesting Ipi. If it were me, I'd want to know the reason since in general, if you can cut it out, go for it.
Keep us posted.
Stay Strong
KingStage IV 7/05 Liver mets
-
- May 17, 2011 at 1:25 am
I don't want to scare you, but don't wait too long on pain in the stomach area…My husband did, telling me he just he had a virus..in the end the resected on portion, in his small intestine….but he had 12 more that were going to do the same thing. He passed away 11 days later. Please get it checked out…I wish you all the best..
-
- May 17, 2011 at 1:25 am
I don't want to scare you, but don't wait too long on pain in the stomach area…My husband did, telling me he just he had a virus..in the end the resected on portion, in his small intestine….but he had 12 more that were going to do the same thing. He passed away 11 days later. Please get it checked out…I wish you all the best..
-
- May 17, 2011 at 2:28 am
Thanks Sherron, and no worries. I'm a 10 minute cab ride to the hospital in NYC, no my symptoms and what they mean, and also have the added reassurance of having a clean CT scan from 4 days ago (minus a small liver MET). I will not hesitate to go to surgery if it gets worse.
-
- May 17, 2011 at 2:28 am
Thanks Sherron, and no worries. I'm a 10 minute cab ride to the hospital in NYC, no my symptoms and what they mean, and also have the added reassurance of having a clean CT scan from 4 days ago (minus a small liver MET). I will not hesitate to go to surgery if it gets worse.
-
- May 17, 2011 at 8:54 pm
Wetterhorn,
I have been meaning to respond because after Bob's initial surgery of the 3 small bowel intestinal mets (he had two resections). He had several scares of pain, nausea and feeling like it was back. The last scare was this past November, right before Thanksgiving. He even went to a gastro doctor for endoscopy and colonoscopy and additional CTSCAN. There was nothing. He felt better after they gave him prilosec. They said he appeared to have Irritable bowel syndrome.
Anyway, it's been almost two years and nothing recurred yet and hopefully we pray it will not ever.
Good luck and we will be thinking of you – hope the liver met is dealt with quickly and the stomach pain goes away. That surgery was very rough for my husband.
Rebecca
-
- May 17, 2011 at 8:54 pm
Wetterhorn,
I have been meaning to respond because after Bob's initial surgery of the 3 small bowel intestinal mets (he had two resections). He had several scares of pain, nausea and feeling like it was back. The last scare was this past November, right before Thanksgiving. He even went to a gastro doctor for endoscopy and colonoscopy and additional CTSCAN. There was nothing. He felt better after they gave him prilosec. They said he appeared to have Irritable bowel syndrome.
Anyway, it's been almost two years and nothing recurred yet and hopefully we pray it will not ever.
Good luck and we will be thinking of you – hope the liver met is dealt with quickly and the stomach pain goes away. That surgery was very rough for my husband.
Rebecca
-
- May 17, 2011 at 11:50 pm
Hi. My name is Walter, and I've been told that one option you are considering for treatment for your liver met is radiofrequency ablation.
In February I had a scan that revealed a tumor in my liver, and the RFA was among the possible treatments proposed by my oncologist. I had it in March. It was done under general anesthesia, and I was out of the hospital after about six hours. There was just a tiny incision where the instrument went in, and there was no discomfort afterwards.
A follow-up scan in April indicated that the tumor is now a small mass of dead tissue; and my oncologist believes that we can close the book on this one. I'm hoping he's right because after mets in my lungs and then my liver, I'd like to take a break.
My best wishes to you.
-
- May 17, 2011 at 11:50 pm
Hi. My name is Walter, and I've been told that one option you are considering for treatment for your liver met is radiofrequency ablation.
In February I had a scan that revealed a tumor in my liver, and the RFA was among the possible treatments proposed by my oncologist. I had it in March. It was done under general anesthesia, and I was out of the hospital after about six hours. There was just a tiny incision where the instrument went in, and there was no discomfort afterwards.
A follow-up scan in April indicated that the tumor is now a small mass of dead tissue; and my oncologist believes that we can close the book on this one. I'm hoping he's right because after mets in my lungs and then my liver, I'd like to take a break.
My best wishes to you.
-
- You must be logged in to reply to this topic.