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need advice – unknown primary – biochemo or wait and see??

Forums General Melanoma Community need advice – unknown primary – biochemo or wait and see??

  • Post
    psutter
    Participant

      Need to know if anyone else has been in my shoes and if so, what advice they can offer.  I had bad stomach pains for approx.

      Need to know if anyone else has been in my shoes and if so, what advice they can offer.  I had bad stomach pains for approx. 2 years – CT scan and upper and lower GI tests did not reveal anything.  A second visit to the ER for partial bowel obstruction prompted surgery on 9/22/11 which revealed a tumor in my small intestines.  The tumor and about 5" of my small intestines were removed.  Biopsy of tumor indicated melanoma.  I had no previous skin melanomas so needless to say, the doctors and I were shocked at the melanoma diagnoses.  Went to MD Anderson in Houston for treatment options.  All CT scans were clean and showed no evidence of the disease and I thank the Lord for this great news!    However, as the doctor indicated, there can always be a few cells floating around that won't show up on a scan.  According to my doctor, the decision to have any further treatment is in my hands, so needless to say I am very confused as to what I should do.  He said I could do nothing and just come back every 3 months for follow up scans to see if anything shows up, or I could have preventive biochemotherapy.  From what I have read, biochemotherapy is very brutal.  Any advice would be greatly appreciated.

    Viewing 20 reply threads
    • Replies
        vickykay
        Participant

          Hi

          I am stage 3b, I had 17 lymph nodes removed 6/29/11. I started interferon the 1st of Oct. everyday for 3 weeks. The side effects were so bad I had to stop the high dose IV. The next week I had one shot of the interferon and had to stop those also because of vomiting up blood, bad headache and high fever. I had a CT last week and it was clean. Just remember with interferon it only give s you about a 7% that it will work. Some oncologist will tell you 20%, but that is not true if you check out all the information they have on interferon.  But all that said, I wanted to try it because its the best they have to offer for melanoma. My oncologist said some people can take interferon and never know they are taking it, other about die. Check out all the side effects before you start, you may be one of those that can take it without any problems. I just take one day at a time now and thank God for every day He gives me. I think cancer will change all of us for the better or worst, I choose better. So the choice is yours, follow your heart and you will do what is best for you. I have found that drs just don't know how to treat melanoma. I was amazed at how little they know about this cancer. But interferon may work for you, I sure hope it does.

           

           

          Vickykay Stage 3b

          vickykay
          Participant

            Hi

            I am stage 3b, I had 17 lymph nodes removed 6/29/11. I started interferon the 1st of Oct. everyday for 3 weeks. The side effects were so bad I had to stop the high dose IV. The next week I had one shot of the interferon and had to stop those also because of vomiting up blood, bad headache and high fever. I had a CT last week and it was clean. Just remember with interferon it only give s you about a 7% that it will work. Some oncologist will tell you 20%, but that is not true if you check out all the information they have on interferon.  But all that said, I wanted to try it because its the best they have to offer for melanoma. My oncologist said some people can take interferon and never know they are taking it, other about die. Check out all the side effects before you start, you may be one of those that can take it without any problems. I just take one day at a time now and thank God for every day He gives me. I think cancer will change all of us for the better or worst, I choose better. So the choice is yours, follow your heart and you will do what is best for you. I have found that drs just don't know how to treat melanoma. I was amazed at how little they know about this cancer. But interferon may work for you, I sure hope it does.

             

             

            Vickykay Stage 3b

            vickykay
            Participant

              Hi

              I am stage 3b, I had 17 lymph nodes removed 6/29/11. I started interferon the 1st of Oct. everyday for 3 weeks. The side effects were so bad I had to stop the high dose IV. The next week I had one shot of the interferon and had to stop those also because of vomiting up blood, bad headache and high fever. I had a CT last week and it was clean. Just remember with interferon it only give s you about a 7% that it will work. Some oncologist will tell you 20%, but that is not true if you check out all the information they have on interferon.  But all that said, I wanted to try it because its the best they have to offer for melanoma. My oncologist said some people can take interferon and never know they are taking it, other about die. Check out all the side effects before you start, you may be one of those that can take it without any problems. I just take one day at a time now and thank God for every day He gives me. I think cancer will change all of us for the better or worst, I choose better. So the choice is yours, follow your heart and you will do what is best for you. I have found that drs just don't know how to treat melanoma. I was amazed at how little they know about this cancer. But interferon may work for you, I sure hope it does.

               

               

              Vickykay Stage 3b

              James from Sydney
              Participant

                Sorry to hear about your diagnosis about 7% of Melanomas are from an Unknown origin in other words the mole may have regressed but a few cells have moved on. You are stage 4 now so Interferon is usually prescribed for Stage 3 patients.  There are some on this Board that have taken Bio Chemo, it usually consists of 3 chemo drugs and IL2 and Interferon.  Your Tumor sample should be tested for any Mutations as there are new drugs that can be targeted towards certain Mutations so you should be ready in the event that it comes back. In the meantime taking the Bio Chemo may or may not halt the Melanoma coming back. Its only my view but Melanoma is an aggressive disease and whilst you are fit and strong i would look into it. 

                 

                best wishes

                James

                  psutter
                  Participant

                    Thank you for the advice.  They are testing the tumor for BRAF mutation.  Have not received the results yet.

                    psutter
                    Participant

                      Thank you for the advice.  They are testing the tumor for BRAF mutation.  Have not received the results yet.

                      psutter
                      Participant

                        Thank you for the advice.  They are testing the tumor for BRAF mutation.  Have not received the results yet.

                      James from Sydney
                      Participant

                        Sorry to hear about your diagnosis about 7% of Melanomas are from an Unknown origin in other words the mole may have regressed but a few cells have moved on. You are stage 4 now so Interferon is usually prescribed for Stage 3 patients.  There are some on this Board that have taken Bio Chemo, it usually consists of 3 chemo drugs and IL2 and Interferon.  Your Tumor sample should be tested for any Mutations as there are new drugs that can be targeted towards certain Mutations so you should be ready in the event that it comes back. In the meantime taking the Bio Chemo may or may not halt the Melanoma coming back. Its only my view but Melanoma is an aggressive disease and whilst you are fit and strong i would look into it. 

                         

                        best wishes

                        James

                        James from Sydney
                        Participant

                          Sorry to hear about your diagnosis about 7% of Melanomas are from an Unknown origin in other words the mole may have regressed but a few cells have moved on. You are stage 4 now so Interferon is usually prescribed for Stage 3 patients.  There are some on this Board that have taken Bio Chemo, it usually consists of 3 chemo drugs and IL2 and Interferon.  Your Tumor sample should be tested for any Mutations as there are new drugs that can be targeted towards certain Mutations so you should be ready in the event that it comes back. In the meantime taking the Bio Chemo may or may not halt the Melanoma coming back. Its only my view but Melanoma is an aggressive disease and whilst you are fit and strong i would look into it. 

                           

                          best wishes

                          James

                          Charlie S
                          Participant

                            Okay, take a deep breath.  Like you, I had an unknown primary that when first detected, was metastatic.  No mole, skin lesion or nothing……….just showed up inside my body.

                            I've been told over the years that an unknown primary 1)occurs in 2% of the melanoma population  2) may not be unknown (occult) because the primary has not been found 3) Melanoma is one of few cancers known to spontaneously regress and 3 can be mis-diagnosed due to the varieties of melanoma.

                            MD Anderson is a fine place.  Been there and had a good experience.  However, no matter where you go with an unknown primary it is important to back up to the pathology…………….and question that pathology with a fresh opinion from a derma-path.

                            Here is why:  There are several forms of melanoma: acral, mucosal, occular, lentigo  and some sub-typ[es.

                            The treatment approach is different for each one.  So, get the CORRECT pathology first.

                            Though it IS your choice because it IS your chance as far as treatments go, without a true dermapath report, you would be operating without the benefit of an informed medical decision.

                            I don't wish to scare you, but you are in deep do-doo ,  though not intractable, your doctors need to give you more information.

                            I implore you, start with the pathology and  INSIST upon a read from a dermapath, before moving forward……one treatment for melanoma, wrongly applied can ignite melanoma; or it can dampen it……………………start with the path.

                            Options abound, but it is imperative that you know what you have in order to know ho treat it.

                            Breathe deep once more.

                            Cheers,

                            Charlie S

                            Charlie S
                            Participant

                              Okay, take a deep breath.  Like you, I had an unknown primary that when first detected, was metastatic.  No mole, skin lesion or nothing……….just showed up inside my body.

                              I've been told over the years that an unknown primary 1)occurs in 2% of the melanoma population  2) may not be unknown (occult) because the primary has not been found 3) Melanoma is one of few cancers known to spontaneously regress and 3 can be mis-diagnosed due to the varieties of melanoma.

                              MD Anderson is a fine place.  Been there and had a good experience.  However, no matter where you go with an unknown primary it is important to back up to the pathology…………….and question that pathology with a fresh opinion from a derma-path.

                              Here is why:  There are several forms of melanoma: acral, mucosal, occular, lentigo  and some sub-typ[es.

                              The treatment approach is different for each one.  So, get the CORRECT pathology first.

                              Though it IS your choice because it IS your chance as far as treatments go, without a true dermapath report, you would be operating without the benefit of an informed medical decision.

                              I don't wish to scare you, but you are in deep do-doo ,  though not intractable, your doctors need to give you more information.

                              I implore you, start with the pathology and  INSIST upon a read from a dermapath, before moving forward……one treatment for melanoma, wrongly applied can ignite melanoma; or it can dampen it……………………start with the path.

                              Options abound, but it is imperative that you know what you have in order to know ho treat it.

                              Breathe deep once more.

                              Cheers,

                              Charlie S

                              Charlie S
                              Participant

                                Okay, take a deep breath.  Like you, I had an unknown primary that when first detected, was metastatic.  No mole, skin lesion or nothing……….just showed up inside my body.

                                I've been told over the years that an unknown primary 1)occurs in 2% of the melanoma population  2) may not be unknown (occult) because the primary has not been found 3) Melanoma is one of few cancers known to spontaneously regress and 3 can be mis-diagnosed due to the varieties of melanoma.

                                MD Anderson is a fine place.  Been there and had a good experience.  However, no matter where you go with an unknown primary it is important to back up to the pathology…………….and question that pathology with a fresh opinion from a derma-path.

                                Here is why:  There are several forms of melanoma: acral, mucosal, occular, lentigo  and some sub-typ[es.

                                The treatment approach is different for each one.  So, get the CORRECT pathology first.

                                Though it IS your choice because it IS your chance as far as treatments go, without a true dermapath report, you would be operating without the benefit of an informed medical decision.

                                I don't wish to scare you, but you are in deep do-doo ,  though not intractable, your doctors need to give you more information.

                                I implore you, start with the pathology and  INSIST upon a read from a dermapath, before moving forward……one treatment for melanoma, wrongly applied can ignite melanoma; or it can dampen it……………………start with the path.

                                Options abound, but it is imperative that you know what you have in order to know ho treat it.

                                Breathe deep once more.

                                Cheers,

                                Charlie S

                                JerryfromFauq
                                Participant

                                  Charlie is so correct.  You need more information to have an idea which way to go.  One of my first items on an unknown primary (possibly a colon or intestinal primary) would be to get a c-kit oncoprotein test run on the tumor material by a local lab.  Should be available at any local lab.  Insurance should over it.  The cost is usually around $125.00.  If the removed tumor contains c-kit there are several cancer targeted chemo drugs that have been FDA approved for GIST, CML, and leukemia that can be used off-label.  They are currently under clinical trials for various c-kit DNA mutations.  Gleevec is one that seems to be most effective against exon 11 C-kit DNA-mutations.  I have been on it for almost 3 years now for c-kit anal mucosal melanoma. 

                                   If the c-kit oncoprotein test is positive then a specialist lab should run the c-kit DNA mutation test.  If both test are positive you will have a good idea of one treatment path to follow if the melanoma were to return.

                                  http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2809%2970036-1/abstract

                                  Melanoma of the small intestine

                                  Intestinal melanomas can be primary tumours or metastases of cutaneous, ocular, or anal melanomas. Primary intestinal melanoma is extremely rare, whereas metastatic melanoma of the small bowel is common because of the tendency for cutaneous melanoma to metastasise to the gastrointestinal tract. Because distinguishing between primary and metastatic intestinal melanoma can be difficult, the main features of each are discussed, and the diagnostic images used to detect intestinal melanoma are assessed. Routine barium examinations and CT have limited sensitivity, but PET imaging can improve detection of melanoma metastases to the small bowel. Although various treatment strategies have been tried in patients with intestinal melanoma, surgical removal of intestinal metastases is the treatment of choice in patients with resectable tumours.

                                  ********************

                                  Also of interest is: http://findarticles.com/p/articles/mi_7453/is_200804/ai_n32268337/

                                  ***************************

                                  If the initil c-kit test is ngative, then I would be interested in getting  BRAF tst on tumor tissue.

                                  JerryfromFauq
                                  Participant

                                    Charlie is so correct.  You need more information to have an idea which way to go.  One of my first items on an unknown primary (possibly a colon or intestinal primary) would be to get a c-kit oncoprotein test run on the tumor material by a local lab.  Should be available at any local lab.  Insurance should over it.  The cost is usually around $125.00.  If the removed tumor contains c-kit there are several cancer targeted chemo drugs that have been FDA approved for GIST, CML, and leukemia that can be used off-label.  They are currently under clinical trials for various c-kit DNA mutations.  Gleevec is one that seems to be most effective against exon 11 C-kit DNA-mutations.  I have been on it for almost 3 years now for c-kit anal mucosal melanoma. 

                                     If the c-kit oncoprotein test is positive then a specialist lab should run the c-kit DNA mutation test.  If both test are positive you will have a good idea of one treatment path to follow if the melanoma were to return.

                                    http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2809%2970036-1/abstract

                                    Melanoma of the small intestine

                                    Intestinal melanomas can be primary tumours or metastases of cutaneous, ocular, or anal melanomas. Primary intestinal melanoma is extremely rare, whereas metastatic melanoma of the small bowel is common because of the tendency for cutaneous melanoma to metastasise to the gastrointestinal tract. Because distinguishing between primary and metastatic intestinal melanoma can be difficult, the main features of each are discussed, and the diagnostic images used to detect intestinal melanoma are assessed. Routine barium examinations and CT have limited sensitivity, but PET imaging can improve detection of melanoma metastases to the small bowel. Although various treatment strategies have been tried in patients with intestinal melanoma, surgical removal of intestinal metastases is the treatment of choice in patients with resectable tumours.

                                    ********************

                                    Also of interest is: http://findarticles.com/p/articles/mi_7453/is_200804/ai_n32268337/

                                    ***************************

                                    If the initil c-kit test is ngative, then I would be interested in getting  BRAF tst on tumor tissue.

                                    JerryfromFauq
                                    Participant

                                      Charlie is so correct.  You need more information to have an idea which way to go.  One of my first items on an unknown primary (possibly a colon or intestinal primary) would be to get a c-kit oncoprotein test run on the tumor material by a local lab.  Should be available at any local lab.  Insurance should over it.  The cost is usually around $125.00.  If the removed tumor contains c-kit there are several cancer targeted chemo drugs that have been FDA approved for GIST, CML, and leukemia that can be used off-label.  They are currently under clinical trials for various c-kit DNA mutations.  Gleevec is one that seems to be most effective against exon 11 C-kit DNA-mutations.  I have been on it for almost 3 years now for c-kit anal mucosal melanoma. 

                                       If the c-kit oncoprotein test is positive then a specialist lab should run the c-kit DNA mutation test.  If both test are positive you will have a good idea of one treatment path to follow if the melanoma were to return.

                                      http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2809%2970036-1/abstract

                                      Melanoma of the small intestine

                                      Intestinal melanomas can be primary tumours or metastases of cutaneous, ocular, or anal melanomas. Primary intestinal melanoma is extremely rare, whereas metastatic melanoma of the small bowel is common because of the tendency for cutaneous melanoma to metastasise to the gastrointestinal tract. Because distinguishing between primary and metastatic intestinal melanoma can be difficult, the main features of each are discussed, and the diagnostic images used to detect intestinal melanoma are assessed. Routine barium examinations and CT have limited sensitivity, but PET imaging can improve detection of melanoma metastases to the small bowel. Although various treatment strategies have been tried in patients with intestinal melanoma, surgical removal of intestinal metastases is the treatment of choice in patients with resectable tumours.

                                      ********************

                                      Also of interest is: http://findarticles.com/p/articles/mi_7453/is_200804/ai_n32268337/

                                      ***************************

                                      If the initil c-kit test is ngative, then I would be interested in getting  BRAF tst on tumor tissue.

                                      KevinM
                                      Participant

                                        I was diagnosed with melanoma after having a large lymph node removed from under my arm. I also have an unknown primary but since I had MANY sun burns in my younger days my docs think it began on my shoulder or arm. I decided to join a clinical trial and was assigned the bio-chemotherapy arm (Interferon was the other arm). 

                                        I had a complete axillary lymph node dissection and then 3 rounds of bio-chemo. My treatment included IL2, interferon, dicarbazine, vinblastin and cisplatin. The treatment was pretty rough…lots of side affects…but was do-able. That was over 5 years ago…..I am one of the lucky ones…I remain NED without any reoccurrence. I can't say that I would be NED without the treatment or that I would be…..that's life with melanoma. You've  already been given some good advice from the others….so my advice is to do the research pick a treatment plan that works for you and go forward without looking in the rearview mirror.

                                        Please don't hesitate to contact me if you have any specific bio-chemo questions.

                                        All my best!

                                        Kevin

                                        KevinM
                                        Participant

                                          I was diagnosed with melanoma after having a large lymph node removed from under my arm. I also have an unknown primary but since I had MANY sun burns in my younger days my docs think it began on my shoulder or arm. I decided to join a clinical trial and was assigned the bio-chemotherapy arm (Interferon was the other arm). 

                                          I had a complete axillary lymph node dissection and then 3 rounds of bio-chemo. My treatment included IL2, interferon, dicarbazine, vinblastin and cisplatin. The treatment was pretty rough…lots of side affects…but was do-able. That was over 5 years ago…..I am one of the lucky ones…I remain NED without any reoccurrence. I can't say that I would be NED without the treatment or that I would be…..that's life with melanoma. You've  already been given some good advice from the others….so my advice is to do the research pick a treatment plan that works for you and go forward without looking in the rearview mirror.

                                          Please don't hesitate to contact me if you have any specific bio-chemo questions.

                                          All my best!

                                          Kevin

                                            psutter
                                            Participant

                                              Thanks for the info.  The bio-chemo treatment they offered me consists of the same drugs you had.  This bulletin board is new to me and I really appreciate everyone's input.

                                              psutter
                                              Participant

                                                Thanks for the info.  The bio-chemo treatment they offered me consists of the same drugs you had.  This bulletin board is new to me and I really appreciate everyone's input.

                                                psutter
                                                Participant

                                                  Thanks for the info.  The bio-chemo treatment they offered me consists of the same drugs you had.  This bulletin board is new to me and I really appreciate everyone's input.

                                                KevinM
                                                Participant

                                                  I was diagnosed with melanoma after having a large lymph node removed from under my arm. I also have an unknown primary but since I had MANY sun burns in my younger days my docs think it began on my shoulder or arm. I decided to join a clinical trial and was assigned the bio-chemotherapy arm (Interferon was the other arm). 

                                                  I had a complete axillary lymph node dissection and then 3 rounds of bio-chemo. My treatment included IL2, interferon, dicarbazine, vinblastin and cisplatin. The treatment was pretty rough…lots of side affects…but was do-able. That was over 5 years ago…..I am one of the lucky ones…I remain NED without any reoccurrence. I can't say that I would be NED without the treatment or that I would be…..that's life with melanoma. You've  already been given some good advice from the others….so my advice is to do the research pick a treatment plan that works for you and go forward without looking in the rearview mirror.

                                                  Please don't hesitate to contact me if you have any specific bio-chemo questions.

                                                  All my best!

                                                  Kevin

                                                  RMcLegal
                                                  Participant

                                                    I did preventive biochemo in 2003 at the University of Colorado Cancer Center after a Stage IIIc diagnosis (14 malignant nodes), and have never experienced a recurrence.  It is indeed very rough stuff, but it's very doable for an otherwise healthy person (I was 50 at the time).  I was pretty heavily sedated during the inpatient infusion days, so that time passed pretty quickly.  The first 7-10 days out of the hospital were pretty rough with flu-like symptoms, but I felt better day by day and enjoyed several days of feeling pretty normal, although very tired, between rounds.  After the fourth and final round, I pretty rapidly recovered but it took some time and effort to regain physical strength because I'd lost a lot of weight during treatment.

                                                    Best wishes to you.  Rich

                                                    http://www.hotelmelanoma.blogspot.com

                                                    RMcLegal
                                                    Participant

                                                      I did preventive biochemo in 2003 at the University of Colorado Cancer Center after a Stage IIIc diagnosis (14 malignant nodes), and have never experienced a recurrence.  It is indeed very rough stuff, but it's very doable for an otherwise healthy person (I was 50 at the time).  I was pretty heavily sedated during the inpatient infusion days, so that time passed pretty quickly.  The first 7-10 days out of the hospital were pretty rough with flu-like symptoms, but I felt better day by day and enjoyed several days of feeling pretty normal, although very tired, between rounds.  After the fourth and final round, I pretty rapidly recovered but it took some time and effort to regain physical strength because I'd lost a lot of weight during treatment.

                                                      Best wishes to you.  Rich

                                                      http://www.hotelmelanoma.blogspot.com

                                                      RMcLegal
                                                      Participant

                                                        I did preventive biochemo in 2003 at the University of Colorado Cancer Center after a Stage IIIc diagnosis (14 malignant nodes), and have never experienced a recurrence.  It is indeed very rough stuff, but it's very doable for an otherwise healthy person (I was 50 at the time).  I was pretty heavily sedated during the inpatient infusion days, so that time passed pretty quickly.  The first 7-10 days out of the hospital were pretty rough with flu-like symptoms, but I felt better day by day and enjoyed several days of feeling pretty normal, although very tired, between rounds.  After the fourth and final round, I pretty rapidly recovered but it took some time and effort to regain physical strength because I'd lost a lot of weight during treatment.

                                                        Best wishes to you.  Rich

                                                        http://www.hotelmelanoma.blogspot.com

                                                        LynnLuc
                                                        Participant

                                                          My friend Linda had melanoma in her intestines…never showed up on any scan…she had pain and they did surgery…-

                                                          …cancer was wide spread

                                                          -resected all of ascending and transverse colons…that is 2/3 of large intestines

                                                          -procedure called a right hemicolectomy & bowel resection

                                                          -tumor size of large grapefruit…some tumor still inside…unresectable 

                                                          She was told and I was also told when it's in the intestines they need to go in there and look with a camera and that PET/CT and MRI'S will not show it.

                                                          She is on anti pd 1 and peptide trial and doing awesomely well now.

                                                          LynnLuc
                                                          Participant

                                                            My friend Linda had melanoma in her intestines…never showed up on any scan…she had pain and they did surgery…-

                                                            …cancer was wide spread

                                                            -resected all of ascending and transverse colons…that is 2/3 of large intestines

                                                            -procedure called a right hemicolectomy & bowel resection

                                                            -tumor size of large grapefruit…some tumor still inside…unresectable 

                                                            She was told and I was also told when it's in the intestines they need to go in there and look with a camera and that PET/CT and MRI'S will not show it.

                                                            She is on anti pd 1 and peptide trial and doing awesomely well now.

                                                            LynnLuc
                                                            Participant

                                                              My friend Linda had melanoma in her intestines…never showed up on any scan…she had pain and they did surgery…-

                                                              …cancer was wide spread

                                                              -resected all of ascending and transverse colons…that is 2/3 of large intestines

                                                              -procedure called a right hemicolectomy & bowel resection

                                                              -tumor size of large grapefruit…some tumor still inside…unresectable 

                                                              She was told and I was also told when it's in the intestines they need to go in there and look with a camera and that PET/CT and MRI'S will not show it.

                                                              She is on anti pd 1 and peptide trial and doing awesomely well now.

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