Re: LEE From China Aug 2014
Posted: Sat Apr 04, 2015 9:25 am
The abdominal location of the primary ASPS might have an influence here, and ASPS is such an unpredictable disease - so it is not common to have mets to liver first but not impossible, there are cases describing ASPS patients have brain mets without any lung mets detected prior so why not liver first - especially given the abdominal location of the primary. It is fairly easy to figure out if these nodules on the liver are benign or ASPS mets - compare couple of consecutive scans spaced out by few months (preferably done at the same place for better comparability). If they grow, the chances that they are ASPS mets are very high.
The other thing is that I noticed that our patients from China and other Asian countries have somehow different pattern of metastasis so probably the genetic make up plays a role here. We have other ASPS patients here from US with the abdominal location of the primary and they all had lungs as their first metastatic site. The other thing is that ASPS is often widely disseminated from the beginning with dormant clusters of the ASPS cells sitting in different locations but the speed of growth might be different so the mets in the lungs could be small (less than 1 mm in size) and be undetected while the ones in liver started to grow and became visible earlier.
It does not really matter now as the goal here is to:
- identify if liver nodules are ASPS mets;
- deal with them in a most efficient way.
If Dr says that RFA could be to painful and not even possible in some locations, they have to refer Lee to a central hospital where cryo is performed as a part of the insurance policy - there should be referral practice in place, keep trying. If they can not referr hee, I strongly suggest contacting the cryo doc and asking him what can be done here.
If the ablations are impossible, was the surgery discussed? To remove a lobe. Liver regenerates so it is not an end of the universe.
The other thing is that I noticed that our patients from China and other Asian countries have somehow different pattern of metastasis so probably the genetic make up plays a role here. We have other ASPS patients here from US with the abdominal location of the primary and they all had lungs as their first metastatic site. The other thing is that ASPS is often widely disseminated from the beginning with dormant clusters of the ASPS cells sitting in different locations but the speed of growth might be different so the mets in the lungs could be small (less than 1 mm in size) and be undetected while the ones in liver started to grow and became visible earlier.
It does not really matter now as the goal here is to:
- identify if liver nodules are ASPS mets;
- deal with them in a most efficient way.
If Dr says that RFA could be to painful and not even possible in some locations, they have to refer Lee to a central hospital where cryo is performed as a part of the insurance policy - there should be referral practice in place, keep trying. If they can not referr hee, I strongly suggest contacting the cryo doc and asking him what can be done here.
If the ablations are impossible, was the surgery discussed? To remove a lobe. Liver regenerates so it is not an end of the universe.