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Chemo and surgery?

Forums General Melanoma Community Chemo and surgery?

  • Post
    VIve
    Participant

      Hello everybody,

      I'm neely diagnosed with metastatic melanoma stage IV, spread in the liver. Since a month I'm on debrafenib/MEK (300/2 mg per  day). Feel good for now. I was told in the hospital that while on this chemo therapy I cannot have a surgery. Does snybody know if this is true? Because I'm not sure if I have to remove my ovaries.  The CT statement says melanoma or ovarian cystuadenocarcinoma.

      I haven't been very often in this forum but some comments encouraged me a lot. 

      Many thanks!

      Victoria

       

       

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        jennunicorn
        Participant

          I would first want to figure out if what is seen on the ovaries is melanoma or not. Already having stage 4 melanoma, it seems more plausible to be melanoma than a whole different type of cancer. If it is melanoma, then you may not need surgery as the immunotherapy drugs should work. Not sure about surgery, immunotherapy is different from chemo and most things that patients on chemo are told they cannot do, immunotherapy patients can do. Taf/mek is a targeted immunotherapy drug, not traditional chemo. Taf/mek side effects are a little different from the other non targeted immunotherapies, so there may be side effects like blood clotting or bleeding issues that could make surgery complicated and/or dangerous. If you're not seeing a melanoma specialist, I would recommend finding one for a second opinion about the overies and about what you can and cannot do on taf/mek. 

            VIve
            Participant

              Thank you very much for the answer! I didn't know that this is slso kind of a immunotherapy. smiley

            cancersnewnormal
            Participant

              I would certainly want to know what I was dealing with on the ovaries. I've had ovarian cysts come and go on my CT scans, depending where I was along my cycle when the CT was done. The radiologists writing the reports always flag attention to them when they see them….. and I just keep telling my docs to wait and see if there is still one there on the next round of scans. It's been up and down for nearly 4 years now. 

              As for having surgery (IF you were to need it) while on the Taf/MEK……. I had my lower right lung lobe removed after being on MEK for 8 weeks. The surgeon as well as my oncologist, had me stop the drug for 6 weeks before surgery. I ended up with a persistent air leak. We never did pin down the reason for the slow healing, but it was never ruled out that MEK might have been the cause. 

                VIve
                Participant

                  Thank you Niki! Hope you are doing well now?

                VIve
                Participant

                  The whole thing is so new and unexpected for me it all arose this year…When I went to the emergency unable to eat and drink and with pain in the back and a bloated abdomen I was guessing almost everything else but not cancer. Now when I read the symptoms about ovarian cancer see that they are the same. But you're right it could be melanoma on the ovaries although if it is not it wont be probably stage IV melanoma. (I mean it will be probably better)

                    cancersnewnormal
                    Participant

                      The likelihood of a concurrent dual cancer diagnosis is pretty low. It's not totally unheard of… but really unlikely. How was the stage IV melanoma diagnosis confirmed? I assume there was a biopsy at some point, and the docs aren't just taking a stabbing guess that what has metastisized is melanoma versus ovarian cancer. What the CT is showing on your ovaries might indeed be melanoma. IF that is the case, the drugs you are currently on, would be effective on that. It is also entirely possible, that you have cystic ovaries which are completely benign. I have corpus luteum cysts….. and for some odd reason… I get them only on my right ovary. Soooo… with my CT's, we've never seen them on the left side, and will only spot them if my CT has been within a week to 10 days of egg release. I also have an asymptomatic cyst of unknown origin on the tail of my pancreas. It has been there since my first ever CT in April 2013. We know it isn't melanoma, as the Keytruda very effectively cleared me of melanotic lesions, yet this cyst remains. Without CT's, people are walking around with God knows what growing in their body. It only becomes frightening, when we have a CT for other reasons, and suddenly see these "things" we would never have otherwise known were there! Eventually, you (and your docs) learn what is "normal" for YOUR body images, and what should be watched more closely. 

                      As for me… Yes, I am doing well. Thank you for asking. : )  April 12th will mark 4 years since I had a grand mal seizure, and we discovered the brain mets that led to the jump from 2007's stage 1a diagnosis, to 2013's stage IV metastatic. Current scans of brain and body have been looking "my normal". 

                      Try not to worry too much about those ovaries. You'll have a better idea of what's going on after another set or two of CT's. : )

                      VIve
                      Participant

                        Hi Niki,

                        I'm happy that you are doing well now! 

                        Seems that you're very familiar with the subject.

                        Something else I was thinking about the immunotherapy. The taf/MEK medicines are good but from what I read IFN-α2b and IL-2 are working better for stage 4 melanoma. Do you know something about it?

                         

                         

                        jennunicorn
                        Participant

                          Those are both outdated drugs. The top immunotherapy drugs used now that are more effective are Yervoy/Opdivo (Ipilimumab/Nivolumab) combo and Keytruda (Pembrolizumab). Taf/Mek are good if you are BRAF positive. There are more drugs currently in trial now too. This is why a melanoma oncologist is very important, they will be up to date on the best treatment options.

                          VIve
                          Participant

                            The doctor is a melanoma oncologist but I'm in Belfast and there aren't many specialists. The first night in the cancer center the consultants came to me and behaved like I'm already dead and didn't want to give me any hope. Good that I'm not easily scared but someone else could take it really bad.

                            Thanks God there is the internet to see that there're many people that survived more than just a couple of months although stage IV. I read about the immunotherapy on the web. The doctors here haven't mentioned anything about it. On the other hand when you feel like you survived the impossible it gives you some extra happiness and selfesteem.

                            The diagnosis is based on the liver biopsy says malignant melanoma.

                            VIve
                            Participant

                              Btw do you know what the following (from the liver biopsy) means:

                              replacement by the liver tissue by a malignant tumor comprising sheets of neoplastic epithelioid cells

                              Diffuse positive staining within the tumor for S100 and focal positivity for HMB45 and MelanA. There is no staining with AE1/3, Ber EP4, glypican 3 and Hep Psr 1. 

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