LEE From China - Dx Aug 2014

[Olga]

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.

[MartinBube]

I agree completely on everything that Olga has written. I do also have few liver "cysts" that starting from next week I will see few doctors oncologist and a specialist for liver to look at them since it is not giving me peace.

I'm not sure only if you notice growth that it is 100% ASPS since the cyst it self or something else also grows otherwise it would not have been there at all

[Olga]

Hi again,
I was reading on the cryoablation of the tumors in liver and came across the study from China

Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma.
http://www.ncbi.nlm.nih.gov/pubmed/25284802
The authors are from the Center of Therapeutic Research for Hepatocellular Carcinoma, Beijing the 302nd Hospital, Beijing, China. The study is done for the primary cancer in liver, not metastases but I would assume that they are high volume liver cryoablation facility and probably have the same high number of the liver mets ablated. I would contact them and ask about the referral procedure is done.