Para aortic and para caval lymph nodes involvement and surgery


My Oc is A Typical but I have enlarged para aortic and paracaval lymph nodes, plus a suspected metastic site on my liver. I am feeling really well and until admitted with pelvic pain was exteremely healthy and fit 58 year old.

I am receiving excellent care and have had my second chemo without any real side effects (hurrah). But I now need to consider surgical options being considered for February.

I have 2 "choices". The first is a hysterectomy and debulking just in the pelvic area, and relying on chemo and radiotherapy to get or minimise the other sites. An op of approx 3 hours and 3 days in hospital. Then home to recover. Avastin will,be prescribed after surgery.

The second is for me to have radical surgery with the gynae surgeon and a vascular surgeon (or a London specialist) to operate in the pelvis and around the upper diaphragm/aorta and possibly removal of the liver lesion. This would mean an extensive 6-8 hour operation, recovery in ICU and a much longer recovery time. There are of course significant surgical risks to this!

So, has anyone had their cancer present in this way? If so did you opt for radical surgery (was it even offered) or just go for the clearing of the pelvis and chemo/radiotherapy and Avastin afterwards?

It will be a big decision, and I still don't have all the information I need from the radical surgeon to make an informed one just yet, but if anyone is out there like me/or presented like me, what helped in your decide making?

Thank you .

16 Replies

  • I think that's a hard decision. I'm really not sure what I would do. I think I'd veer towards radical but, as you say, there are risks. Radical wouldn't have been offered unless there are significant advantages in terms of recovery but it's still a huge thing to think through. Sending hugs. Xx

  • Thank you.

  • I have had three operations, the first was key hole, minimal, the second a radical hysterectomy precautionary. I have just had very intensive surgery which was several hours, and included part of my sigmoid colon being removed.

    I personally, knowing what I do now would go for the extensive surgery, these surgeons are very experienced and you are the most important person in the room during the operation. The aftercare is very important, rest and don't rush. If they have given you the option they must have great belief they can clear a lot of the cancer, which is better out than in. I would also go to see your GP and ask for a referral for a second opinion, don't feel rushed, feel confident with your choice, but I don't honestly think surgery hours should be the base for the decision.

    The very best of luck

    LA xx

  • Thank you. I have followed your surgical experience over the last month, and well done on your bravery, acceptance and recovery. May it continue and remission be yours. The radical surgeon is a second opinion referral from my lovely gynae surgeon, as he wants me to make an informed decision. I will post again once I've seen the other surgeon and let you know what I decide.

    Best wishes

  • Hi, I gah radical surgery in September ..10 hours ! Whike recovery was tough I'm so glad I went for it. There were 3 surgeons a gynaecologist oncology one bowel one and gastrointestinal one. The lead said the future of ovca treatments should involve surgeons in different specialities working together . i know chemo in in lots of cases the main treatment but if my surgery gives me a longer remission than last it will bi so worth it , good luck with your decision

  • Thank you for this. Much appreciated you taking the time to reply.

  • There are so many pros and cons to think about, but from what I've read, if they can remove absolutely all the visible disease, that is the single biggest factor affecting long-term survival. It's hard having to make such a big decision and it's good that you're getting a second opinion to help you decide. Hugs, Gina x

  • Thank you for taking the time to reply and for the info and hugs c

  • Looking at the separate thread with the discussion about the Chief Medical Officer's report, it seems to me that that supports a more radical approach......

    Tough decisions. Good luck with it all.....

  • Thank you and for the good luck!

  • Hi there, I have had 3 separate ops, 1st was the radical hysterectomy, then 2 years on I had a spot on the liver, which was removed, then a further 2 years on it returned in the lymph nodes next to the liver, so that was removed as well. I haven't had any further chemo since the first op, and was very pleased to be given the option of surgery on the last 2 occasions. Sometimes the choices that we are given are really hard ones, but you have to go with what suits you.I tend to ask my consultant what they would opt for in my position, as they have more knowledge about the likely outcomes, and I go for that.

    Good luck in whatever you decide to do



  • Thank you for taking the time and sharing this with me. Well done on your recovery.

  • I'd go for the radical surgery - all the results suggest that the more disease is removed the better the long term outcome. Two friends have had radical surgery, for one a 10 hour surgery meant an overnight stay in a high dependency unit and then four more days in hospital, the other had surgery lasting 8 hours, but a longer recovery time in hospital by a few days. At your consultation, you are likely to be given the worst case scenario - you might get on a lot better than expected. Also, any radical hysterectomy such as the one planned locally for you can lead to complications.

    It's not an easy decision, but I hope you can make the right one for you. I'm delighted that the new BGCS guidelines are taking effect at last. Best, Vx

  • Thank you. And yes quite timely given the recent news.

  • I would agree with Victoria and others. Go for radical surgery if it is offered. Your fitness counts in your favour.

    I am a retired GP as well as a PPC (type of ovarian cancer) patient.

    All best wishes.

    Eileen x

  • Thank you for taking the time to reply. Much appreciated

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