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Oncology (General Cancer)/surgery removal of secondary teratomas: standards

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QUESTION: I had cancer of ovary, teratocarcinoma III, in 2001 and, therefore, total oophorohysteroectomia.
Since then I have used the oral contraceptives (now it is Marvelon) for hormone replacement therapy purpose.
From 2002, I have a few more tumors that are considered nonmalignant and which are situated in the liver, abdomen and pelvis. The tumors grow slowly, yet the tumor in the liver is now 5,5 cm (MRI 2014) and causes me pain that has become permanent in 2016 and also the feeling of fullness in the right quadrant of abdomen. However, the oncologists in Iceland refuse to operate me on the ground that these are benign tumors. I am scared if the tumors will become malignant and I am unhappy that they grow anyway and symptomatic. Besides, I cannot stop using hormones, which might provoke the tumors growth. I also have a family history of cancer (my father and aunt died from cancer).
Do you know if there any EU medical standards concerning surgery of benign tumors, especially liver tumors?
What authorities can make the doctors change their decision?
I would like to have the tumors removed. And the University hospital of Zurich offered me an operation, but the Icelandic insurer refused to pay because the doctors don't think that the operation is necessary.

ANSWER: I don't know anything about EU standards.  I certainly think that if you have symptoms something should be done.  Removing a tumor from the liver, however, is not without risk, and sometimes leads to life-long complications.  I suggest you explore some other alternatives. Tumor embolization might be a very good way to deal with this problem.  Interventional radiologists are trained in this and similar techniques, which could reduce the size of the tumor and relieve your symptoms.  Certainly in the United States this would be a reasonable step.  You might look up Dr. Siggurdur Bjornnson in your capital city.  He trained in the US and may be able to direct you along these lines.  Hope this helps.  

---------- FOLLOW-UP ----------

QUESTION: Thank you, doctor, but are you sure that the tumor embolization method can be used in the case of benign tumor?
Do you perhaps know the EU best surgeons well-experienced in benign tumors' resection from the liver?
Thanks in advance.
Marina

Answer
I don't know any EU surgeons who do this.  Embolization is a common way to deal with uterine myomas, which are benign.  If you can find the arterial supply you can embolize it.  Generally the radiologist inserts a catheter through the femoral artery and brings the tip into the general region of the tumor.  Small amounts of radiopaque dye are injected to outline the vessels and the tip is moved closer to the main artery supplying the tumor.  When it is in position, the embolizing material (gelfoam or something like that) is injected.  Success can be judged by whether afterward any dye can move through the tumor.  Hope this helps.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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