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Ovarian Cancer (Expert Forum)
Fallopian tube cancer, post debulking surgery, second occurance...
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center
Boston - MA
This forum is for questions and support regarding ovarian cancer issues, such as: Biopsy, Chemotherapy, Clinical Trials, Genetics, Hysterectomy,Immunotherapy, Ovarian Cancer Types, Radiation Therapy, Risk Factors, Screening, Staging, Surgery.
Fallopian tube cancer, post debulking surgery, second occurance...
by Mark4124, Nov 05, 2006 12:00AM
My mother originally was diagnosed with Fallopian tube cancer in May of 2004. In the summer of that year she had a complete hysterectomy and 4 rounds of carbopaltin/taxol or taxotere. She did not tolerate the taxins well and had severe neuropathy. This summer a tumor was discovered between her IVC/Aorta. It was removed last week in a 5hr surgery that required cutting the 5cm tumor from the IVC. Her current oncologist is recommending just radiation if biopsies elsewhere in the abdomen come back negative. Her one of her colleagues feels chemo and then radiation would be more appropriate. I have to say that I am an advocate of the chemo approach as well as it seems more global in nature and would take care of the possibility of distant metastasis which radiation would not address. My mother dreads chemo, but I wonder if an agent like gemzar with carbo would be better on the neuropathy. What would you recommend in such a situation relative to radiation and chemo?
Doctor's Answer
by Annekathryn Goodman, M.D., Nov 05, 2006 12:00AM
, Nov 05, 2006 12:00AM
Dear Mark,
There is no wrong answer. Your mother has four options:
-Close follow up without other therapy right now
-Chemotherapy
-radiation
-a combination of chemotherapy and radiation.
The reason that there is such a range of options is because we do not have data to suggest that the addition of more therapy right now will reduce the chance that her cancer will come back.
Now, I am going on the assumption from your note, that she does not have any other sign of cancer at this time. If other cancer was seen at surgery or on a postoperative scan, that is a different situation.
But if at this time, her CA 125 and her scan is clear, then she could choose what to do based on quality of life issues, and her history of previous toxicities.
Unfortunately, she will probably be facing another recurrence at some time in the future. You could argue that you want to save chemotherapy options for that time. The more chemo she receives, the more her bone marrow is affected. The danger is that some people get to a point where they cannot receive chemo because their blood counts are too low.
A small field of radiation to the area where the tumor was removed is a very common recommendation. The thought is that this will reduce the recurrence of cancer right at that particular location. The radiation will not ,however, reduce recurrence at any other location. Too much radiation will reduce the ability of her bone marrow to make blood cells. For this reason, I would be cautious about extending the radiation field beyond the area of the affected lymph node.
I know these are tough decisions. Let your mother's doctor help guide your through the various options.
best wishes
There is no wrong answer. Your mother has four options:
-Close follow up without other therapy right now
-Chemotherapy
-radiation
-a combination of chemotherapy and radiation.
The reason that there is such a range of options is because we do not have data to suggest that the addition of more therapy right now will reduce the chance that her cancer will come back.
Now, I am going on the assumption from your note, that she does not have any other sign of cancer at this time. If other cancer was seen at surgery or on a postoperative scan, that is a different situation.
But if at this time, her CA 125 and her scan is clear, then she could choose what to do based on quality of life issues, and her history of previous toxicities.
Unfortunately, she will probably be facing another recurrence at some time in the future. You could argue that you want to save chemotherapy options for that time. The more chemo she receives, the more her bone marrow is affected. The danger is that some people get to a point where they cannot receive chemo because their blood counts are too low.
A small field of radiation to the area where the tumor was removed is a very common recommendation. The thought is that this will reduce the recurrence of cancer right at that particular location. The radiation will not ,however, reduce recurrence at any other location. Too much radiation will reduce the ability of her bone marrow to make blood cells. For this reason, I would be cautious about extending the radiation field beyond the area of the affected lymph node.
I know these are tough decisions. Let your mother's doctor help guide your through the various options.
best wishes
