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Ovarian Cancer (Expert Forum)
Ct Results and Rising Ca-125
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.
Ct Results and Rising Ca-125
by Hazel30, Feb 05, 2007 12:00AM
Dear Dr. Goodman,
My Mom just had another CT Scan done last week because her ca-125 has been rising the past few months. November = 7, December = 14, January = 19. She is going for another ca-125 next week. I wanted to hear your opinion on what the CT Scan report says.
FINDINGS: helical CT of the abdomen and pelvis was performed after oral contrast was given, and after the IV injection of 100cc of Optiray 250 without reaction. The study was compared to the prior exam dated 11/20/06. There is no apparent pleural effusion. The liver and the spleen are not enlarged, and there is no focal hepatic lesion. The gallbladder, pancreas, and adrenal glands are unremarkable. There is no renal mass or hydronephrosis. Retroperitoneal lymph nodes are slightly more numerous then the last exam. A lymph node adjacent to the proximal left common iliac artery is larger then on the last study, and measures approximately 1.0 x 1.4 cm. There is no apparent bowel obstruction or ascites. Borderline thickening of the wall of the left colon is probably related to underdistention. There is no apparent free pelvic fluid. A small umbilical hernia contains fat, and is unchanged in size from the prior study.
IMPRESSIONS: Slightly enlarged left common iliac chain lymph node. Periaortic lymph nodes are slightly more numerous on the prior exam.
She also had a chest x-ray that is clear.
Please let me know your true feelings of what this ct scan represents.
Thank You so much
-Fiana
My Mom just had another CT Scan done last week because her ca-125 has been rising the past few months. November = 7, December = 14, January = 19. She is going for another ca-125 next week. I wanted to hear your opinion on what the CT Scan report says.
FINDINGS: helical CT of the abdomen and pelvis was performed after oral contrast was given, and after the IV injection of 100cc of Optiray 250 without reaction. The study was compared to the prior exam dated 11/20/06. There is no apparent pleural effusion. The liver and the spleen are not enlarged, and there is no focal hepatic lesion. The gallbladder, pancreas, and adrenal glands are unremarkable. There is no renal mass or hydronephrosis. Retroperitoneal lymph nodes are slightly more numerous then the last exam. A lymph node adjacent to the proximal left common iliac artery is larger then on the last study, and measures approximately 1.0 x 1.4 cm. There is no apparent bowel obstruction or ascites. Borderline thickening of the wall of the left colon is probably related to underdistention. There is no apparent free pelvic fluid. A small umbilical hernia contains fat, and is unchanged in size from the prior study.
IMPRESSIONS: Slightly enlarged left common iliac chain lymph node. Periaortic lymph nodes are slightly more numerous on the prior exam.
She also had a chest x-ray that is clear.
Please let me know your true feelings of what this ct scan represents.
Thank You so much
-Fiana
Doctor's Answer
by Annekathryn Goodman, M.D., Feb 14, 2007 12:00AM
, Feb 14, 2007 12:00AM
Dear Fiana,
Thank you for the detailed information. i agree with your mother's doctor. i do worry that this may represent a recurrence. There is a very fancy x ray that may not be available in some locations called a PET CT scan. This uses a radioactively labeled sugar molecule (called FDP)that is injected IV. Areas of active growth will absorb the radio labeled sugar and light up on the scan. The other option is to try to biopsy the lymph node.
As far as therapy, definitely carbo or carbo taxol (or taxotere) are reasonable to consider. There are many other options as well. I would first concentrate ion confirming the diagnosis.
I know this must be so hard ! Please keep me posted
best wishes
akg
Thank you for the detailed information. i agree with your mother's doctor. i do worry that this may represent a recurrence. There is a very fancy x ray that may not be available in some locations called a PET CT scan. This uses a radioactively labeled sugar molecule (called FDP)that is injected IV. Areas of active growth will absorb the radio labeled sugar and light up on the scan. The other option is to try to biopsy the lymph node.
As far as therapy, definitely carbo or carbo taxol (or taxotere) are reasonable to consider. There are many other options as well. I would first concentrate ion confirming the diagnosis.
I know this must be so hard ! Please keep me posted
best wishes
akg
Do you think there is still a chance this might not be a recurrence?
If this is a recurrence....What would you advise for your patient. My Mom had a very good reaction to taxotere/carbo and did well with very mild side affects. She only needed a shot of nuelesta once her first treatment. The other five treatments her counts were good. He mentioned clinical trials but Im not sure about that and also different combinations of drugs including avastin.
I know when women have recurrence it comes in two forms either lymph nodes or a tumor. Which is worse the nodes or a mass? I know its not such a good questions to ask but I want to know the difference and risks.
She finished her chemo May 16, 2006. Almost 9 months ago.
What are your thoughts?
Thank You so Much
-Fiana
I know of the PET scan, but my Moms insurance does not cover it. Her doctor and I already spoke about that. I will mention to him doing a biopsy of the lymph node.
Also is there any sense to maybe test and see if she is resistant to taxotere/carbo drugs? What is your strongest advise on chemo drugs to be used in her case.
Thanks again
-Fiana
you should ask her doctor about what chemo-resistance assay testing they have . It does require getting some tissue as in a biopsy. that may not be possible. we usually base decisions on further chemotherapy on what drugs has a person recently had.
carbo and taxol or taxtotere a good combination if it has been more than 6 months since the last chemo.
best wishes