25 x 15 x 12 cm complex cystic mass in pelvis with ascites

Hi, My mom (65 years + 4 children - Disease free background) is diagnosed with Ovarian cancer, It was confirmed by clinical as well cytopathology analysis of ascitic fluid (Metastatic adenocarinoma and stain for intracytoplasm is +ve). Her tumor markers are elevated ( CA 125 = 157.2 units, CA 19.9= 6,255 units (six thousand plus),  CA 72.4 = 26.49 units). CEA is in normal limits.

Her gastric fundal and rectal biopsy does not show any malignant cells. We have done repeat upper GI endoscopy biopsy and FNAC, as well. Yet no sign of malignancy of gut.  Gastroentrologist though have seen unusaul deposits but benign.

Her mammography, lung CT also does not show any malignant growth. Liver, pancreas are also clean on CT.

She has porcelain gall bladder.

Her symptons include (lack of appetite, weakness, bloating of abdomen, loss of weight, occasional constipation, she saw some blood laced stool one and half  month ago - (Todate - 26th Jul, 2008)

Does these test results mean that she is having primary ovarian cancer. If not, then what we should do to find out the primary cancer type/site/organ causing this secondary ovarian cancer.

Onco Gynae surgeon/ Medical oncologist has suggested neo-adjuvant chemotherapy (3/4 sessions) using carbo-platin + taxol. Followed by surgery + 3/4 cycles of chemotherapy.

Please advice if we are on right track if primary cancer type is not ovarian.

Its been very hectic 3 weeks. I'm worried that she might not receive treatment in time if we are hell bent on finding the primary cause of ovarian cancer.

regards
Pal

[msjazz]

That does sound confusing. I had 2 ct scans at 2 different places, one at the gastrenerologist, the next one at the hospital within 3 weeks of each other. I had gone to the ER due to severe pain in my right side. Also the hospital did Tvultrasound and I had a colonoscopy. My gyn told me it was not female related, the ct showed ill defined inflammatory processes. My gatro dr. ordered a laproscopy and it was ovarian cancer.. It was diagnosed primary peritoneal. When the gyn/onc did surgery it was even stage 3c . It was explained to me that it originated from an ovarian cell that basically broke loose and floated. It sounds strange if they don't see anything on ct to do chemo before surgery.Usually on ovca they only do chemo first if they feel tumors need to be reduced to do an optimal debulking at surgery. Maybe a laproscopy with tissue samples should be done. It was done as an outpatient on me. Hope you get some answers. Donna

[OzBron]

From what you have said the diagnosis for adenocarcinoma in the ascitis fluid and the presence of the large complex cystic mass is sufficient to assume ovarian cancer source. The only definitive way to know is through surgical staging that would occur when they remove the mass. As donna said, chemo may be done first to shrink the mass and make surgery easier for large masses (your mums at 25X15X12cm would count for this) or if the mass looks in a challenging place (near/attached to arteries/veins etc). The down side of chemo first is that your mum's immune system will be lower so the risk of infection is higher.
At this point I would think to get the information your mum needs to make the decision to have chemo before or after surgery and get moving. The staging/debulking surgery will likely provide the answers as to the primary source - no other test will help solve this until they get in there, see what is where and take samples for biopsy.
It sounds like your mum is already on a good path with a gyn/onc surgeon already on board. Good Luck. Bron

[msjazz]

Oh Bron, I see the title now, I read the post and didn't focus on the title. Thanks for helping. That is probably why chemo first. Hugs Dona

[ppsr]

bron, donna, thanks. My mom got admitted to the hospital for chemo. Since Gynae-onco also asked for CA-125 cell block of the ascitic fluid. We did that last week. Results came in time. CA-125 cell block test was negative. Which means there could be other primary site instead of ovaries. Doctor has asked for PET/CT scan, Laproscopic biopsy of the pancreatic cavity and MRCP tests to establish the primary site.

Regards
Pal

[ppsr]

its a ovarian primary cystic mass confirmed after PET/CT scan. She is neoadjuvant chemo therapy comprising taxol + carboplatin.

[msjazz]

I am sorry you both are going through this, but hopefully she will not have too many side effects from chemo, and feel better soon.  Donna