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Anyone diagnosed at Stage I? Chemo or no chemo?
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Anyone diagnosed at Stage I? Chemo or no chemo?

On Wednesday I am going in to see my third gyn/onc about my situation (Stage IA grade 1 mucinous cystadenocarcinoma).  I was wondering if anyone else here was diagnosed at Stage I and whether or not they were referred for chemo.  Why or why not?  

My first gyn/onc (who performed my surgery back in MI) stated without hesitation that I would need 6 cycles of chemo, and eventually, a radical hysterectomy (once I was done having children or decided I didn't want any, whichever came first; I'm 33).  I came back to IL expecting to follow through on those instructions, but my gyn/onc here disagrees with the one in MI, saying that because of my type of ovca, there isn't a good chance for the chemo to be effective.  This threw me for a complete loop, hence my going for a third opinion.

I was hoping I could hear back from others' situations - what is your specific type/stage/grade and what did you have to do?  It's not that I want chemo at all - I find it to be quite frightening - however, I do not feel very comfortable with simply waiting and being monitored.  

Any commentary is very much appreciated!  Thanks!  :)
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564735_tn?1263947126
Hi,
I am assuming debulking was done. With stage 1a, if the tumor is completely removed and the surgeon is confident that he got it all of the cancer ...then having no chemo is not uncommon. And it is true that low grade cancers are not usually as responsive as high grade cancers to chemo, but I would try and get another opinion. Hopefully one of the other women on this site who have low grade mucinous cancer will also comment.  Julie
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Avatar_f_tn
Hi I was recently diagnosed with Stage One Ovarian Cancer and I am not going to go through Chemo...only because the type of tumor that was removed from me (serous fluid). They did take out my my left ovary and fallopian tube and plan on monitoring me via ultrasounds and the CA-125 test every 3 months for the next couple years...to make sure they got everything out, doesnt grow back and etc. I am actually going to be taking the CA-125 test every month for a while b/c my CA-125 test is elevated.

My GYN/ONC did say that the type of tumor and the stage I was at would not be supressed or slow down from spreading by having chemo. About the hysterectomy my doctor also had a case similar to me and he "staged" her by performing a hysterectomy and took out surrounding lymphnodes b/c she was 50 years old. I am only 24 years old so they are trying to save my fertility...so I feel like it's normal for them to want to wait b/c you have not had children yet. Every doctor has referred me as a difficult case b/c I have not had kids yet. All I can suggest is when you get your second opinion to go into the office with a list of questions and keep asking why...

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Avatar_f_tn
What about having a second opinion done on the pathology (by a specialist in gyn pathology)?  It's usually recommended for borderline ovarian cancers but if you're getting conflicting opinions fr you gyn-onc maybe make sure the diagnosis is correct.  Just a thought?  

Debbie
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Avatar_f_tn
Hi,

Hmmm.  I am stage 1a and didn't have chemo.  I am two years out with no recurrence.  But, I had a total abdominal hysterectomy with my omentum and cervix removed as well.  I am followed every three months and have had three scans and several CA125s since my surgery.  The only reason for so many scans is because there have been concerns of recurrence but they were found to be other complications.

It is just my opinion that you are at high risk of recurrence in the other ovary until you have a total abdominal hysterectomy.  Chemo isn't very effective on low grade tumors so I would skip the chemo and opt for the surgery first.  I understand the fertility issues, but you should seek another opinion from a major cancer center.  I think you show be very, very closely monitored and have kids right away if that is the goal.  Otherwise, you are risking not being here to raise them.  Best of luck to you.
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801514_tn?1273680386
I was diagnosed as stage 1c; so, I had to have chemo. (C means they found malignant cells in the abdominal washings.  Originally they planned 3 cycles, but my CA-125 refused to go down until the 2nd chemo; so, I had 6.  They want you to have a normal CA-125, then two more cycles of chemo.

Had I been 1a, there would have been no chemo at all, and I have a high grade (3) cancer.  Low grade cancers don't respond well to chemo, but they also don't grow/spread very fast.   Some women, even at much later stages, are just treated surgically even when the cancer recurs.

It will be interesting to hear what you get for a third opinion.  If you had my doctor, surgery would be it, followed by close monitoring of course.   Once you have your children, you probably will want to have a prophylactic oophorectomy.
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Avatar_f_tn
I was 55 when I was diagnosed IC mucinous cystadenocarcinoma.  After my surgery I had 6 rounds of carbo/taxol......it wasn't fun but so far so good!  Tomorrow I will have a follow-up CAT scan and hopefully it will give me an all clear.
During my surgery, the tumor ruptured spilling malignant cells into the peritoneal cavity causing me to be staged at IC vs IA.....stuff happens!  
I understand you are young and want to preserve your fertility.  However, if you were my daughter, I would really want you to have surgery removing everything and follow up with chemo.  I would be mortified with the "wait and see" option.
You are going to be forced to be "wise beyond your years"; this isn't the "end" of anything; it's the beginning of a new life.  Please "use good judgement".....that's what I tell my kids when they are making a major decision.
Peace.
dian
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155056_tn?1333642288
I was stage 1A, diagnosed on Sept 13, 2000.  I did not have chemo.  It is my understanding that protocol, is stage 1C or higher, but, there are reasons why some doctors recommend it over other.  I was told that with Stage 1A, chemo does not effect the survival rate.  

Again, each doctor is different.

Best of luck to you.
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Avatar_f_tn
I was stage IA, grade 1, endometrioid carcinoma. My gyn onc said no chemo, as did a second gyn onc I consulted with. I have done some reading about this issue, and it is my understanding that with most tumor types, if the stage is IA or IB and the grade is 0 or 1, the standard is not to do chemo. Apparently no one has been able to prove that chemo will improve survival, which is around 95% without chemo. I don't know if this applies to your particular tumor type, however.

You might also want to try posting here:
http://www.inspire.com/groups/ovarian-cancer-national-alliance/
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Avatar_f_tn
I just dug up an article that came out the year after my diagnosis. It may contain useful information for you. Here is what it said:

"In the ICON1 trial, no data were presented to suggest that the low-risk subset of patients—patients with well-differentiated histology, stage Ia and Ib—benefit from adjuvant chemotherapy."

This is the URL:
http://jnci.oxfordjournals.org/cgi/reprint/95/2/94.pdf

I believe this was an editorial in the issue of JAMA that published studies about the use of chemo for early stage ovca.

This National Cancer Institute page also has some information, and the studies in the footnotes may be of interest as well, though some are rather old:

http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/HealthProfessional/page5
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725998_tn?1258052308
I was diagnosed stage 1C borderline (10cm mass in ovary).  I had a TAH/BSO.  My gynoc said no chemo just monitoring every 6 months.  I also have a co-worker who was stage 1A grade 1 and didn't have chemo.  That was 11 years ago and she's been cancer-free.

Sometimes the effects of chemo are more problematic than no chemo.  It's good you're going for a third opinion.  
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