Chemo for Stage IIIC primary peritoneal cancer

[chopps]

Hi Dr.,
My mother was recently diagnosed with Primary Peritoneal Cancer.  Surgery is scheduled for Thursday, September 25th.   She is healthy, vibrant and strong.

They say the next step is chemotherapy of which Interperitoneal Chemo is an option.  I read one of your comments regarding chemo and that it is not effective on stage III tumors.

They will probably not put in the port during surgery because they will need to remove some intestine and bowel and there is a risk of infection.

Please give me your valued opinion about chemo. in this case and what direction would be the best for lower chance of recoccurance and a longer lifespan.   My mother had stage III C primary peritoneal cancer.

So, questions:
1.  Do you recommend chemo for stage III primary peritoneal cancer?  Or, did I read that you felt it wasn't effective?
2.  Thoughts on the effectiveness of Interperititoneal Chemo?
3.  Thoughts on carboplatinum chemo with taxol?
4.  Scraping the bowel and intestine vs. removing part of it.
5.  Are there different types of peritoneal cancer.  He said she has primary peritoneal cancer.

Again, looking for the best quality of life, longest lifespan, and longer period of remission.  Thoughts and opinion of what you would do?

Thank you,
CH

[jdbobo]

Hi Chopps,

Carboplatinum & taxol are the standard first line chemo treatments for Ovarian and Primary Peritoneal cancer. Adding Avastin is an interesting trial as it has shown effectiveness with OvCa.  Google "ovarian avastin" and you can read an article or two about Avastin for OvCa on patients with recurring disease.  There were obvious benefits, but gastrointestinal perforations proved to be a substantial risk in up to 20% of the patients.  As a firstline treatment, the chances of gastrointestinal perforations may be less than was experienced in these previous studies on patients with recurrences.

You should read this post to medhelp on the topic:

http://www.medhelp.org/posts/show/450832

[StillFighting]

I had the IP chemo, I prefere it over a regular IV chemo. it gives you a more full feeling in your abdomin, but it saves the ole blood vessles from bursting. Good luck to your family.
Michelle

[chopps]

That's great information.  They are saying my mother is no longer eligible for IP chemo because the 2 tumors they left in her body (they also left the uterus and cervix) are bigger that 1 cm.  and it won't be effective.  They did not have to do a bowel resection, which they thought they were going to have to do, so they can start chemo in the hospital.  They have offered carboplatinum with taxol or a clinic trial that ads avastin.
Thoughts?
I am aware that for all intensive purposes Primary Peritoneal cancer and Ovaian cancer are considered the same and treated similarly.
Thanks for your post.
Chopps

[jdbobo]

Hi CH,

I know you intended to post to the Dr's forum -- but I can't resist giving some advice...

I recommend you go to the New England Journal of Medicine (www.nejm.org) and search for "Armstrong".  The IP chemo study will be the first paper that pops up in the search results.  Read the "pdf" version as it has some interesting graphs and statistics that are not in the "full text" version.  This will give you tons of info about IP vs. IV chemo and answer most of the questions you have.

Given the info you have supplied, there is a 99% chance that your Mom will be getting some sort of chemo.  My mother had the IP chemo...today almost a year after treatment she and I both agree that IP chemo was the best choice for attaining the goals you mention.  But everyone's does not qualify for IP and the IP chemo regimen is definitely harder to tolerate than IV, so IP chemo is certainly not right for everyone.

By the way, in case you haven't figured it out already, Primary Peritoneal cancer and Ovarian cancer are pretty much same thing and are treated similarly.   The naming difference is simply a distinction of whether the first tumors appear to have originated on the ovaries or on the Peritoneal walls (omentum, etc).

-Dave

[silver&gold]

Hi, I f you click on forums , look at the right hand side you will see ask a doctor forums , scroll down til you find ovarian cancer , click on it and that should take you there . There is usually only space for 2 posts per day so you may have to check a few times .

Best Wishes Angie