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Evaluate Response to initial treatment

My mother was diagnosed with Stage IIIC/IV ovarian cancer in Dec 2007.  At the time of diagnosis her CA125 was around 4700 and the CT scan showed a large pelvic mass with enlarged ovaries and Cancer spread to the peritoneum.  She had moderate amount of fluid in her abdomen and had pleural effusion.  The scan was not very clear in regards to a rectal involvement and on physical examination the oncologist could not feel any substantial mass in the rectum. No other organ involvement was detected in the scan.  The Gyn-Onco suggested we first go in for 3 cycles of CarboTaxol and then have an IntervalDebulking followed by 3 more cycles of CarboTaxol.

She started with her Chemo in Jan 2008 and after her 2d cycle the CA125 levels came down from 4700 to 1900. Also, after her initial diagnostic tap of ascites from her abdomen she started to see a lump develop at the site of the drain which grew initially and is now shrinking with her chemo.

The oncologist says that she has responded to the treatment but would not consider it a very good response since the CA125 level is still above the normal level and that the lump at the ascites drain site has not completely gone away.  He has continued the same CarboTaxol combination for the 3d cycle as well.  She is scheduled for a PETCT and blood test next week to evaluate outcome of her initial treatment (3 rounds) so that gynec-oncologist can schedule surgery.

Thought the treatment my mother has been healthy with very few side effects like hair loss and joint pain.  Also her ascites has significantly reduced in her abdomen and around her lungs and is almost next to nothing.

How would you evaluate my mother’s response to her treatment?

Does one see a significant drop in CA125 level only after surgery?

Is the lump at the ascites drain site a tumor?
12 Responses
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242604 tn?1328121225
MEDICAL PROFESSIONAL
Hi There,
Thank you for your complete information.

It sounds like your mother is getting really good care. It makes sense to re-evaluate after 3 cycles of chemo to see if surgery to the right things.

She is responding to therapy but without surgery, the response will be slow. The single most important treatment intervention  for women with ovarian cancer is surgical removal of tumor.

The lump at the drain site probably was tumor. It sounds like the cancer that your mother has is responsive to chemotherapy which is great news.

Please keep us posted .
best wishes
Helpful - 2
242604 tn?1328121225
MEDICAL PROFESSIONAL
Hi There,

Thank you again for your complete information.
as to your questions:

1. the definition of platinum resistance is the regrowth of cancer within one year of completing chemotherapy with platinum based agents. So technically, it is not possible to answer your question. However, another situation where I would say someone is platinum resistant is the lack of tumor shrinkage and the actual progression of cancer while on chemotherapy. This did not happen to your mother.

In fact, looking at her CA 125, she has had an amazingly great response to chemo. she started with a very big cancer. As I said before, chemo alone is not enough to make it go away.

2. I agree with continuing taxol and carbo.
3. The plan for IV followed by IP makes sense as well.
best wishes
Helpful - 1
Avatar universal
A related discussion, Maintenance Chemo was started.
Helpful - 0
Avatar universal
At this moment beleive it or not , I would try to find Naturopathic doctor. They are great at diminishing side effects of chemo and helping the rest of the treatment work .
I heard mirracles about some homeopathics and also yoga and meditation .
I know someone who was predicted to live 1 months with ovarian cancer after all the treatments. As of now , it's been 10 years, she is well and cancer free , but completely changed her life doing yoga meditation, cleansing her body and seeing naturopathic practitioner together with her regular gynecologist of course .
Wish all the best to your mom . A lot depends on her will power . Good luck .
Helpful - 0
Avatar universal
Dr Goodman,  Hello again,

My mom is to begin her 5th IV cycle of carbo/taxol tomorrow.  She had her blood tests today and her CA 125 has gone up to 29 from the earlier value of 4.8 post surgery.  

The Oncologist dismissed our concern and said that she is 6 weeks post surgery and that we should not read too much into it yet.

However, what ever information i can read up online suggests that if the CA 125 level doubles, it suggests some cancer activity.  What are your thoughts about this.

CA125 at Diagnosis 4700
CA 125 after 2 cycles of Carbo/Taxol 1900
CA 125 after 3 cycles of Carbo/Taxol   700
CA 125 3 weeks post surgery 4.8
CA 125 after 4 cycles of Carbo/Taxol   29

Thanks OVCIndia
Helpful - 0
Avatar universal
Hi OVCIndia,

Are u from INDIA? I am from india any my mother is also having ovarian cancer dx as 3C in june 2007,can you give me some details  about you and your where abouts and in which hospital is she getting her treatment?
Helpful - 0
Avatar universal
Dr Goodman

My mother completed her interval debulking surgery on March 8th and will resume her chemo treatments tomorrow.  The surgeons left no macroscopic desease behind.  My prior post on this thread has the pathology report from her surgery.

My questions to you are:

1>  Is the remaining microscopic cells platinum resistant.  The surgeons were very happy with the surgery but were not satisfied when they saw the amount of cancer left after 3 cycles of Carbo/Taxol ?

2>  They initially wanted to put her on 2d line treatment for the remaining chemos but last
weekend there was a conference in India where the Head of GYN/Onc from MD Anderson had come down.  They discussed my mothers case with him and was decided that she stuck with her current treatment of Carbo/Taxol since she has had some response.   Would you agree with this ?

3>  Though she was optimally debulked they have decided not to go ahead with IP chemo for now because the cancer had spread to the ascites drain site beyond the abdominal wall.  They had to remove lot of tissue from this area and had to install a mesh.  For now her treatment plan is to complete her remaining 3 cycles with Carbo/Taxol via IV and give her additional 3 cycles via IP with Cisp/Taxol.  Do you agree with this treatment plan?

Her CA125 at diagnosis was 4700
After 1st cycle it was at        1900
After 2d  cycle it was at          700
3 weeks post surgery it is at    4.8

Thanks
OVCIndia
Helpful - 0
Avatar universal
Dr Goodman,  

As in my prior post.  My mother completed surgery this saturday.  They were able to optimally debulk her.  Below are the pathological findings:

CLINICAL DIAGNOSIS:   CARCINOMA OVARY
NATURE OF SPECIMEN:   CYOREDUCTIVE SPECIMEN-POST CHEMOTHERAPY

GROSS MORPHOLOGY

1) Uterus- Specimen measuring 5 x 5 x 4.5 cm.  Cervix is 3cm length along with adherent tissue on
  the lateral aspect of uterus because of which there is lack of orientation of fallopian tubes and
  ovaries.  The myometrium of the fundus measures 1.3 cm and grey white homogenous mass on the
  serosal aspect measuring 1.3cm thickness.  On the posterior wall of the body of uterus, fibroid
  measuring 3.1 cm diameter is present.
  A- Body+serosal grey white area(left lateral), B Body(anterior wall), C-Fibroid, D-Cervix(two strips),
  E - Left tube + grey white mass, F - Right tube + grey white area(ovary), G- Posterior parauterine tissue(ishamic).

2) Omnetum- Specimen measuring 47 x 7.5 x 5 cm.  On slicking firm areas are identified.  HIJK.

3) Nodule in the rectal sheath - Three firm measuring 8 x 5 x 4.3 cm.  Slicing reveals firm grey white areas-LMN

4) Nodule over caecum - Specimen measuring 5.5 x 4 x 2.5 cm. OP

5) Inra-aortacaval lymph node - specimen measuring 3.5 x 1 x 0.6 cm. Partly embed. Q.

6) para-aortic lymph node - Specimen measuring 1.5 x 1 x 0.4 cm all embed R

7) Appendix - A 4.5 cm length of appendix. part embed. S

8) Right diaphragm striping - Flatted tissue measuring 17 x 5 x 0.4 cm surface nodular deposits are present measuring 3 - 1.8 cm diameter. Partly embed. TU

9) Left diaphragm striping - Flattened tissue measuring 7.5 x 4 x 0.3 cm. Part embed. V.

10) Mesoractal nodule - A 3.5 x 3 x 1.2 cm of firm tissue piece partly embed. W

11) Peritoneal wash (CYT-334/08) - Received 30 ml of fluid.

MICROSCOPIC DESCRIPTION

1) Multyple sections from firm tissue on both lateral aspectsof uterus show poorly differentiated serious papillary cystadenocarcinoma.  The tumor is
   adherent to the serosa of uterus, however no infiltration is seen into the myometrium.  There are lymphovascular emboli and perineural tumor spread.

2) 'Omnetum', 'nodule over caecum', 'nodule over rectus sheath' shows large areas of tumor deposits.

3) The tumor is present in the para-appendicel soft tissue however appendiceal wall is not inflitrated by tumor.

4) The Tumor is present in the right and left diaphragm stripings.

5) The section from mesoractal nodule show tumor deposit.  No lymph node is seen

6) The lymph nodes (5) sampled from 'Intra-aortacaval' show tumor metastasis in one, without any perinodal spread.

7) The lymph nodes (4) sampled from para-aortic area does not show any metastasis.

8) The uterine-endometrium, bilateral fallopian tubes and cervix appear unremarkable.  The uterine myometrium shows leiomyoma in the posterior wall.

9) Smears(CYT-334/08) reveal many single lying and tight clusters of malignant serious epihelium.  numerous clacified areas are seen.

IMPRESSION

Poorly differentiated serious papillary cystadenocarinoma, see above.
Peritoneal washings - Metastatic adenocarinoma.

My questions to you are:

1>  Since she has already had 3 cycles of Taxol/Carbo.  Will the next 3 cycles via IP be of any help.  What ever research i do on the net they give stats for 6 cycles via IP?  

2>  Is her Cancer Platinum resistant, since it did not clear up the most of the tumors after 3 cycles prior to surgery.  However her CA125 numbers did drop from 4700 to 700 after 3 cycles prior to surgery.

What do you read out of all this?

Thanks
OVCInida
Helpful - 0
Avatar universal
Dr Goodman,  

My mother completed her surgery yesterday.  It was a very long one lasted around 10 hrs.  The surgeons said that she was optimally debulked.  On opening her they found that the tumor had not invaded her rectum and found no bowel involvement.  The Scans had shown no spread to the diaphragm but they could see some spots on that which they could trip out.  They also found significant amount of spread in the peritoneum and had to strip out pretty much the entire area of the peritoneum to get complete clearance.

On the surgical front they where happy with the outcome but said that the 3 chemo cycles she has had should have cleared most of the peritoneum deposits but it has just shrunk it.  They have sent the tumors and other stuff they removed for testing to get a better picture.  They have also implanted an IP port.

Her complete treatment details are on my other posts on this same thread for your reference.

My questions to you are:

1>  Since she has already had 3 cycles of Taxol/Carbo.  Will the next 3 cycles via IP be of any help.  What ever research i do on the net they give stats for 6 cycles via IP?

2>  The surgeons were concerned that the cancer spread to the ascites drain site during chemo which is not a very good sign.  However the PET did not show any activity.

3>  Is her Cancer Chemo resistant, since it did not clear up the peritoneum after 3 cycles.  The surgeon has scheduled a meeting with the medical Onco to see what needs to be done next?  

4>  Are there any sites in the US where we can send her tumor for culture to see how her cancer will respond to different chemo agents to plan her further treatment?

Dr Goodman what do you read out of all this?

Thanks
OVCIndia
Helpful - 0
242604 tn?1328121225
MEDICAL PROFESSIONAL
Hi There,
thank you for the follow up.  My personal rule for chemo after surgery is to wait until a person is eating. Also to be sure that there is no sign of infection.  So chemo can start 1 to 3 weeks after surgery. It sounds like her medical oncologist has a good plan in place.
best wishes
Helpful - 0
438514 tn?1305734140
My mother also had surgery and was told that chemo could start no sooner than 2 weeks after the surgery and possibly 3.  Her surgery involved 3 areas of bowel resection and we started her chemo on day 14 after surgery.  (Her cancer was very agressive and within 13 days of surgery a 5.6 cm tumor had already grown back in her bowel area.)

Hope this helps you.  Best of luck:-)
Helpful - 0
Avatar universal
Dr Goodman,  

My mothers PETCT and blood work are back (After her 3d cycle of Taxol/Carbo)  Her CA125 is now down to 700.  The scan shows that the fluid in her abdomen and around her lungs has dried up and the small tumors in the peritoneum have reduced significantly.  Her main tumor (Pelvic mass) has also shrunk but not considerably.  The PET scan shows cancer activity only in this area and no additional spread after the initial diagnosis.

The medical oncologist reviewed the results and recommended going ahead with surgery.  Today she visited the Gyn-Oncologist who is going to perform the surgery.  He explained to my mother in detail the procedure and a possibility of Colostomy since the rectal involvement is not very clear in the scans.  He said though the scans do not show any other organ involvement, this can be confirmed only on the table and they will do everything possible to remove all the cancer spread.  He has scheduled the surgery for this Saturday March 8th.  However, on hearing all this she is very scared and is insisting on pushing the surgery to Monday March 10th.  We are taking her to a Psycho-Oncologist who she has been in touch with thought her treatment to remove the fear of surgery in her.  

My question to you is:

1>  Her 3d chemo was given on Feb 14th Taxol and Feb 15th Carboplatin.  The Medical oncologist has recommended that he will start her 4th cycle via IP 3 weeks after surgery if there is no involvement of the bowel and 4 weeks via IV if there is a bowel involvement.  Her surgery is scheduled for March 8th.  

      Is the 3/4 week gap after surgery appropriate? In the US what is the
      recommended rest between surgery and start of the 4th chemo ?
      

Thanks
OVCIndia
Helpful - 0

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