First recurrence~next steps?

[NotDyingToday]

Hello~ Hope you might advise....My most recent CT scan suggests that I've begun to relapse after 15 month remission following 11/06 dx of Stage IIIC, papillary serous ovarian cancer, grade II.  I am only 55 and otherwise very healthy (if that makes sense).  Induction chemo was IP Cisplatin and IV Taxol and Carboplatin, six cycles.  I tolerated this very well, only requiring Neulasta shots twice and had no drop in red count or other blood work. I opted for and completed 12 months of maintenance chemo, Taxol IV, which ended in May 2008.  My CA125 at end of induction chemo was between 7 and 8 and at end of maintenance it was between 9-11.  In July it nudged up to 14 and in August it jumped to 26, prompting the CT Scan.  My scan shows slightly enlarged nodes in chest (still within normal range but larger than my 11/07 scan) and a lesion in or on my spleen and a lesion near one of my kidneys. My doctor has suggested several options. Debulking surgery this fall to reduce tumor load, followed by chemo which would probably be a platinum drug since I'm evidently platinum sensitive is one aggressive approach. He believes he can remove all nodes and lesion or entire spleen but not the periaortic node which is also slightly enlarged.  This would be handled via chemo.  Another option is chemo now (platinum), or Avastin in combination with platinum.

We're also thinking I might want to wait to do another CT in about a month to see how indolent my tumor is and to confirm that nodes etc. are/remain enlarged etc. If no evidence of further progression, we might wait another month and scan again.  If progression, then decide on course of action, i.e. start treatment which would be surgery/chemo,  or chemo only, or chemo/Avastin.  
FYI, I work full time, am fairly active doing yoga and walking 1 to 2 miles most every day.  I have no pain or discomfort, no ascites etc.  --just early indicators of a relapse. Any advice you might offer would be greatly appreciated.

[nyc lady]

There are many women on this forum going through recurrences and I am certain that they will be along shortly to offer their opinions.

Your doctor sounds as though he is on top of things and is aggressive with treatment.  

Best of luck and keep in touch.
Pam

[elizza]

I'm so sorry u are having a recurrence.  My mom's story sounds similar to yours, as far as chemo goes and what not.  She was dx with stage 3c ovca in May 06, and had 6 rounds of IP chemo (cisplatin, and taxol), and then did 12 rounds of maintenance chemo after that. She finished in September 07.  Her ca-125 has mostly been 4, but has ranged from 4-7 through out that time.  However, in May 07 she had a ct scan that showed no disease, but her ca-125 went to 14.  She had blood work done yesterday and we get the results on Monday.  We are very worried naturally.  Anyway, I just wanted to let you know I am thinking of you, and best of luck to you!
What was ur ca-125 at ur initial diagnosis?

[crecco]

Your Dr has given you several choices of which are good. Many of us recieve no choices at all. I think that you should think them all through and go with what you feel the most comfortable. Your Dr does sound on top of things, but here is something to think about. From the sounds of it, no matter which route you decide to take, you will still have to have chemo. Now this is just my opinion but why put yourself through another major surgery when you will still be having chemo afterwards. If it does happen to be a recurrence, then you are catching it as it is just starting so it will not get out of hand. The chemo should be able to control it. As I said this is just my opinion. I was dx at stage IV did the chemo, had surgery and also recieved taxol as maintenence. But I did not make the full 12 months before it was back. (I actually only made it 4 months) I have been on chemo ever since but we have been able to hold the cancer steady. My Dr has opted for no surgery as he would rather me keep my strength for the chemo.
I wish you luck on what ever you decide.
  Chris

[marie3B]

Chris makes sense to me to me.  Marie

[marie3B]

Oops don't know why I typed "to me" twice. Marie

[JC145]

Just as another option to discuss with  your MD .. if you decide to wait a month or two, ask about tamoxifen.  It will work for 10% of OVCA women and has worked for me.  My CA went to 104 gradually after chemo 11/06 thru 7/07.  In my case, there was no sign of disease .. just a small amount of ascites.  After 6 to 8 weeks, the count dropped to around 70 and continued to drop until 12/07 to a normal of 20.  It has since been rising again .. 8/08 was 72.  I know I have a lymph node that showed on the PET/CT scan in May and we are redoing the scan at the end of next week.  IF the only thing there is the lymph node, we are waiting another couple of months.  If there are more lymph nodes or something else, I'm off to chemo.  This is just food for thought.  The tamoxifen may not work for you, but if you are waiting around, it won't hurt either.  Other than hot flashes, no real side effects for me.  As far as my lonely little lymph node, the chemo will work in 2 months as well as today, so I'm opting for waiting and watching.  Again, just a thought to discuss with your MD.  Judy