Primary Peritoneal Cancer

[chopps]

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

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.

Thank you,
CH

[marie3B]

Carboplatin is less toxic to the kidneys than cisplatin.  I had never heard of the Cavitron Ultrasonic Aspirator.  Sounds promising.  So many things are in the test stage, just not available for us to benefit from yet.  I sure wish your mom the best.  She is lucky to have you.  Marie

[chopps]

Hi Maria,
Surgery for my mother was today.  She looks great, has a sense of humor and is ready to fight her cancer.

She was suboptimally debulked which was very disappointing.  There is a nodule on her intestine and one in the pelvis he couldn't remove.  He also said that he wouldn't do IP therepy because she wasn't optimally debulked and what's left is bigger that 1 cm.  I told him I thought the research was inconclusive regarding tumors larger that 1cm.

I have mixed emotions.  I am glad she got through the surgery with out needing a bowel resection (she was worried about this).  It ended up that the omentum had wrinkled causing her bowel pain and there was no cancer penetration into the wall of the intenstines.  I am a little upset that the surgeon did not get the tumors under 1 cm. and when I asked about the one in the pelvis and why he didn't remove that one..his response was there was 1 another nodule I couldn't get and it was safer to leave it.

I just read about an aggressive ultrasound called Cavitron Ultrasonic Aspirator, which uses sound waves to remove tumor growth by crushing and sucking it out.  Not sure why he wouldn't use this unless Kaiser, SF doesn't have equipment. (Most likely)

Input on suboptimal debulking and the best direction to go in?

Also, it's difficult to push these dr.'s.   It seems that they have one way and that's the only way they will consider.   I know I need to just keep asking questions.

Any input on intervenous vitamin C and B17?

Thanks,
Chopps

[JC145]

Cisplatin is used when doing IP chemo.  Carboplatin is used when everything is done through a vein.  They are "cousins" as my MD said.  Very similar.  Judy

[chopps]

Thank you very much.  I'll update you after surgery.  
Do you know anything about the chemo drug carboplatnum & Taxol? A friend of the family had this chemo four years ago in stage III and is doing great with one reoccurance in '06.  She is now on the maintenance drug Doxal.
Chopps

[marie3B]

I am back.  I did not choose I/P chemo.  While in surgery the gyn/onc made the decision for me and placed the I/P port.  He chose to install a larger one than normal because often port cath failure is the reason all treatments cannot be completed I/P.  My port worked all the way through.  The size of it being screwed onto my rib was uncomfortable, but it served its purpose.  I am glad he made the decision for me.  He felt it was the best option they had and wanted to give me as much time as possible.  The way it turned out I have no way of knowing if it did give me better results than regular chemo.  I do know that I tried my hardest to kill this cancer.  Following chemo my scan showed the implants in my left abdomen (diaphragm area) were still there. They are stable and that may or may not be from the chemo.  I am now 10 months out from chemo and they are still stable.  Some oncs will not do I/P if there has been colon resection.  Mine did.  My chemo drugs used were cisplatin I/P, taxol I/P, and taxol I/V.  I had 6 I/V treatments and 12 I/P treatments.  The I/P treatments took a long time due to the pre med I/Vs they give to help avoid allergic reaction and kidney damage.  The cisplatin treatments took around 8 hours and the taxol about 6 hours.  They were no fun, but my IBS made them worse on me than a person without bowel trouble.  I am glad I did it, but I know I would never do it again if it was offered to me.  It won't be because it is not used for 2nd line treatment as far as I have heard.  I wish her the best and am here if you need me.  Good luck.  Marie

[marie3B]

I will be back after 5pm to answer this fully.  Right now the kids are here and I can't concentrate.  I want to give you my full attention.  Marie

[chopps]

Thank you for your response and input.  Also Conquerer as well.

I figured out how to post to doctors and it's full.  I'll try tomorrow.

Marie and Conquerer please share your knowledge and experiences.  

Here are some questions:

1.  Does she do IP or regular chemo?  It's a touch question. Please give your opinions of why you chose the IP.  Many people I have heard can't finish the cycle. Congrats to you.

2. Does IP Therepy outweigh the negatives of the toxicity.  I have heard neuropathy and side effects are worse than regular chemo however, in the long run, life can be extended 1 year to 18 months.  Quality of life is important to my mother and at the same time she wants the best procedures and chemo to extend her life to the fullest and legthen the time before a recoccurance.

3.  Do you feel that waiting to get the port in could cause the microscopic cancer cells to spread?  Was your doctor concerned about infection with the procedure you had done on your colon and intestines?  Why did you put the port in right away?

Thank you for your support and opinions.  I have researched and researched but it's difficult to find the pros and cons of IP chemo.  Thoughts?

You are in my prayers and thoughts.  Hang in there.  Your input is helping others!  
Thank you,
Chopps

Any information, knowledge and experiences you can share are appreciated.

2.  Are there other successful options? (I now success is relative)

3.  Do you know any experimental drugs or things not on the market that have helped delay

[marie3B]

They may have met the question limit for today.  Click on the expert ovarian cancer link to the right of this and keep trying.  Good luck.  marie

[chopps]

How do I post on the doc forum?
Thanks,
Caren

[Conquerer]

I too had IP although my two ports where put in 2 weeks later in an out patient procedure.  I think after 6 hours they wanted me out of the or.  I am doing fine although long term the IP kick my b  and i get tired easier now.

[marie3B]

This did not post on the doc forum, but I will tell you that they put my I/P port in during my surgery and I also had colon and rectal resection.  They remove as much of the tumors in surgery as possible.  If what is left is tiny it is considered optimal debulking and I/P is possible.  I completed all of my I/P so feel free to contact me with any questions.  Good luck,  Marie