Aa
IS IT IN RIGHT TRACK????
Hi
I am wiritng this on behalf of my mom who has been recently diagnosed of ovarian lesions.
ABOUT THE PATIENT:
AGE - 53
MENOPAUSAL - YES - 2 years back
FAMILY HISTORY OF OVARIAN CYSTS/ BREAST CANCER/MALIGNANCY - YES
SYMPTOMS:
- acute lower abodminal pain for more than 4 months
- walking difficulties
- mild rise in temperature at nights
EXAMINATION:
- USG - OVARIAN CYSTS SIZING 3.8*3.6MM
- CT SCAN - LEFT OVARY - 4.cm ENLARGED ; RIGHT OVARY - 7cm*4cm GROSSLY ENLARGED ; BILATERAL OVARIAN LESIONS WITH POSITIVE NEOPLASMS ; PERITONIAL FOLLICULES SEEN/DOUBTED
- doctors feel that the ovaries contain MASS and the other is 50% cystic
- CA 125 - 145
SUSPICION:
- ovary - mailgnant / benign
- tuberculosis
After referring the physian and medical and surgical oncologist, they doctors have proposed to do a LAPAROSCOPY followed by STAGING LAPAROTOMY.
I wish to know for the following:
1. Is the above case suspected of OVARIAN CANCER? When does that come to a conclusion?
2. Is the treatment on right track?
I am wiritng this on behalf of my mom who has been recently diagnosed of ovarian lesions.
ABOUT THE PATIENT:
AGE - 53
MENOPAUSAL - YES - 2 years back
FAMILY HISTORY OF OVARIAN CYSTS/ BREAST CANCER/MALIGNANCY - YES
SYMPTOMS:
- acute lower abodminal pain for more than 4 months
- walking difficulties
- mild rise in temperature at nights
EXAMINATION:
- USG - OVARIAN CYSTS SIZING 3.8*3.6MM
- CT SCAN - LEFT OVARY - 4.cm ENLARGED ; RIGHT OVARY - 7cm*4cm GROSSLY ENLARGED ; BILATERAL OVARIAN LESIONS WITH POSITIVE NEOPLASMS ; PERITONIAL FOLLICULES SEEN/DOUBTED
- doctors feel that the ovaries contain MASS and the other is 50% cystic
- CA 125 - 145
SUSPICION:
- ovary - mailgnant / benign
- tuberculosis
After referring the physian and medical and surgical oncologist, they doctors have proposed to do a LAPAROSCOPY followed by STAGING LAPAROTOMY.
I wish to know for the following:
1. Is the above case suspected of OVARIAN CANCER? When does that come to a conclusion?
2. Is the treatment on right track?
Hi Dr Goodman
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovarian lesions - confirmed - as shown in Ct scan
I couldn't ask him on whether there are positive lymph nodes.
right now the course of treatment was informed as follows:
1. have 3 sets of chemotherapy to allow optimum regression of the disease.
2. do again laparoscopy to find the extent of regression.
3. if satisfactory, then de-bulk the organs/tumors.
4. or else, in any case invasive surgery must take place. - DESPERATION SURGERY.
5. again 3 sets of chemotherapy.
Ur comments?
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovarian lesions - confirmed - as shown in Ct scan
I couldn't ask him on whether there are positive lymph nodes.
right now the course of treatment was informed as follows:
1. have 3 sets of chemotherapy to allow optimum regression of the disease.
2. do again laparoscopy to find the extent of regression.
3. if satisfactory, then de-bulk the organs/tumors.
4. or else, in any case invasive surgery must take place. - DESPERATION SURGERY.
5. again 3 sets of chemotherapy.
Ur comments?
MEDICAL PROFESSIONAL
Hi There
thank you for your complete information.
The proposed intervention of laparoscopy to see what is going on and then possible larger surgery to remove the ovaries is absolutely right.
After menopause, an elevation in CA 125 is very worrisome. There are other reasons for elevation such as infection, heart failure, liver disease. But if your mother has no other health problems then it is less likely.
The normal range for a CA 125 protein level in premenopausal women is under 35 and can vary with the menstrual cycle. After menopause, most women have a CA 125 level that is under 10.
Your mother's ultrasound is also concerning.Those are significant ovarian lesions. It is important to have a gyn oncologist involved with her surgery or a surgeon who is familiar with cancer surgeries.
I am not sure whether Lithuania has the subspecialty of gyn oncology.
Now while I am worried by the description that you give of your mother's condition, it is possible that she has another benign condition of the bowels called diverticulitis. This is a condition where small swellings develop in the wall of the large intestine (colon) that can become inflamed. This can cause pain. the colon is in close proximity to the ovaries and the ovaries can become inflamed and enlarged as well. The inflammation can cause an elevation in the CA 125.
Please let us know what happens with your mother.
best wishes
thank you for your complete information.
The proposed intervention of laparoscopy to see what is going on and then possible larger surgery to remove the ovaries is absolutely right.
After menopause, an elevation in CA 125 is very worrisome. There are other reasons for elevation such as infection, heart failure, liver disease. But if your mother has no other health problems then it is less likely.
The normal range for a CA 125 protein level in premenopausal women is under 35 and can vary with the menstrual cycle. After menopause, most women have a CA 125 level that is under 10.
Your mother's ultrasound is also concerning.Those are significant ovarian lesions. It is important to have a gyn oncologist involved with her surgery or a surgeon who is familiar with cancer surgeries.
I am not sure whether Lithuania has the subspecialty of gyn oncology.
Now while I am worried by the description that you give of your mother's condition, it is possible that she has another benign condition of the bowels called diverticulitis. This is a condition where small swellings develop in the wall of the large intestine (colon) that can become inflamed. This can cause pain. the colon is in close proximity to the ovaries and the ovaries can become inflamed and enlarged as well. The inflammation can cause an elevation in the CA 125.
Please let us know what happens with your mother.
best wishes
MEDICAL PROFESSIONAL
Hi There
the report tells us she has a cancer of gland forming tissue. 'Adeno' means glads
Itwould be improtant to talk with the pathologist who signed out this report to see if more information about origin can be gathered. However, given that she has a 7 cm mass on her ovary by CT scan, I am suspicious that this is ovarian cancer.
please keep us posted on how your mother is doing
take care
the report tells us she has a cancer of gland forming tissue. 'Adeno' means glads
Itwould be improtant to talk with the pathologist who signed out this report to see if more information about origin can be gathered. However, given that she has a 7 cm mass on her ovary by CT scan, I am suspicious that this is ovarian cancer.
please keep us posted on how your mother is doing
take care
Hi Dr,
Thanks a ton for the reply.
The biopsy is as follwos:
SPECIMEN:
PERITONEAL NODULE
MACROSCOPIC DESCRIPTION:
Received a specimen of small nodule measuring 1.0*0.8*0.3cm. Cut surface appears pale white.
MICROSCOPIC DESCRIPTION:
Section shows a tumor arranged in islands, cords and trabeculae with focal areas of glandular differentiation separated by thin bands of fibrous septa. The tumor cells are round to oval with moderate cytoplasm and rounf to oval vesicular nuclei with indistinct nucleoli.
IMPRESSION:
Peritoneal nodule: Features are sugestive of a METASTATIC ADENOCARCINOMATOUS DEPOSIT.
I dont find mention of whether the metastasis is from the ovaries. Does bowel and pancreatic cancers have adenocarcinomatous development.
Thanks a ton for the reply.
The biopsy is as follwos:
SPECIMEN:
PERITONEAL NODULE
MACROSCOPIC DESCRIPTION:
Received a specimen of small nodule measuring 1.0*0.8*0.3cm. Cut surface appears pale white.
MICROSCOPIC DESCRIPTION:
Section shows a tumor arranged in islands, cords and trabeculae with focal areas of glandular differentiation separated by thin bands of fibrous septa. The tumor cells are round to oval with moderate cytoplasm and rounf to oval vesicular nuclei with indistinct nucleoli.
IMPRESSION:
Peritoneal nodule: Features are sugestive of a METASTATIC ADENOCARCINOMATOUS DEPOSIT.
I dont find mention of whether the metastasis is from the ovaries. Does bowel and pancreatic cancers have adenocarcinomatous development.
MEDICAL PROFESSIONAL
Hi There,
It sounds like the surgeon made an appropriate decision to just do a biopsy and wait for the results. It is important to see what the biopsy shows. If this is cancer, it is important to understand where it comes from. Is it ovarian cancer or a cancer that has spread form the bowel or the pancreas? You should ask the surgeon for the final report. The management will be very different depending on the origin of the cancer.
The standard of care for ovarian cancer is an attempt at complete surgical removal of all the cancer (this would involve the removal of the uterus, fallopian tubes, ovaries and omentum (an apron of fat that covers the stomach and intestine.) Surgery can also involve the removal of segments of intestine if they are involved.
Many surgical oncologists may not have the training to do this cytoreductive surgery for ovarian cancer. They are usually trained to perform surgery for early colon cancer, pancreatic and stomach cancers and even liver surgery. Many surgeons in this subspecialty have not had alot of experience with ovarian cancer.Or it is possible that your mother's doctor has had special surgical training for ovarian cancer (you should ask him how many case of debulking surgery (cytoreductive surgery) for ovarian cancer he has done. A gynecologic oncologist usually does 30 to 50 surgeries of this type per year.
There are some ovarian cancers that are very large and primary chemotherapy followed by cytoreductive surgery is reasonable. I do not recommend a second laparoscopy, she needs a real surgery if she has ovarian cancer.
best wishes.
It sounds like the surgeon made an appropriate decision to just do a biopsy and wait for the results. It is important to see what the biopsy shows. If this is cancer, it is important to understand where it comes from. Is it ovarian cancer or a cancer that has spread form the bowel or the pancreas? You should ask the surgeon for the final report. The management will be very different depending on the origin of the cancer.
The standard of care for ovarian cancer is an attempt at complete surgical removal of all the cancer (this would involve the removal of the uterus, fallopian tubes, ovaries and omentum (an apron of fat that covers the stomach and intestine.) Surgery can also involve the removal of segments of intestine if they are involved.
Many surgical oncologists may not have the training to do this cytoreductive surgery for ovarian cancer. They are usually trained to perform surgery for early colon cancer, pancreatic and stomach cancers and even liver surgery. Many surgeons in this subspecialty have not had alot of experience with ovarian cancer.Or it is possible that your mother's doctor has had special surgical training for ovarian cancer (you should ask him how many case of debulking surgery (cytoreductive surgery) for ovarian cancer he has done. A gynecologic oncologist usually does 30 to 50 surgeries of this type per year.
There are some ovarian cancers that are very large and primary chemotherapy followed by cytoreductive surgery is reasonable. I do not recommend a second laparoscopy, she needs a real surgery if she has ovarian cancer.
best wishes.
Sorry but i guess i forgot to add that the sample from the peritoneum has been sent for biopsy result and after that the doctor recommends the mentioned treatment if confirmed by the result.
Hi Dr Goodman
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovarian lesions - confirmed - as shown in Ct scan
I couldn't ask him on whether there are positive lymph nodes.
right now the course of treatment was informed as follows:
1. have 3 sets of chemotherapy to allow optimum regression of the disease.
2. do again laparoscopy to find the extent of regression.
3. if satisfactory, then de-bulk the organs/tumors.
4. or else, in any case invasive surgery must take place. - DESPERATION SURGERY.
5. again 3 sets of chemotherapy.
Ur comments?
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovarian lesions - confirmed - as shown in Ct scan
I couldn't ask him on whether there are positive lymph nodes.
right now the course of treatment was informed as follows:
1. have 3 sets of chemotherapy to allow optimum regression of the disease.
2. do again laparoscopy to find the extent of regression.
3. if satisfactory, then de-bulk the organs/tumors.
4. or else, in any case invasive surgery must take place. - DESPERATION SURGERY.
5. again 3 sets of chemotherapy.
Ur comments?
Hi Dr Goodman
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovarian lesions - confirmed - as shown in Ct scan
I couldn't ask him on whether there are positive lymph nodes.
right now the course of treatment was informed as follows:
1. have 3 sets of chemotherapy to allow optimum regression of the disease.
2. do again laparoscopy to find the extent of regression.
3. if satisfactory, then de-bulk the organs/tumors.
4. or else, in any case invasive surgery must take place. - DESPERATION SURGERY.
5. again 3 sets of chemotherapy.
Ur comments?
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovarian lesions - confirmed - as shown in Ct scan
I couldn't ask him on whether there are positive lymph nodes.
right now the course of treatment was informed as follows:
1. have 3 sets of chemotherapy to allow optimum regression of the disease.
2. do again laparoscopy to find the extent of regression.
3. if satisfactory, then de-bulk the organs/tumors.
4. or else, in any case invasive surgery must take place. - DESPERATION SURGERY.
5. again 3 sets of chemotherapy.
Ur comments?
Thanks Dr Goodman
Your reply is indeed throwing light on the posible outcomes tht the surgeons may see after the laparosopy.
Sorry but i guess i didnt check my profile while signing in, FYI I am from INDIA, from a city in south of the country.
My mom's surgery is going to be done my a laproscopic surgeon and the staging laparotomy by a SURGICAL ONCOLOGIST.
Thanx for your wishes and sure shall update you s well.
Your reply is indeed throwing light on the posible outcomes tht the surgeons may see after the laparosopy.
Sorry but i guess i didnt check my profile while signing in, FYI I am from INDIA, from a city in south of the country.
My mom's surgery is going to be done my a laproscopic surgeon and the staging laparotomy by a SURGICAL ONCOLOGIST.
Thanx for your wishes and sure shall update you s well.
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