Interval de-bulking what next?

Seems like a very fast growing ovarian cancer? My sister had a 10x11x7.5 cm mass show up in middle lower pelvis 11 days after surgery for stage 2C, grade 3, endometrioid cancer. Surgeon left some scattered disease in pelvis and posterior sigmoid colon but said bulk of disease was removed. She had to wait 6 more days to start chemo. Her CA-125 was 295 at surgery, 195 starting 1 st chemo and down to 13.3 before 4th. She then had surgery after fourth chemo to fix fistula, colostomy, and debulk the tumor. Disease left on vaginal cuff, bladder and rectum stump. Surgeon said he got 98% of it. Now what to do? Should we continue with carbo/taxol rounds 5 and 6, etc. Surgeon is thinking about radiation or switching chemos because disease was still there. How would he expect chemo to take care of such a large mass? We are really scared it is going to grow back fast again. How long does it usually take to become platinum/taxol resistant? I want to keep with same chemo and if no response then switch or radiate since it worked before. I am a little hesitant as her symptoms seemed to be getting worse before surgery. Could infected tumor swell? No disease in abdomen.  Sigmoid colon was involved with tumor and removed. Would you recommend staying with Carbo/taxol for at least 6 rounds and monitor response or ?

[Annekathryn Goodman, M.D.]

Hi there,

Thank you for the detailed report. from the information about the CA 125, your sister's cancer is sensitive to the chemotherapy she has received. She had a rapid drop in her Ca125 to normal by cycle 4.

There are many options and no wrong answers here.
You have quite correctly listed the various approaches:
-stay with the same chemo regimen
-change to a different chemo type
-change to a differnt form of therapy such as radiation

My leaning would be to do just as you suggest, push the present chemo drug as far as they will go say another 2 to 4 treatments.
however, I was not at her surgery. that direct information is very important. It may be that her surgeon saw more cancer than he was expecting and that is why h suggests a change.

best wishes