Low-grade Papillary Serous Carcinoma

Hi Dr. Goodman,

Would you please explain the difference between Low-grade Papillary Serous Carcinoma and Micropapillary Serous Carcinoma?  I've researched both of them online but it is very confusing.  

I have recurrent Low-grade Serous Carcinoma and I'm being treated now with topotecan.   After 6 treatments I have had a 40% reduction in CA-125 but no tumor reduction.  It makes logical sense to me that when the CA-125 goes down the tumors would shrink, but this is not the case.  What is going on in the body that causes this scenario of CA-125 reduction but non-shrinkage of tumors?  

The doctor that I see now has referred me to a surgeon at my request.  If the surgeon thinks that the recurrence that I have is totally resectable, would that be the best option for this type of low-grade cancer?  Would you recommend hormonal therapy or chemo afterwards if I was a candidate for surgery, and if so, what would you recommended?  If I am not a candidate for surgery, and since I'm never likely to get tumor shrinkage with chemo, what would your thoughts be on stopping chemo and starting hormonal therapy?

Thanks,
Ramsay

P.S.  More complete info is in my profile if you need it.    

[Annekathryn Goodman, M.D.]

Dear Ramsay,
thank you for your question.
As far as micropapillary - that is just a description of how the cancer looks microscopically. It is not important for staging, prognosis, or treatment decisions.

What is important  is the stage, extend of surgical resection at first surgery and grade.

You are now experiencing a recurrence. Here is a good description of grade from this site:

http://www.oncologychannel.com/ovariancancer/tumor-grade.shtml

Tumor grade generally refers to the degree of differentiation—or maturity—of the cells that make up the tumor within the ovary. Yet, worldwide, there are many different systems for the grading of ovarian cancers, without a common standard.

Most investigators use criteria such as the architectural "pattern" of the cells and their nuclear content (e.g., DNA "ploidy," or how many pairs of chromosomes are present), although additional factors may be considered, such as the tumor's margin, invasion of the blood vessels, and penetration of the ovarian capsule (surface).


Most epithelial cancers are categorized by three grades of cells:

Grade 1:  the least malignant, with well-differentiated cells  
Grade 2:  intermediate, with moderately differentiated cells  
Grade 3:  the most malignant, with poorly differentiated cells  


Overall, low-grade (e.g., Grade 1) tumors grow more slowly and have a better prognosis than high-grade tumors.

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Low grade ovarian cancers are a mixed blessing.
They grow slowly.  But because so few of the cancer cells are in active DNA synthesis and cell division (which is where chemo kills the cells), low grade tumors are not very sensitive to chemotherapy.

That your CA 125 is dropping means that a proportion of the cancer cells which produce the CA 125 protein are being killed. Not all cancer cells produce this protein. It could be that what is seen on a scan is cancer, is scar , or a combination.

For low grade tumors, surgical resection of the cancer, if possible, can be an important treatment intervention.
Please let us know how you are doing
best wishes
ak

[Michael7549]

A related discussion, Why is important to know grade level of tumor was started.