Question about number of chemo treatments

[jennifer71]

hello doctor.My mother was diagnosed with a 17 cm cyst in May. She had a radical hysterectomy in June and was originally told it was stage 1c ovarian cancer. Once the pathology report came back,she was told it was stage 1A,Grade2 cells.Her ca125 before surgery was 65. After surgery instead of coming down,it went up to 158! The dr said its not the number its the trend,or maybe its more advanced than they thought. After her first taxol treatment it decreased to 42,and a few days later to 37. Her second chemo treatment was 3 days ago. Her 2 oncologists are now deciding instead of the 3 recommended chemo sessions,whether or not it should be increased to 6 because of the second ca125 result. Yet,everyone tells her that to have it diagnosed at 1a she is incredibly lucky,and that usually doesnt require any further treatment beyond surgery. My mom is only 58 and my best friend. How many treatments would you recommend if she were your patient. Also,what are the chances for recurrance of a stage 1a grade 2 tumor. Thanks so much for your time..
A loving daughter

[Annekathryn Goodman, M.D.]

Dear Jennifer,
Your mother is so lucky to have you!
So here are some general thoughts:

staging of ovarian cancer is based on histological information obtained at the time of surgery. That means: what the biopsies look like under the microscope. "Staging surgery" involves removal of the uterus and cervix, right and left tubes and ovaries, the omentum (the apron of fat that is attached to the stomach and larger intestine), biopsies of the lining of the peritoneum (the lining tissue of the abdomen) and lymph node biopsies. It is important to biopsy lymph nodes along the pelvic blood vessels and the aorta. The blood supply to and from the ovaries comes into the aorta up by the kidneys so it is important to obtain lymph nodes from that region of the aorta.

So one question would be, how many biopsies did your mother have at her surgery? It turns out that about 20% of women who are initially thought to have stage one ovarian cancer actually have stage III disease when enough biopsies are done. If you mother did not have many biopsies, one option is to assume that she might have cancer cells outside of the ovary and give her extra chemotherapy (6-8 cycles). Another option is to perform a second surgery to get more biopsies. If your mother had an excellent staging surgery, then she probably does have a stage Ia cancer which would be wonderful. Then her prognosis is excellent and some people might argue that she does not need chemo at all.

As far as the CA 125 goes, it is very common to bump up after surgery. The surgery in and of itself causes irritation to the lining, the peritoneum. That releases more of the protein called CA 125. The way I look at it, her CA 125 halved after surgery and one chemo treatment. That is just right. I would just throw out the 158 value.

best wishes to you

[jennifer71]

Hello,
Thank you so much for your response.If it is not uncommon after surgery for the numbers to go up then I feel better about the ca125. Her dr we are told is one of the best at Dana Farber,so I would hope her staging was done correctly. Thanks again for your comments. They are much appreciated.