Question about recurrence

I finished chemo 7 months ago and I've just learned that I am having my first recurrence - they found 2 tumors. One is 4.5x2cm in diameter and the other is 1.5cm. My question is, how could these have grown so quickly when I have grade 1 cancer? My last CT scan on May 27th showed nothing, now 4 months later, I have these. I'm so overwhelmed right now. I'm 27yrs old and I feel like I'm right back where I was a year ago - my surgery and hysterectomy were done September 30th 2005. I guess at this point it doesn't really matter how the tumors got there - I was just so stunned at my appointment that I never asked.
Thank you in advance,
Becky

[Annekathryn Goodman, M.D.]

Hi Becky,
This must be very overwhelming. Could you please give me a little bit more information? As I recall, you have written before, is that right? You have your surgery for a stage III ovarian cancer? Tell me a little bit more about your therapy and what the CT scan shows. Where are these cysts? What is your CA 125? Then we can think about this carefully
take care.

[Tybear]

I'm so sorry - I should have also mentioned that my CA125 was only 18 - why would it be so low? It was 20 when I finished chemo and in May, had gone down to 14. Thanks again,
Becky

[Tybear]

I'll give you as much as I know. I was diagnosed September 30th, 2005 stage 3c grade 1 - path report says "serous adneocarcinoma with psammoma bodies - the tumor exhibits micropapillary like patterns in some areas". My last CT scan done September 25th, 2006 shows:
"the right kidney appears normal. The left kidney now demonstrates significant hydronephrosis with dialation of the left ureter down into the mid pelvis. There are surgical clips present in the pelvis bilaterally. There are now enhancing nodules present, related to the clips, more pronounced on the right side, where there is a mass present at 4.5cmx2cm in diameter. There is a smaller nodule related to the surgical clips, adjacent to the sigmoid colon that measures 1.5cm in diameter. This latter abnormality is presumably what is obstructing the left ureter. There are no acitites present. The patient has developed left-sided hydronephrosis in the interim and there are now enhancing masses present in the pelvis bilaterally, consistent with local tumor recurrence".
My CA125 prior to surgery/chemo was 46. After surgery, 16. After chemo finished 20, then 14 in May and 18 this appointment. The grade of my cancer is defined on my path report as "architecture 2, nuclear grade 1, mitosis 1, total score 4/9."
Chemo consisted of taxol/carbo and finished February 23rd this year. I was left with no visible tumor after surgery. I hope this helps.

[akg]

Hi Becky,
Your additional information helps alot! It sounds like the cyst is somehow related to the previous are of surgery. The most important finding on your CT scan is that your left ureter is blocked. I would not jump to the conclusion that you have a recurrence. Yes, that is possible but it could also be a benign finding especially with your normal CA 125. You could have something called a lymphocyst which  is a collection of lymph fluid that can collect and make a cyst. It usually occurs in an area of lymph node removal. Think of it like a blister.

At this point, the first thing you need is to have that ureter fixed. I imagine that your doctor will send you to see a urologist. Usually what is done is a procedure called a cystoscopy where the urologist looks inside the bladder with a scope. Then under direct xray vision (using fluoroscopy), a little radio-opaque dye is instilled into your ureters (the tubes that bring the urine from the kidneys to the bladder.) This will show exactly where the blockage is, the a small flexible tubing called a stent is threaded into the ureter to go past the area of blockage. This opens up the ureter and allow the urine to drain.

After your blockage is opened up you either need a biopsy of that cyst or a surgery to remove it and at that time permanently fix the ureter.
let me know what happens.
take care

[Tybear]

I actually developed a blockage (similar to the one that was just discovered, and in the exact same spot too) right after my surgery in Sept 2005. They determined it was a soft tissue mass (happened 3 weeks after surgery) and I did have to have a stent inserted, because it was causing the same problem - hydronephrosis of the left kidney. That is what has raised my red flag - I find it very strange that this tumor grew back in the exact same spot as before - they even thought, before, that maybe it was the surgical clips interfering with my ureter. Would the presence of surgical clips indicate that they removed lymph nodes from that location? I don't have an appointment to see my urologist until the 18th - I'm very concerned that it seems like too long a wait. I'm not having any kidney pain, though, so I guess the doctors aren't too concerned. Aside from all that, is it really possible for a grade 1 cancer to grow that fast? I'm just confused because I thought that grade one meant slow growing. I'll let you know how I make out - I'm still waiting for an appointment at my Regional Cancer Center (Sunnybrook) in Toronto. Thank you for answering my question.
Becky

[akg]

Hi Becky,
yes usually clips are used in a lymph node dissection. The ureter runs over the pelvic blood vessels (the iliac vessels). A blocked ureter in an area of previous surgery can occur from scar tissue in that area or from the development of some growth -benign such as a lymphocyst or abcess (abscess), or malignant such as recurrence in a lymph node.
If your kidney function (the blood tests - BUN and creatinine) is normal, it is probably OK to wait 10 days to see the urologist. I would be happier if you got an earlier appointment.
It is unusual but not impossible for a grade one cancer to recur in a year.
take care

[Tybear]

Thank you so very much for your prompt answers - I'm actually waiting for a call back from the hospital this morning as I developed flank pain last night and I'm in quite a bit of discomfort. Hopefully this will be resolved sooner rather than later.
Respectfully,
Becky H.