Treatment options for Stage 1C

[Jackie37]

In December 2005 at 34 I had a self diagnosed palpable abdominal pelvic mass.  Scanning confirmed a 15x15x12 centimetre mass posterior to the uterus with a CA125 elevated at 618.  25 January 2006 I underwent a laparotomy with right salpingo oophorectomy, paraaortic lymphadenectomy, appendicectomy, omentectomy and left ovarian biopsy.  Histology confirmed a borderline tumour within the right ovary but with small area of invasive tumour.  The borderline change did however breach the capsule.  I was thus staged at 1C adenocarcinoma in the right ovary with incomplete assessment of the left.

I then had 6 doses of carboplatin chemotheraphy over 21 weeks and six weeks after completion of chemo my CA125 was down to 15 and I believe my last count in February was 8.  I am now 35 and still wish to have children.  My consultant gynaecologist however wants to complete the surgery.  

I was wondering if this was always the course of action for someone in my situation and what the implications may be if I decided to forgoe surgery and maintain fertility.  I seem unable to find any research or data to aid my decision making.
Thank you.

[Jatoo]

This is just to put on record that a donor egg and in vitro fertilization  is not a good idea. I can put volumes and volumes of reasoning  here but sensible research would prove that my point is reasonable and correct.

[Jackie37]

Thank you for your comprehensive response.  My surgeon did a biopsy of the left ovary and stated it was incomplete assessment, as it would be impossible to ever say with certainty that there was no disease through biopsy as there is to much area to cover.

I have had no children as yet and I have never had endometriosis and there is no family history of any cancer, other than one case of lung cancer (my mother's mother due to excessive long term smoking).

The surgery and chemo have not impacted my monthly cycle, I only had 4 days of post operative bleeding (light), I only missed one month and that was after the surgery and since then its been as normal.

My surgeon is not keen to just remove the left ovary and has stated I should either do nothing or remove everything.  I was also told that no fertility clinic would consider harvesting my eggs because of my age and the fact I had stage 1c ovarian cancer, my eggs would not be considered viable, plus hyper stimulating the ovary to produce the eggs, puts me at increased risk of recurrance.
Thank you again.

[Annekathryn Goodman, M.D.]

Dear Jackie,
It sounds like there are three separate issues for you to consider:
1. You have an ovarian malignancy that appears to be confined to your right ovary and has been completely treated. So the Present question is: is there any sign of cancer now that you have completed your therapy? My question to you is: if you had a second surgery that revealed more cancer, would you be willing to undergo the removal of your uterus and your other ovary? The standard recommendation would be for you to remove that remaining ovary and uterus and have more chemotherapy if persistent cancer was seen at surgery. On the other hand, if you had a surgery 'second look surgery' and multiple biopsies showed no evidence of cancer, it is not unreasonable to preserve your uterus and ovary and try to have a child.

2. What is your risk of having a second , unrelated cancer in your left ovary? I do not know any good statistics on this. I would assume that your risk is higher than the general public. Other factors that may be helpful to know include : do you have any endometriosis? Do you have a family history of ovarian, breast, endometrial, and/or colon cancer? if so , your risk is even higher. You should ask your doctor about getting genetic testing for BRCA1 and BRCA2 gene mutations. That information will give you good statistics on your risks. Regardless of this information, if you decide to get pregnant, after you have completed child bearing, I would recommend that you consider the prophylactic removal of your other ovary. Remember, we have no screening test for ovarian cancer.

3. What is your fertility potential? Have you had any other children? In your mid - 30s and with the extensive surgery and chemotherapy that you have had, you may have a reduction in your fertility. Should you decide that you want to get pregnant, I would recommend that you consult with a fertility specialist so that you do not waste any time trying to get pregnant. You should also ask the fertility doctor about that option of donor egg with in vitro fertilization. That is , even if you decide to have your left ovary prophylactically removed, you can carry a pregnancy in your uterus with someone else's egg.

there is no evidence that pregnancy per se triggers ovarian cancer and escalates it.

best wishes to you. I know this is a tough issue.

[Jackie37]

Hello

Thank yu for your suggestion but I did visit the patient to patient forum first and pose the question (with less medical info) to see if there was anyone else who had or is in my situation and I have had one reply.  As you can see, I have not had a response from DR Goodman either, so I don't seem to have much joy in ever getting any answers to my predicament and time is running out.

[dian07]

Hey kid...don't give up yet!  Your issue is the next one up in this forum.....hopefully Goodman will respont to your questions shortly.....I can certainly understand your desire to maintain your fertility.....and bear children of your own....still some of us aren't able....just hang in there....answers or different perspectives will come soon.
Peace.
dian

[Jackie37]

thank you, trying to hang on in there and be patient.

[Jo A]

Darlin' this is not the time to be trying to maintain fertility, it's time to try to save yor life! Please have the surgery, actually I;m surprised it was all don at the time. Why keep an ovary you know is cacerous?

[SimplyStar]

come visit the patient to patient forum  on OVCA  and let some of the ladies there tell you their stories  they are a big help and so smart