Right decision?

[rubyellen46]

I have ovarian cancer, stage 1C, grade 2-3.  I am 46 years old, and am otherwise healthy.  (I have written you before).  I have completed three chemotherapy treatments.  I have had a difficult experience, especially with muscle pain.  I have lost 25 pounds.  Today, my oncologist told me WBC count was getting too low.  Today on the day scheduled for chemotherapy four, my NE# was 1.4, and was 1.0 a week before (2/11), and 0.9 (2/7).

Today, my oncologist gave me a choice:  (1) Full strength chemo with neulasta shot; OR
(2) reduce chemo to 75% strength (both carboplatinun and taxo); OR (3) Full strength chemotherapy four weeks apart.  

I decided to reduce chemotherapy by 75%.  This was a hard choice as I do not have any bank of knowledge on which to make an infomed decision.  I ultimately decided to reduce chemotherapy to 75%.  I am 5'9", and I weigh 170 pounds.  Carbo-platinum was reduced from 590 to 440, and Taxol reduced 348 to 264.  Was this a good decision?  Should I change oncologists?

My CA 125 has been 10, 10 and 13 since chemo.  It was 10 at time of diagnosis, but did rise to 84 following hysterectomy, but went down again on its own before chemotherapy.

Thank you for your advice.  

[Annekathryn Goodman, M.D.]

Hi There,

It sounds like you are having a tough time!. Your decisions are fine. The lower dose of chemo is not a problem. In fact there has never been shown to be a dose response to chemo for ovarian cancer. that is - a higher dose is not more effective than a lower dose.

It is common for the CA 125 to go up after surgery just from the irritation of the lining of the abdomen. It does not mean the cancer is growing.

I cannot comment on your lymph nodes and would rely on your doctor's judgement.

It is a very stressful experience!
best wishes

[rubyellen46]

As I indictataed above, my ca-125 went from 10 to 84 following surgery but before chemotherapy.  During the surgery, the cyst containing the cancer ruptured.  It was apparently "bagged' but i know nothing else.   When the CA-125 went fom 10 to 84 three weeks following surgery, my eosinophils also skyrocketed to 16.3.  Is is possible that my ovarian cancer progressed between surgery on 11/15, and beginning chemo on 12/20?  Isn't this another good argument for a PET scan?

[rubyellen46]

In addition to the muscle aches which occur primarily in breasts and chest area, I have had very painful lymph node pain in armpits, sides of breast and neck. I know extra-abdominal lymph node metases are rare, but I am concerned about cutting back on treatment without even a PET scan (F-FDG-PET/CT).  My doctor flatly refuses to do a PET/CT scan because it is "unnecessary," and keeps telling me it is a virus or ordering massage.  It has persisted for three months.  The lymph node involvement followed surgery before chemo commenced, but has progressed from neck to armpit and breasts following chemotherapy.  I also have mid-line abdominal discomfort that has never resolved.  I know it sounds paranoid, but ovarian cancer is serious business, is it not?