Rising ca 125

[rbradle]

I Had maximum debulking  surgery on 7-9-`10 with a  TAH/ BSO  lymphadenectomy.2  positive nodes, 1 in pelvis, 1 para-aortic and positive pelvic wash.   Diag  uterine adenocarcinoma with a very small foci of carcinosarcoma stage 3c followed by 6 cycles Taxol/Carboplatin..  Had a PET/CT scan 1-3-11 which was NED.  My ca 125 level  before surgery was 77 then during chemo went from 40 ,34,20,16,10,8 .  I have blood testing every 2 months my ca 125 level 2 months after chemo  was 7 then16,  today it is 40.  I feel great.  I am very concerned about this rising ca 125. .Is the ca 125 an accurate test for cancer recurrence. Are there false positives with this?  Are there any other tests I can take? or perhaps vaccine studies you may be familiar with?  Is there anything I can do  to prevent cancer recurrence.  I would appreciate any advice you have.
Thanks so much.

[Annekathryn Goodman, M.D.]

Hi There,
surgery can be useful and we definitely think of surgical removal when surgery is technically possible and does not cause too many side effects

but as there are multiple nodes, there can be complications of removal including
vascular injury
nerve injury
alteration in bowel function
lymphedema

please keep in touch
take care

[rbradle240]

Hi Dr.Goodman,
I am so grateful for your response.  You have helped me to be much more hopeful.  I do have a question about surgery.  It was suggested to me to have  possible surgery to remove the lymph nodes .  Is this something that should be considered and then have chemo? or is chemo first line? I really appreciate all you have sone for me you are truely an angel.  Thanks again.

[Annekathryn Goodman, M.D.]

Hi there,

first of all, there is hope! and do not cancel your trip to Boston.
Your PET CT does suggest that you have an early, asymptomatic recurrence.
one lesson from this is that you can trust small changes in your CA 125 to be reflective of what is going on with you cancer.

This is occurring more than 6 months from your diagnosis. I would call your cancer platinum sensitive. I would push further therapy immediately with a combination of carboplatinum and either doxil or gemcitabine.

You are not sick from this recurrence. there are various philosophies about when to treat recurrence disease.  I think you would not find it tolerable to wait until you are symptomatic to start treatment.

please let us know what you decide to do
take care

[rbradle240]

Dear Dr Goodman,
Thanks for responding to my question  about rising ca 125. I appreciate your help.  I need some medical advice.  As you suggested I had a full body  PET/CT scan today and there are some concerning results and I need your opinion on the next step.Abdomen and pelvis PET/CT images:
- multiple enlarged FDG avid retroperitoneal lymph nodes. 11 x 11 mm left periaortic lymph node table position 482.0, SUV max 4.1. Previously, this lymph node measured 11 x 8 mm and did not demonstrate FDG avidity. 12 x 9 mm left perirectal lymph node at table position 503.2, SUV max 3.3, previously measured 9x6 mm and did not demonstrate FDG avidity. 12 x 8 mm left para-aortic lymph node table position 528.8, SUV max 3.7, previously not clearly present. Moderate focus of FDG activity in the left common iliac region measuring SUV max of 4.6 likely corresponding to the not well visualized 11 by 8mm lymph node, not currently seen.
- atherosclerosis of the descending abdominal aorta and common iliac arteries.
- evidence of prior pelvic and periaortic lymphadenectomy with multiple postsurgical clips in the prior surgical bed.
- evidence of prior TAH/BSO.
Bone windows: Moderate osteophytosis of the lower thoracic vertebral bodies.  Mild osteopenia. Minimal dextroscoliosis thoracolumbar spine. No obvious osteolytic osteosclerotic changes to suggest osseous metastasis.
IMPRESSION:
1. FDG PET/CT scan demonstrates 4 lymph nodes in the left periaortic and left iliac regions which are newly moderately FDG avid and have increased in size since the prior exam and are highly concerning for metastatic disease.
2. Evidence of prior TAH/BSO, pelvic and periaortic lymphadenectomy.
3. Stable linear area of groundglass in the left apex with blood pool FDG avidity, unchanged, likely scar.  Stable 3 mm adjacent pulmonary nodule. Continued attention on followup recommended.
I was told that choices are very limited  if there is a recurrence.  What about more chemo, surgery or radiation? I  need some encouragement.  I am coming to Boston this weekend for a meeting, should I cancel this.    I really would appreciate any help you could give me.  Thanks so much for listening

[Annekathryn Goodman, M.D.]

Hi There,
A CA 125 measures protein secretions of cells of gyn origin both benign and malignant.

You have had state of the art care for your cancer. There is still a risk of recurrence.

The next step should be a CT scan of the chest and abdomen.
please let us know how things are going
take care