Doctors disagree

[vegas2cr]

I was diagnosed with stage IV April of 07.  6 rounds of chemo and full debulking surgery leaves me feeling good at this point..Spots to my liver disappeared after chemo... Surgery was last September...Every month I have my ca 125 and in January of this year it was 6.0 and every month has climbed to now it is 13.9 but certainly normal range... I see my gynecological oncologist every 3 months and my oncologist and do a pelvic ultra sound and a transvaginal every 3 months..

This week gynecological oncologist wants MRI and radioactive bone scan.. I am self paying here in Costa Rica and although cheaper than United states not cheap.. My oncologist says this week actually the next day.... absolutely NOT.. you do not need those tests and don't do them...They are freinds so I tell her to call him..

My question is I have not had one scan since my optimal debulking surgery and my oncologist likes that.. I do not understand why they have a disagreement going here with me in the middle...She says again that my ca 125 is within normal range and those tests are a waste of money...So now what??? I am puzzled as to who to listen to.  

What is protocol for watchful waiting on ovarian cancer.. the internet is full of different theories.. Thanks for your help..
Ronni

[Annekathryn Goodman, M.D.]

Dear Ronni,

It sounds like you are doing so well.
Getting  CA 125 results can be very stressful.

With a stage 4 cancer, there is a high risk that it can recur.  The fact that it has not yet recurred in 18 months is awesome. It means you  have a platinum sensitive cancer.  There may come a point with your slowly rising CA 125, that it does become clear that you are experiencing a recurrence.

Your two good doctors are giving you two perfectly reasonable approaches. Their differing views reflect the dilemma we all have which is - how hard do we look for a recurrence if someone is feeling well?

The internet is full of different theories because there is no wrong answer. We do not know if it helps to find a recurrence earlier.  I would probably take a middle ground and set some value of the CA 125 at which I would want to look with xrays.  For instance say when it goes above 35.

You could ask your doctors to find a value beyond which they are no longer just watching you without further investigation.

best wishes

[vegas2cr]

Thank you so much for your complete answer.  I feel a whole lot better knowing that neither doctor is right or wrong...I think your advice that if it goes above 35 is sensible... Again thank you for devoting your time to this site.. Ronni