Spread of Grade 1 cancer

Hi again. Since I spoke with you last, I had a stent inserted into my left ureter to relieve the hydronephrosis on my kidney. I took a copy of my CT scan down to Toronto and my Dr told me he didn't see anything. He said he would get a second opinion, but I guess feeling as though it wasn't much of an emergency, it was just done last week. One month later. They called to tell me the wrong scan was copied and when he said he saw nothing, it's because he was looking at a scan from May. Not impressed. The next day (last Wednesday) I had horrible right side kidney pain. I went into emerg and they did another CT scan. "there is now mild to moderate right hydronephrosis and right hydroureter. The uretic obstruction is caused by the pelvic masses with psammomatous calcification. The lesion on the right has increased in size, measuring 4.6 by 3.2 cm compared to 3.5 by 2.5 on the previous exam. There are some nodular densities anteriorly within the pelvis, which are presumably peritoneal metastases or post-operative scarring. There is also a lymph node seen adjacent to the external iliac artery, which is stable in size. It has psammomatous calcification within it and is therefore metastatic. I think that there is increased soft tissue density seen along the medial aspect of the right common iliac artery at the site of previous metastasis. It has increased slightly in size." How can a grade one cancer spread so much in 4 weeks? Is that even possible? I know that psammoma bodies mean cancer - they weren't there on my last scan. Any thoughts? Thanks in advance,
Becky

[Annekathryn Goodman, M.D.]

Dear Becky,
You have been through alot in the last month.
Here are your choices:

surgery: a laparoscopy or laparotomy to see if these masses can be resected or biopsied.

Chemotherapy: as I recall, you had 6 cycles of taxol and carboplatin for a stage 3 c ovarian cancer in 2005. If the biopsy shows recurrent cancer, further chemotherapy should be considered.

Now: psammoma bodies is a pathologic term (a term used to describe how something looks under the microscope). It describes little whorls of calcium. They look like tiny oyster shells under the microscope. Psammoma bodies are famously associated with ovarian cancer. There is also a type of ovarian cancer called psammoma carcinoma because it has so many psammoma bodies in it. So seeing a description of psammomatous just means that there are calcium deposits in these masses. Yes it could be from cancer or it could scar.

Grade 1 cancers are less sensitive to chemotherapy because the cells are slower growing. Chemotherapy works best on cells that are actively undergoing DNA duplication and cell division. So it is possible that your cancer was not treated well by chemo.

Sometimes antigrowth hormones such as tamoxifen or arimedex are a better choice. Tamoxifen should be considered in cancers that are estrogen receptor positive .

You need to get started on some therapy - surgery/chemo/or tamoxifen soon. Something is changing for you and your doctors should not delay intervention.

[Tybear]

Thanks for your response - my Dr won't test my tumors for estrogen. Say's it's not an issue. I think it is, so I've sent all my slides and samples to John's Hopkins for a second opinion. In the meantime, I've stopped taking my Premarin for my peace of mind. He said he can't do more surgery at this point because he was so aggressive with the first one, he'd be worried about damaging my quality of life, say, with a colostomy bag or something. I'm going to start back on Taxol/Carb next week. Unfortunately, my CA125 never went above 18, so I guess CT scans will be the only way to monitor how well it's working.
Thanks for your answer,
Becky

[akg]

Dear Becky,
keep us posted .
good luck to you