Stage 1A Clear Cell Reoccurrence after 4 1/2 yrs

[Jane39]

Dr. Goodman, I am a bit befuddled as I was diagnosed with Stage 1A Clear Cell OV CA in 3/2006, had complete TAH/BSO, 6 cycles chemo, all CA125 test and PET/CT scans up until yesterday completely normal, CA125 test in June 2010 was 5.9, had another one yesterday but don't what the # is.  Had a PET/CT scan yesterday which showed a soft tissue density mass posterior to the greater curvature of the stomach measuring 2.6cm AP x 2.6 cm transverse (this is new from PET/CT of 11/2009) not opacified with contrast less likely to respresent loop of small bowel, felt to be nodal mass.  Did have associated FDG uptake on pet component within lesion with a maximum SUV of 3.69 on ct slice.  It goes on to state that there is no FDG uptake in cervical or supraclavicular nodal region, abdominal, periaortic, aortocaval, pelvic, inguinal or femoral nodes. No omental thickening
It's been confirmed on the dedicated CT that this is a nodual mass.  I am stunned.  MY PCP and my gyn/oncologist have spoke and they will be doing a biopsy to confirm that it is ovarian tumor, but are rather confident that it is, and will probably end up doing surgery and more chemo.  
I know no one can tell me how this happened, I know it is due to the clear cell histology, I am just scared, terrified frankly that now that this cancer has shown that it will re-occur with in a 5 year period, will this just keep happening and happening, over and over again?  The doctors are saying since I responded so well to the carboplatin/taxotere chemo that I should do the same again.
I am worried about the surgery again, they are saying this tumor is interposed between the posterior wall of the stomach and the tail of the pancreas, the doctor says that it's a big surgery, but doable.  Any advice you may have is greatly appreciated.

[Annekathryn Goodman, M.D.]

Hi Jane
thank you so much for your question
and JulesFrances thank you for your comments
it is terrifying
it sounds like your doctor has been taking good care of you and screening you for recurrence in the only way we currently know how to do:
labs,xrays, exams.

it could be that the CT scan finding is a recurrence, an inflammatory mass, or a new malignancy.

doing a biopsy is the next step in understanding this.

another test worth considering if you have not had it is an endoscopy and a colonoscopy.

if this is a recurrence, surgical resection is worthy of consideration but given the location, you should ask your gyn oncologist about his/her thoughts of partnering with a surgical oncologist who has experience operating in the region of the pancreas.

Some recurrences are identified before you have symptoms. Intuitively it makes sense to me to look and treat before you are sick from a recurrent cancer. However, that is an area of active debate. That is why some doctors advocate not checking CA 125s routinely until a person is symptomatic from a recurrence.

please let us know what happens
best wishes

[JulesFrances]

Hi Jane and Dr. Goodman-
I am also an OvCa survivor, stage 1C CC/mixed endometriod-- now 4 years since my surgery Very  sorry for your news.Terrified would be my first reaction too! I know many women who have been through the OvCa nightmare, some stage 1 recurrences. But no one in my group is a CC survivor.
  I just stumbled on your post today, because I was going to ask Dr. Goodman  "How do you know you have a recurrence of OvCa?" My DrGyn Onc has stop believing in CA125 or any diagnostic blood test w/o my complaining of symptoms.
So I'm curious- What kind of symptoms are we talking about? What indicates a recurrence? I still have all kinds of   pain ...How do you know what is side effect and what is new growth?
Jane- Hope you don't mind my needing info. My thoughts are with you.
How did your doctors know to give you your PET and CT? Thanks much!

[Jane39]

I just wanted to give you some details from the dedicated CT:
At upper left quadrant, between stomach and tail of pancrease and in contact with the medial wall of the splenic flexure of the colon, there is a 2.6 cm complex cystic mass with peripheral ring of enhancement.  It has a mural small area of enhancement.  The rest of its internal component has a water density. The mass corresponds to the recent PET finding and likely represents an ovarian metastasis.  
Calcification within the wall of the abdominal aorta and iliac arteries (??)
ureters and urinary bladder are normal. no enlarged lymph nodes, ascites or ventral hernias are demonstrated.  Bony structures are normal.

I am schedule to have a needle biopsy and some type of endoscope ultra sound this coming monday, again your thoughts~~  Thank You.  Jane