Staging and Prognosis

Dear Dr.,

My mother was diagnosed with stage Ic ovarian cancer, clear cell pathology, last February.  She went through the standard surgery and six cycles of platinum based chemotherapy, finishing up in July.  About six weeks ago, we learned that her cancer had spread to the lymph nodes in her neck (some palpable, some visible with CT), and is probably present in her bowels as well (she is symptomatic but there are no visible tumors).  She's been on Doxil for a month now, but thinks that a new tumor is growing above the largest of the previously diagnosed ones, as she can feel a lump, and it is warm and painful.  We'll know more when she goes back for her next round of chemo...

Beyond these specifics, my question is also a fairly general one.  I understand that staging is something that only happens once (at the time of surgery, right?) and never changes.  Is there any way for the layperson, such as myself, to judge the seriousness of disease progression when the stage no longer seems relevant?  It seems logical to me that the stage 1c prognosis given before would be overridden by what is happening now, i.e. spread to distant lymph nodes...  

I think that my mom's treatment team is doing a fantastic job, but they (no doubt correctly) tend to be very optimistic in discussions with her.  I'm an only child living in a foreign country, worrying about a mother that lives by herself, and for me the best course of action seems to be: optimistic with her, and realistic with myself.  I guess I'm trying to gauge what types of signs I can look for to judge when it may be time for me to think about coming home...  

Thank you in advance for your help.

[Annekathryn Goodman, M.D.]

Hi There,
It must be so hard to be far away at a time like this.
Your mother has a cancer that has returned within 6 months of completing chemotherapy.

She was given a Stage Ic diagnosis. We know that up to 20% of stage I ovarian cancers are really stage 3 (have spread to the lymph nodes). Sometimes this is initially missed because the lymph nodes that are involved are far away from the ovary (such as being under the bowel, pancreas, and near the kidneys ) .These lymph nodes are not always biopsied because they are hard to reach or the surgeon is concerned about causing harm.

You are right, it is not really relevant that she was given a stage I diagnosis now that it has come back.  The label for her kind of cancer is platinum resistant cancer. There are definitely other chemo choices. Women who experience this kind of ovarian cancer are doing  much better with current treatment compared to the past. However, your mother still has a high chance of becoming sick from this cancer and having continued progression of this cancer in the next 2 years.

I know you face a hard decision about when to come home.
best wishes