Surgery during chemo 2nd debulking

[kmoe]

My sister had surgery on Jan 29 for stage 2C, grade 3, endometrioid cell, OVCA. Some disease was left in pelvis, around ureters and on sigmoid colon. She had a mass appear 11 days after surgery, 11x8x7 cm on CT scan. Report mentioned much soft tissue so hopefully not all cancer back. She started chemo 6 days later so mass may have been even bigger. After 3 chemos mass has shrunk some to 8x8x? cm. Her CA-125 was 296 before surgery, 195 before chemo, 95 after 1st, 17.2 after second, and 13.3 after 3rd. She had the fourth and I think she needs a second surgery now to remove mass and let remaining 2 or 3 chemos work on what is left. They may even get it all. If she waits until the end of chemo and it's still there and it is cancer she will be in worse shape. She had excellent CA-125 response so we don't know how much is cancer, complex mass on report. The only reason they want to do the surgery is to fix a recto-vaginal fistula and let her anal fissure heal. Pain is taking a toll on her as she can't walk very far or sit in chair. I've read in Europe they do 3 chemos, de-bulking, and 3 more chemos on people who had a lot of disease after 1st surgery. The criteria is good chemo response and/or stable disease, she has both. In america we do surgery and 6 chemos. Any comments on interval debulking? I think she needs it ASAP in her special case whether it is cancer or not.

[Annekathryn Goodman, M.D.]

hi There,
You are a wonderful sister. You have been devoted to your sister's care.  I believe I have answered your question before. You need to ask her surgeon for her/his thoughts in this matter. I believe that her fistula should be repaired. the timing will depend on the individual patient. There is no wrong answer. So therapy is tailored to the individual person based on how they are doing.

In my patients, I usually operate after 2 to 3 treatments.
best wishes