Surgery for 1st Recurrance?

I am 50 years old, diagnosed in May 2006, with stage IIIA, grade 3 OC (tumors on ovaries/ uterus & microscopic cells found in pathology on omentum).  Had optimal debulking surgery & 6 rounds of Taxol/Carbo @ MD Anderson with what appeared to be a great response.  CA125 before surgery was 1444; after 1st chemo was 32, after 2nd chemo was 9 & was <7 after each remaining treatment.  Just diagnosed last week with a 2cm tumor in my abdomen; CA125 is 8.  Oncologist indicates she will not perform surgery since there is likely microscopic disease that needs undelayed chemo.  She is leaning towards Doxil.  I remain unconvinced that surgery should be ruled out here.  Some studies indicate surgical removal-or even radiofrequency ablation-of recurrant cancer improves prognosis.  My doctor is also exploring Avistan with Doxil but if there is no precedent with this combo, we will go Doxil alone and if the tumor shrinks enough, then radiation.  

1) What is your opinion about second surgery here?  
2) Could Doxil alone put me into a long remission and totally eliminate this new tumor or should I only expect it to possibly shrink?  
3) What about Avistan+Doxil?  
4) My onc indicates testing the biopsy cancer cells to see which chemo drug might work best really does not work.  I obviously want to make sure I get this "as right as I can" in order to maximize results.
5) Is radiofrequency ablation an option?  Does radiation in any way restrict or limit any future treatement options that might be needed.  
6) Is CA125 no longer a good tumor marker for me?  THANKS- Rachael

[Annekathryn Goodman, M.D.]

Dear Rachel,
It would be good to review your films. It is possible that you have a recurrence within 9 months of primary therapy. It is a bit surprising because of the factors that you mention:
-Optimal cytoreduction
-Immediate drop in your CA 125.

My questions for you include:
-Do you know what the histology of your cancer was? That is - do you know the pathology report?
-Can you write out the exact CT scan report?

You should ask your oncologist if she is 100 % certain that that 2 cm "tumor" is cancer. If there is any question, there are three other options to sort out the diagnosis:
1. Surgery
2.A biopsy of the two cm thing
3 A PET CT scan

As far as a second surgery in the setting of recurrent ovarian cancer, the standard thinking is that secondary cytorection is reasonable if it has been more than a year from therapy. Sometimes very small tumors cannot be easily resected because as your doctor says, it is more of a coating and not an actual isolated tumor.

Radiofrequency ablation in people with ovarian cancer has mostly been used for small (less than 5 cm) tumors in the liver. It has also been used for some isolated lung nodules. So part of the decision about RF would depend on the location of this 2 cm thing (once it has been confirmed to be cancer)

CA125 is still a good marker for you. However, it is always important to use many different measurements to assess for recurrence including x-rays and physical exam. Sometimes parts of a cancer cell population do not secrete this particular protein (the CA 125).

As far as Doxil and other agents- there are many options. Some people do go into remission and others will have a partial response. We are not good at predicting this at this time.
I look forward to hearing more form you
Take care

[milashka]

Unfortunately, I don't have any answers but I love the questions that you are asking!

How was the new tumor discovered?

[RAS50]

Change in status.  Today my onc informed me the needle biopsy results are negative- no cancer; she was very surprised.  They took two seperate samples and did the pathology test again when the first results came back negative (when I went in for the biopsy, they performed the procedure, then after a 30 minute wait, came back and told me they needed to do it again.  My onc says they used  two different needle sizes if this is relevant).  My onc indicated she has no reason to believe the biopsy tests are wrong (MD Anderson has excellent biopsy results) especially with two tests done.  She says while she is cautiously optomistic, she feels this is still cancer since it felt hard during a pelvic exam.  She does not recommend another biopsy right now or a surgical biopsy/ removal of the tumor since it is close to the bladder & plans to scan again in 3 weeks.  My cancer was grade 3 (fast growing).  What is your opinion about options here?  If this is not cancer, what could it be? What about radiation/ radiofrequency ablation even with a negative biopsy?  Thanks  Rachael

[RAS50]

The tumor was found on a cat scan and felt in a pelvic exam.  Oncologist felt very certain it was cancer because it felt hard and "looked like cancer" on the scan; she scheduled an immediate chemo date pending results from a biopsy and as you can see above, biopsy was negative.  Rachael

[akg]

Dear Rachel,
Thank you for the additional information. See my comments above. I guess, I am not surprised that the biopsy was negative. However, I agree with further evaluation. You should ask your doctor about the option of taking a look with a laparoscopy if she feels something on examination. I imagine that it will be hard for you to rest easy until you absolutely know what is going on.
best wishes to you