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Treatment after surgery
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Treatment after surgery

Hi.

The background is my mom had sugery for OVCA and it was found to be papillary serous adenocarcinoma that has metasized to her appendix, one kidney, diapraghm, liver, lower left lobe of her lung, colon (she now has a colostomy) and brain. They have done a spinal which showed tumor marker and a stereotactic biopsy which also shows it is OVCA. They have done as much debulking as they could but there were many areas they said they weren't able to remove including a spot against her aorta I think. They took several invaded lymph nodes in her groin. Two days after her surgery they took her back to surgery because there was too much blood coming out of her drainage tube and her platelets were low and creatinine high and her albumin low as well as her red cells and hematocrit off.One of the masses of the metastasis to the brain sits on top her brain stem so they say they cannot do surgery but will do whole brain radiation. They have also talked about IP chemotherapy.

My questions are...
              1) How aggressive is this type of cancer
              2) Which should happen first....the brain radiation or the chemotherapy? or should they
                 happen at the same time.
              3) If there are tumor markers for ovca...does that mean that she has some metastasis to
                  her spine?
              4) She was put on estrogen a few months ago to try to resolve the cysts and I have read
                 that her kind of cancer feeds on estrogren. Could that have possibly contributed to the
                 fast spread?
Thank you for your help. Rose
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Dear Rose,

Thank you for your complete information.  Your mother has a very aggressive cancer.  It is unusual for ovarian cancer to spread to the brain. It happens but usually this happens late in the course of the disease after multiple therapies and surgeries. it is unusual to see this situation at first diagnosis.

Your mother has a stage 4 ovarian cancer based on the spread to the lung and the brain.  I usually avoid survival statistics because each person has a unique story and a differing response to therapy. However, it is important to have an overall sense of what might be ahead for you and your mother and your family. The five year survival for stage 4 ovarian cancer is 4 percent.  Many women with the volume of disease that your mother is facing may die within a year. For sure - there are some women with ovarian cancer that has spread outside the abdomen who do have a complete response to chemotherapy after surgery, but those women are, sadly , the minority.

It is really, really hard to think about these things. However, it is important to have a really honest discussion with the medical team caring for your mother about what the goals of therapy are.  It is also really important to have a discussion about who will be the health care proxy to help make decisions, and to find out what your mother's wishes are if there is a time when she is too sick to tell you.

In terms of your specific, excellent questions:
2) Which should happen first....the brain radiation or the chemotherapy? She needs therapy to her head first. The brain is in a closed space. Any growth or swelling of a tumor there will cause a seizure, neurologic injury, and even death. The standard approach is to start steroid to reduce brain swelling, an anti-seizure medicine, and then whole brain radiation. There are certain solitary brain tumors that are managed by surgical removal. It sounds like your mother is fairly unstable and brain surgery may not be a safe option fro her right now.

3) If there are tumor markers for ovca...does that mean that she has some metastasis to     her spine? The CA 125 is the tumor marker for ovarian cancer. Spine disease would be identified by xrays, not blood work

4) She was put on estrogen Could that have possibly contributed to the    fast spread?
I do not think so. Most of these very aggressive cancers are not estrogen receptor positive.

5) How long before a chest tube comes out? The drainage has been about 550 ml a day? How does bleomycin help?  Usually the drainage must be below 50 cc a day. I suspect that the chest tube will stay in until she is able to get chemotherapy. Bleomycin is a good addition once the drainage is low. The bleomycin is directly instilled into the space between the chest wall and the lung. This causes an irritation and seals that space to prevent further fluid build up. This is a very different use than the bleomycin that is given IV for germ cell tumors.

6) IP chemtherapy would be inappropriate in the setting of cancer that has spread outsdie of the abdomen

lease let us know how everything is going. You should also see if there is a support group fro families. This maybe a really tough road for you all
best wishes


5 Comments
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I hope the doctor answers you soon
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If it isn't too much to add a couple more questions. How long before a chest tube comes out? The drainage has been about 550 ml a day? How does bleomycin help? Thank you and sorry for soo many questions.
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16702_tn?1234094245
Glad you brought up the bleomycin...there is a post on the community forum titled "Possible Reccurence?" by ashwee3284
She has stage 4 Germ Cell ovarian Cancer March of 2004. She received 6 rounds of five day chemotherapy (cisplatin, bleomycin, etoposide).  Last treatment was September of 2004 and has been cancer free since.
Dr. Goodman, can you tell us what your know about this combination cisplatin, bleomycin, etoposide as well as a possible treatment.
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I just wanted to say thank you so much for your very kind, honest and thorough answer. It will help me so much to know what directions to take to help my mom. Rose
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