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Ovarian Cancer (Expert Forum)
Treatment of low grade recurrent cancer...
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center
Boston - MA
Treatment of low grade recurrent cancer...
by Tybear, Oct 29, 2009 12:36PM
Hi Dr. Goodman
I was diagnosed 4 years ago with stage 3c Micropapillary serous carcinoma during surgery for which I was optimally debulked. I did 6 rounds of taxol/carbo and my cancer recurred within 6 months. Since the resurrence, I have tried taxol/carbo again, a clinical trial (PXD101) and avastin with oral cyclophosphamide. I did have luck with the avastin but the second time I tried it, I had no luck. It was too costly to continue on so I found a surgeon who was willing to try another debulking surgery and had surgery this past August. The surgery was not sucessful - they weren't able to de-bulk all the tumors as my insides had become cement like with a mix of blood vessels and scar tissue. The doctor said it was too hard to cut into and it took the urologist nearly 45 minutes just to free up my one ureter. The surgery took a turn for the worse when they accidentally severed an artery in my leg trying to remove a tumor - the vasular surgeons had to be called in and once that was repaired, they closed me up. I had several tumors removed from my abdomen and had the muscles on the right side removed due to tumor involvement. It has been 8 weeks now since my surgery and my latest MRI showed that my tumors in my pelvis and abdomen have progressed, with some even doubling in size.
My question is - what treatment would you recommend at this point? I know that grade one cancers don't respond well to chemotherapy because they are slow growing and I don't know what to go on next. I was thinking of trying etoposide or caylex - what are your thoughts? Have you treated anyone who has had a grade one invasive, aggressive cancer and had sucess?
I appreciate any information you could pass along...
Sincerely,
Becky H.
I was diagnosed 4 years ago with stage 3c Micropapillary serous carcinoma during surgery for which I was optimally debulked. I did 6 rounds of taxol/carbo and my cancer recurred within 6 months. Since the resurrence, I have tried taxol/carbo again, a clinical trial (PXD101) and avastin with oral cyclophosphamide. I did have luck with the avastin but the second time I tried it, I had no luck. It was too costly to continue on so I found a surgeon who was willing to try another debulking surgery and had surgery this past August. The surgery was not sucessful - they weren't able to de-bulk all the tumors as my insides had become cement like with a mix of blood vessels and scar tissue. The doctor said it was too hard to cut into and it took the urologist nearly 45 minutes just to free up my one ureter. The surgery took a turn for the worse when they accidentally severed an artery in my leg trying to remove a tumor - the vasular surgeons had to be called in and once that was repaired, they closed me up. I had several tumors removed from my abdomen and had the muscles on the right side removed due to tumor involvement. It has been 8 weeks now since my surgery and my latest MRI showed that my tumors in my pelvis and abdomen have progressed, with some even doubling in size.
My question is - what treatment would you recommend at this point? I know that grade one cancers don't respond well to chemotherapy because they are slow growing and I don't know what to go on next. I was thinking of trying etoposide or caylex - what are your thoughts? Have you treated anyone who has had a grade one invasive, aggressive cancer and had sucess?
I appreciate any information you could pass along...
Sincerely,
Becky H.
Doctor's Answer
by Annekathryn Goodman, M.D., Oct 29, 2009 04:08PM
, Oct 29, 2009 04:08PM
Dear Becky,
Wow! You have been through so much!!
It sounds like you have had excellent care. Secondary surgery can be very tricky as you describe. I wonder whether your cancer continues to have the same histology that it did 4 years ago. Do you have a pathology report from your most recent surgery?
Have you had estrogen and progesterone receptors checked on your tumor?
As for therapy, etoposide and caelyx are both excellent drugs. However, if you have a slow growing , grade one tumor, these tumors are less responsive to chemo.
I have taken care of many wonderful women with advanced ovarian cancer who have a low grade histology. I would say their therapies were all individual. As a general rule, I try surgery when feasible. I have seen good response and stabilization of disease with tamoxifen and arimidex when the tumors have been estrogen receptor positive. I have not been impressed that antiangiogenesis agents are helpful for these types of tumors.
please let us know what you decide to do
best wishes
Wow! You have been through so much!!
It sounds like you have had excellent care. Secondary surgery can be very tricky as you describe. I wonder whether your cancer continues to have the same histology that it did 4 years ago. Do you have a pathology report from your most recent surgery?
Have you had estrogen and progesterone receptors checked on your tumor?
As for therapy, etoposide and caelyx are both excellent drugs. However, if you have a slow growing , grade one tumor, these tumors are less responsive to chemo.
I have taken care of many wonderful women with advanced ovarian cancer who have a low grade histology. I would say their therapies were all individual. As a general rule, I try surgery when feasible. I have seen good response and stabilization of disease with tamoxifen and arimidex when the tumors have been estrogen receptor positive. I have not been impressed that antiangiogenesis agents are helpful for these types of tumors.
please let us know what you decide to do
best wishes
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My original testing said my tumors were diffusley positive for estrogen and progesterone receptors. I had asked in the past about trying arimidex but my oncologist didn't feel it was aggressive enough at the time.
I don't know about any new pathology but will be going back to see my doc on Tuesday - I will ask him if the histology has changed at all.
Thank you,
Becky