Update: Mom's OVCA

[Borgs]

Doctor- thanks for your response before, it was much appreciated.  Mom was diagnosed a few weeks ago with OVCA.  Path reports came back that the Tumor was aggressive, was on the surface of the ovary, was in the other ovary, but was no where else (no cancer in ascites, or other abdominal organs).  However, the path reports could not determine if the cancer had spread to the lymph nodes, so she can't be staged yet.  The GYN/ONC is sending her for a CT scan, and then might have to operate again to remove/biopsy the lymph nodes.  It seems this could either be stage 1 or 3 cancer. (she had a partial hys. 20 years ago and a tubal).  My question is, if cancer is to spread, where is the first place it usually spreads?  Can we assume that if it hadn't spread to the ascites, or other surrounding organs, like in her case, that it didn't make it into the lymph nodes also?  Or is the lymph nodes one of the earliest places it spreads, (it would spread there before spreading to ascites, which doesn't make sense to me, or other pelvic abdominal organs)?  

[Annekathryn Goodman, M.D.]

Hi Borgs,
That is great. If the fluid is going away, it is most likely just a post op phenomenon
take care

[Borgs]

Update: Mom had appointment today to aspirate and test fluid around her lungs.  Apparently the fluid disipated to such an extent that they said there was no reason to safely aspirate and test, so they didn't.  We are hoping this is good news in that the fluid was there still because of the IV and the abdominal surgery, and no mets to the lungs.  She has a follow-up with the GynOnc on Friday and he will talk with her more about staging and the start of chemo.

[Annekathryn Goodman, M.D.]

Dear Borgs,
The fluid could be cancer or it could be postop. the only way to know is to tap the fluid and analyze it. I hope all goes well.
best wishes

[Borgs]

Thanks so much again for the response.  I appreciate your candor.  Follow-up: as I said, due to some issues with the PATH reports of her lymph nodes, she isn't staged yet.  She had cancer on both her ovaries, but there was no other cancer found.  Ascites was negative, omentum, etc. was negative.  She hasn't started chemo yet because they need to stage her first.  CT last week just found some fluid around her lung.  Is this common after major abdominal surgery and intravenous almost a month ago now?  I am guessing there is a chance there could be mets to the lungs, but to me it seems uncommon because there was no cancer anywhere else but the ovarian tumor itself.  Many thanks.

[Annekathryn Goodman, M.D.]

Dear Borgs,

Ovarian cancer can spread in several ways. It can directly grow off the ovary to involve the fallopian tube, the uterus, and the other tissue within the pelvic area.

Cells from the surface of a cancer can shed and float around the abdomen. This can cause ascites. There can be tumors or a coating of cancer cells over other structures such as the intestine, the lining of the diaphragm, the stomach, or the omentum.

Thirdly, cancer cells can go directly into the blood stream or lymph system. In that case the most common place for lymph node involvement is around the blood vessels to the kidneys. That is because the blood vessels of the ovaries attatch to the larger blood vessels at the level of the kidneys.  (The big blood vessels are called the aorta (the big artery coming down from the heart and the inferior vena cava (IVC) the vein that takes blood back to the heart and lungs.)

Sometimes for some people, ovarian cancer spreads in all three ways. In other people, their cancer only spreads through the lymph nodes but all else is fine (about 20% of the time).

It sounds like your mother's gyn oncologist has a good plan
best wishes