very scared, please help answer

[sophiee2]

Hi Doctor Goodman,

     My name is Sophia and I am 23 years old. I have reason to believe that my mother has ovarian cancer and would ask of your expertise based on these results. There were many tests done such as CT scan, abdominal ultrasound, and a blood test (CA-125).  Any advice would be helpful as this is a stressful and emotional time for me and I would like a better understanding of the results and to ask of some kind of guidance for this situation.
     The CT scan procedure was a CT Pelvis w/o contrast, what they suspect is probable ovarian carcinoma with extensive mesenteric adenopathy paritoneal carcinomatosis and ascistes.  What the findings were is as follows: "There is extensive ascites in the upper abdomen extending into the pelvis and cul-de-sac.   There are multiple pelvic and mesenteric masses with irregular heterogeneous appearance.  Several of these masses are confluent and difficult to measure precisely considering lack of contrast material.  One of the largest is located in the left side of the pelvis behind the uterus.  The omentum is probably involved in the right upper quadrant.  There is no other retroperitoneal mass or lymphadenopathy.  There is a normal radiographic appearance of the liver, spleen, kidneys, adrenals, gallbladder and pancreas. The ultrasound was done on the abdominal area and the results are as follows: "Multiple transverse and longitudinal scanning of the abdomen from the umbilicus to the xiphoid was performed.  There is a moderate amount of ascities in the RUQ and LUQ.  The liver, kidneys and spleen appear normal.  The retroperitoneal structures as far as can be seen are unremarkable.  The pancreas appears relatively normal . The gallbladder appears normal as to size shape and position without evidence of cholelithiasis.  The extrahepatic biliary radicles are not dilated.  The common bile duct measures 0.4cm which is within normal limits.  


    

[Annekathryn Goodman, M.D.]

Hi There,
thank you for your question. I know this is very scary.
The young woman that I took care of had an extremely rapidly growing tumor. Because of that , immediately after surgery, she was given chemotherapy with taxol, cisplatin, and etoposide. She received 4 cycles and then immediately received whole abdominal radiation.

Because this is such a rare tumor (this was the third patient I have cared for in 20 years), it is hard to make big generalizations.  We called around the world to get advice on how to treat her and pooled everyone's experience.

The good news about rapidly growing cancers is that they are very chemo and radiation sensitive. This is because most of the cancer is in growth phase. Chemo works on cells that are making DNA and trying to divide.

My patient is doing well at almost three years now.  I hope the same for your wife.
Please let us know how things are going
best wishes

[Annekathryn Goodman, M.D.]

Thank you so much for your follow up.
the chemo is so hard!
it is very important that she stays hydrated
sometimes it is not possible to drink enough fluids because of feeling sick
I sometime give extra IV hydration for a week after chemo such as a liter of IV fluid a day

please keep in touch
take care

[jjwebster15]

Thank you for your response.  We are undergoing the same treatment, which started back on the 27th.  Her response to the treatment has been very difficult, we are a week out now and she still can't eat much and is in bed 99% of the time.  The work that the oncology field does is amazing and I appreciate hearing from you.

[jjwebster15]

My wife was told today that she has a very rare form of ovarian cancer.  The name of it is small cell carcinoma of the hypercalcemic type.  Her Dr. gave us a stage of IIIA due to microscopic peritoneal metastases beyond the pelvis no macroscopic tumor.  Last week she had a large tumor removed that had originated with the left ovary.  They also removed 24 lymphnodes, omentum tissue and some cancerous material on her pelvic wall.  The pathology was studied locally then referred to specialists at Stanford University.  Our Dr. is using your article published in NEJM, March 18, 2010, to guide her treatment since the two cases are very similar.  We are hoping to get more information on the survivability of this disease, since reading other articles, put her prognosis at very poor at best.

[Annekathryn Goodman, M.D.]

absolutely!
please keep us posted
take care

[sophiee2]

Thank you doctor Goodman for all your help!

I will definitely keep you posted! I am so thankful to have your help.  I really do hope for the best. My mom has been really calm and positive. I know she does not want to scare me nor make me worry. I hope you will be able to answer more questions for me as i go through this journey with my mom.

Sincerely,

Sophia

[Annekathryn Goodman, M.D.]

Thank you abrite!

[abrite1]

I sent you a "note" with the name of my gynecogic oncology group in Orange County. Dr. Goodman is right....we have many excellent resources here.

[Annekathryn Goodman, M.D.]

Hi Sophiee,

Thank you for writing here. You and your mother are facing a very scary time.
The ct scan shows a very abnormal process that includes tumors or growths in the pelvic area and fluid around the abdomen (called ascites).

There is a benign condition called Meig's syndrome where a benign ovarian fibroma causes ascites and fluid in the lung.
However, the description from the CT scan most likely reflects a malignant tumor.
The possible malignant tumors can be :
ovarian
fallopian tube
uterus
bowel

It is the right next step to operate. The appropriate surgical specialist is a gynecologic oncologist. It would be inappropriate for a general gynecologist to do this surgery.And it would be inappropriate for a general surgeon to do this surgery.

Orange County California is blessed with many outstanding gyn onc surgeons.who is your mother seeing?


Surgery is the next step. At surgery, biopsies are taken to understand the nature of the tumor. AT the same time, the gyn onc surgeon will evaluate the abdomen to decide if a complete surgery is appropriate at this time.  There are some situations where giving chemotherapy first for 2 to3 cycles and then re operating makes sense.That is called neoadjuvant chemo and is used to shrink cancers down so that surgery is not as big.

please keep us posted
I know how hard this is
take care

[sophiee2]

Still noted is a large complex cystic pelvic mass extending to the umbilicus with a moderate amount of free fluid in the pelvis."The impression is that there isa moderate amount of ascities in the abdomen and a large pelvic complex cystic mass.
  The blood test showed that there is a CA-125 level of 3625 U/mL where the reference range is <21.      I am very worried about what these results mean and what are to come.  If there is any advice that you could give me, or if there are any pre-treatment/treatment opportunities that you believe are helpful I would appreciate it.  My mother is planning to get a surgery within the next three weeks for diagnostic purposes as well as to remove any masses that are questionable.  Also, if there are any competent and outstanding gynelogical oncologists or related surgeons, in southern california (we are located in orange county), we are open to suggestions as well. Thank you so much for your time and support.