what happens to CA after surgery?

[talatilo]

hi.. my mum is 53 years old, she is diagnosed as stage IV ovarian adenocarcinoma, poorly differentiated cancer cells. her CA was 970 at diagnosis.. she had 3 chemotherapies & her CA dropped to 33.5 before she underwent an optimal debulking surgery where the surgeon removed both ovaries, uterus and 1 meter of her intestine. the cancer didn t reach the breasts,nor the lungs, nor the kidneys, nor the liver ,and nor the pancreas... she has little left on the lymph nodes near the heart, where the surgery didn t include. after 4 weeks from the operation, the day she went to take her 4 th chemo, but the first after the operation, her CA was 142. how many chemos u advise? any supplements or herbs? what about bioyheraby? what about her survival chances?? i mean in general such patients ?

[Annekathryn Goodman, M.D.]

Hi There,

Prognosis means several things:
-1. What is the chance a person will have a remission of their cancer? Remission means that there is no sign of the cancer by blood tests, exam, and xrays.

For all ovarian cancers, 80 percent of women will have a remission after treatment with surgery and chemotherapy.


-2. What is the risk that a cancer will come back? That is - what is the chance that a normal exam, blood test, and /or xray will show signs of cancer and when will that happen?

The risk of recurrence in ovarian cancer depends on various factors:
stage of cancer (more likely with stage 4 than with stage one)
ability to maximally remove cancer at surgery
age of patient (younger women do better than older women)
the sensitivity of the cancer to being killed by platinum based chemotherapy.

For women with ovarian cancer,  there is a very higher risk of recurrence. Women with stage 4 cancers probably have a 80 to 95 %  chance of the cancer coming back within 5 years.

3. What is the risk of dying from an ovarian cancer?

Women can live a long time with ovarian cancer if their cancer is sensitive to platinum chemotherapy.  The definition of platinum resistance is a cancer that recurs within six months of completion.

I have pasted a good discussion of this issue from a Johns Hopkins site
http://ovariancancer.jhmi.edu/treatment.cfm

Treatment of Recurrent Cancer

Patients who develop recurrent cancer despite surgery and primary chemotherapy, and will be given salvage chemotherapy, may be placed into one of three groups (A-C):

Group A: are patients resistant to primary therapy and have shown tumor growth during treatment. This persisting tumor is considered to be refractory i.e. have absolute platinum-resistance. Secondary non-cross resistant chemotherapies or biological therapies should be considered.

Group B: are patients who respond well to initial chemotherapy, but develop recurrent cancer within months after the end of primary care. This group with relatively platinum resistant tumor has an intermediate prognosis.

Group C: are patients who showed a good response to primary chemotherapy, and did not develop recurrent cancer for more than 6 months after the end of primary treatment. This group with platinum-sensitive tumor shows the best responses to re-treatment with a platinum-containing regimen.

The probability of response to salvage chemotherapy is also markedly dependent upon on the number of preceding chemotherapy regimens, such that third and fourth line chemotherapies are of limited benefit. However, unique patients responding to multiple retreatments with even the same regimen of chemotherapy are sometimes observed. Tumor burden, as assessed by the size of the largest lesion and the number of disease sites and histology (serous having the best outcome) are also independent predictors of response to salvage chemotherapy.

Drug Resistance

The likelihood a patient will respond to salvage chemotherapy correlates with, for the most part, the cancer's degree of platinum drug resistance

The Gynecological Oncology Group (GOG) defines platinum resistance as meeting any of the criteria listed below:

Disease progression while on a first-line platinum-based regimen
Tumor progression within 6 months of completion of platinum-based therapy
Persistent clinically measurable disease with best response as stable disease at the completion of planned first-line therapy
Persistent clinically measurable disease with best response as stable disease with rising CA 125 while receiving first-line non-protocol therapy. Rising CA 125 levels must be documented with two examinations where the last result being greater than or equal to 100.
The most commonly used indicator of resistance is the period of time between the end of primary chemotherapy and relapse: the longer this length of time, the better the chances of responding to salvage chemotherapy.

Cancer that relapses after primary treatment using a single platin analog will have less resistance to treatment than cancer that relapses after primary treatment using multi-agent treatment

Generally, about 25%, 33%, and 60% respond to salvage treatment when their time between last chemotherapy and relapse is 6-12 months, 12-24 months, and greater than 24 months respectively.