Treatment for unstaged ovarian cancer?

[Jenikita]

I had surgery to remove two large ovarian cysts which were confined to the ovary.
the surgery was done by a gynecologist/obstetrician who did not test the peritoneal washings, nodes or remove the appendix.
The pathology report indicated cyst adenocarcinoma, poorly differentiated.
I have been told that my staging was "incomplete".
what is the best treatment for someone in my situation?

[Annekathryn Goodman, M.D.]

Hi There
You should see a gynecologic oncologist for consultation.
You need surgical staging. At the time of surgery the gyn oncologist will possibly place a port for intraperitoneal (IP) chemotherapy.

IP chemotherapy is considered for women with stage III ovarian cancer (spread to the upper abdomen or the lymph nodes.

If there alot of adhesions or the person needs to have bowel resections, IP chemotherapy may not be the best approach.
This is because in the presence of adhesions, there may not be free flow of the chemotherapy solution throughout the abdomen. In the setting of bowel surgery, there may be a higher risk of bowl injury. However, that may vary depending on the extent of surgery.

We usually do not consider IP chemotherapy for stage I.

After a thorough surgical assessment (and resection of all visible tumor), the next step is chemotherapy. Current standard chemotherapy uses 2 drugs: a platinum agent usually carboplatin, and taxol. These drugs can be given intravenously or IP depending on the particular situation.
best wishes

[Annekathryn Goodman, M.D.]

Hi There,
Your doctor has given you several good options to consider.
We are all reluctant remove normal organs. There is some evidence to suggest that there is an increased risk  of cardiac disease in postmenopausal women who have had their ovaries removed.

The potential risk of cardiac disease needs to be weighed against risk of ovarian cancer.

So the suggestion to watch and repeat an ultrasound to look for change in what appears to be a benign appearing cyst is reasonable.

On the other hand, if the lining of the uterus is abnormally thickened, that may represent a polyp or growth in the uterus (unrelated to the cyst) and a biopsy or D&C (dilation and curettage) is appropriate.

Finally if you have a family history of cancer and you may be at increased risk for ovarian cancer yourself, that is a reason to consider the prophylactic removal of both your tubes and ovaries.

So you have several options to weigh. Your doctor sounds very thoughtful and you should bring these issues to him and discuss the pros and cons.
best wishes

[ethicalgirl]

I am 68; have a cyst on left ovary and a thickened endometrial stripe in my uterus.  CA 125 good reading.  Gyn says he's confident that the cyst is benign and that I can choose to have an exam every 3-4 months or have the ovary removed and at the same time he'd do a biopsy on the uterus.  Why would I not just have the ovary removed?  An aunt on my father's side had overian cancer 40 years ago; my mother died of pancreatic cancer as did two of her brothers.
Thank you for advice.