CA125 decreased slowly, do we need to change chemo plan?

[glu_2002]

Dear Dr. Goodman, it is so nice to have this forums and you to answer questions from patients. my mother, 51, used to be a very healthy woman only suffering a little about hypertension, got ovarian epithelial cancer staging IC. She got the surgury and then chemo after 7 days with Carboplatin/Docetaxel (400mg/100mg per three weeks). Her CA125 before surgury was 199.3 and after first chemo it decreased only to 168.8. The white cell count decreased after first chemo to 4.1 and returned to 9.8 before the second chemo. Now she is having the second Chemo with same medicine. It seems to me that her CA125 did not decrease a lot after the surgury and the first chemo, which is really disappointing to me. Is this normal? Do we need to change the chemo plan to other medicines or stick on the current plan? Thanks for your time and I really appreciate your help.

[Annekathryn Goodman, M.D.]

Hi There,

I wonder if her CA 125 is reflecting tumor presence or if the elevation is due to something else.

A Stage I cancer means that the cancer was confined to the ovary. In that case, chemotherapy is given to theorectically prevent a recurrence. It is not given because we are trying to kill cancer cells that are there.
Therefore in your mother's case, I wonder about two things:

could she not have a stage I cancer? Is there cancer in the omentum or in the lymph nodes that was missed at surgery? You will have to ask her doctor about that. Is she being taken care of by a gyn oncologist?  There are situations where women are operated on by general gynecologists or surgeon and then are sent to medical oncologists for chemo. They may not get comprehensive surgical staging in that case.

My other thought is that if she did have comprehensive surgical staging an there is no evidence of tumor outside the ovary, then the CA 125 is elevated for non cancer reasons such as heart disease, inflammatory conditions such as gallbladder disease, diverticulitis, etc, or liver disease.

You should ask her doctor about these issues
best wishes

[glu_2002]

Dear Dr. Goodman

Thank you for your reply. My mother was diagnosed as stage IC because her doctor found some cancer on the surface of left ovary and there was some cancer orgn on the omentum of the vigina. Her doctor is a gy oncologist and she is taking caring of my mother including the surgury and current chemo. I hope the surgical staging is complete, because they did not find anything abnormal before the second chemo, except CA125. My mother has hypertension for several years, but no any inflammatory conditions. I feel that maybe we still need to wait for another chemo to see its effect because it is too early to say for the first chemo. Is it right?

Thanks again for your time and I really appreciate.