Confused by Pathology Report

[PF_PVD]

After 3 rounds of chemo and then surgery 3 weeks ago, I just got my hands on the pathology report and it is quite puzzling.  I was dx ovca iv but there was some discussion of the primary (between uterus or ovary) by the gync/onc who quickly said it didn't matter as the treatment is the same.  But, here are a few excerpts from the path report:

Comments:
Type of surgery:  uterus cervix/bilateral adnexa/omentum
Tumor site:  Right tube
Tumor location:  distal fallopian tube
Extent of invasion:  invading into ovary and adjacent tissues

Final Diagnosis:
Omentum, uterus, cervix, left ovary--high grade serous carcinoma (condensed version)
Left fallopian tube: No tumor identified
Right fallopian tube and ovary:  Fallopian tube showing extensive involvement by high grade serous carcinoma involving the fimbriae, appearing to be primary in the distal fallopian tube involving mainly the fimbriated end and the adjacent ovary.

The confusing part--do I have ovca or do I have tubal cancer?  To me this points to the right tube.  Maybe the treatment is the same, but I still believe I would want to know the primary site.  I don't have my surgical follow-up until next week.  Thanks for any light you can shed on this

[PF_PVD]

I really appreciate your thoughtful responses.  Unfortunately, my dx is stage 4, grade 3 due to mets to neck lymph nodes. I especially thank you for your response on the use of IP chemo on ovarian vs. fallopian tube cancers which tells me the primary site may matter in terms of treatment options.  

Due to a twin sister and a mother with breast cancer, it has been recommended many times to have the genetic testing.  Unfortunately, my insurance company will not cover it (big surprise there), and since my income has been severely reduced since dx and I am paying some large medical bills at this time (even with insurance), I really can't afford it.  I suspect I am not alone in this.

[Annekathryn Goodman, M.D.]

Hi there,

Thank you for your reports. It looks like you have a primary fallopian tube cancer, stage III.  There are many pathologists and oncologists who feel that alot of serous carcinomas actually arise from the fallopian tube.

your doctor is right in that we treat cancers from the ovary, fallopian tube, peritoneum, and the subtype of cancer from the lining of the uterus called "serous Papillary" - all the same way.
Which is:

Primary surgery to remove as much or all of the visible cancer ("optimal cytoreductive surgery")
followed by 6 cycles of combination chemotherapy with carboplatin and taxol.

The debates are as follows:

who should be offered intraperitoneal chemo. The current data is only for optimally cytoreduced cancers, stage 3 from the ovary, who have not had a bowel resection.

We do not have data that intraperitoneal chemotherapy is better than intravenous chemotherapy for women who experience fallopian tube cancers, women with Stage I, II, and IV cancers, and women whose cancers were not optimally cytoreduced.

Finally - fallopian tube cancers appear to be part of the BRCA1/2 gene mutation syndrome. You should consider genetic testing. If you have the gene mutation, your family members should consider getting tested as well
best wishes

[PF_PVD]

I saw my onc Friday, but he didn't really respond to this question.  My appointment with my gyn/onc isn't until late next week and I would like to go in there armed with some information in case he tells me "it doesn't matter," but I've had difficulty finding anything to really help.  Maybe I'm wrong, but it seems to me that with a daughter, a twin sister, and multiple female nieces, it might matter--if not today then sometime in their lifetimes if not mine.