Scared

[standing_stone]

My 66 year old mother was recently diagnosed with ovarian cancer, stage III.  While waiting three days for a bed in a larger hospital, her colon perforated and she had to have emergency surgery and ended up with a colostomy.  She was home in six days, at home for four days and back to the hospital because of an elevated temperature.  It turned out that the wound was infected from the inside out.  She now has a PICC, low potassium, elevated white cell count to name a few.  When talking to her 'team' of doctors, I get so confused.  They are saying her colon is leaking but when they run a cat scan (four now), they can't find any leakage.  Yet they know there is a leak because of stool or some such that has been found in the fluid.  They are trying to allow her colon time to heal on its own but, may have to do further surgery.  They have drained the fluid from her abdominal cavity (two times).   I asked about the cancer and they can not stage it beyond stage III because she never had her debulking surgery and as yet, the cancer has NOT been addressed at all.  I suggested to the doctors that the cancer is not sitting there waiting for them to figure all this out.  During the emergency surgery, he removed tumors from her colon.  I understand that their focus is on her current situation, but this continued wait to address the cancer is worrisome.  I trust her doctors but am scared that we will not get to the point of addressing the cancer if this continues.  

[Annekathryn Goodman, M.D.]

Dear Standing Stone,
I am so sorry to hear about your mother. This is my take on what you have described:

She has untreated ovarian cancer. The treatment of ovarian cancer has two very important parts.
1) She needs a surgery to remove as much or all of the cancer. This involves the removal of the uterus, both tubes and ovaries, the omentum - an apron of fat that is connected to the stomach on one side and free on the other, it commonly is very involved by advanced cancer - and removal of any other cancer spots. That may involve resecting part of the intestine, the appendix, and rarely the spleen. This is big surgery. It can involve losing blood and needing transfusions. It can cause infection or postoperative blood clots in the legs or lungs.  So if someone is really sick from an infection, it is dangerous to operate until the infection is cleared up.

2) Chemotherapy. The standard drugs are taxol and carboplatin. These can been given intravenously (IV). In selected cases, the chemotherapy can be given directly into the abdomen. One of the side effects is low blood counts. In the setting of infection, chemo can be dangerous because it is harder to fight infection with low blood counts.

Now she had a bowel perforation. That can be life threatening if she develops peritonitis.  The standard intervention is emergency surgery and a quick colostomy. At the time of surgery, the abdomen is rinsed out with copious amounts of saline.  There can be postoperative consequences such as an abscess, continued fever, continued infection.

It may be that she has to go back to surgery to rinse out the abdomen again. If the perforation is from her cancer, she may need part of her colon removed.

Please let us know what happens
best wishes

[Shari4444]

Dear Scared,
    I'm very sorry to hear about your mother. I am not the doctor, but rest assured she will answer your questions (it may take a few days). In the mean time, may I suggest that you visit the ovarian cancer Forum on the opposite side of the page as you found this forum. It is a little further down than this one.The ladies there are wonderful and may be able to answer some of your questions. They gave me courage when I needed it most!!!! The majority of us have or have had ovarian cancer or a fear of it (I  was fortunant and cancer-free). That site is much more active and you will have more people to talk to (keep checking back on this one for the doctor's advise, though).
    Best of luck to you and your mother. I will think about and pray for you both.
                     Hugs,
                        Shari