I was dx'd with IIIC in July of 2005 and went through 6 rounds of standard Taxol/Carboplatin. I had a good response with my CA125 dropping from 537 at diagnosis to 7. Ten months later I started to experience positional headaches, vertigo, nausea and vominting. A brain MRI revealed what they think was brain mets with 4 lesions in the cerebellum. What is confusing to me is that my CA125 at that time was only 13. Would you expect to see a rise in this number with further disease in the brain? Also does Taxol/Carbo penetrate through the blood brain barrier? I'm wondering if the brain lesions started after I completed treatment and would be considered a recurrence or if they were growing while I was receiving my original chemotherapy? Since my tumor marker was not sensitive to the disease in the brain, is it no longer considered a reliable marker in my case? Thank you for your assistance, Dr. Goodman.
It must be very scary for you to find out that you have 4 lesions in the brain that are thought to be suspicious for brain metastases.
Ovarian cancer can spread to the brain but it is very uncommon. It will be important to undergo a very thorough evaluation of these brain lesions: First, it is crucial to be absolutely certain that these lesions are cancer. It is possible that your doctor and the neuroradiologist who has looked at the brain MRI are certain that based on the x rays, these lesions can only be malignant. If it is not certain, it is important to consider a biopsy. There are other possibilities such as fungus infections. Some people who have a compromised immune system can develop unusual infections in the brain. We have alot of experience with this now for people with HIV disease. Please ask your doctor about whether further testing is necessary to be sure the lesions are malignant.
Secondly, because brain metastases from ovarian cancer are rare, it is important to be sure that another cancer that more commonly spreads to the brain is not present. Lung cancer and breast cancer much more commonly spread to the brain. Have you had a recent chest CT scan and mammogram? If you have a biopsy and the lesion is malignant, the brain biopsy can be compared to the biopsies from your hysterectomy to make sure that the cells look the same.
There was a very nice review paper on brain metastases from epithelial ovarian cancer by Pectasides and colleagues from the journal "The Oncologist" volume 11 pages 252-260 March 2006.
Here is my summary of what they say: Brain metastasis are rare and are a late manifestation of ovarian cancer in women who have been long term survivors. The incidence ranges from 0.29% to 5%. In a review of 22,240 women with ovarian cancer, there were 219 women who had experienced brain metastases. About one third of women with brain metastases have no signs of other disease in their body. about half the women had only one lesion in their brain and half had multiple lesions. The cerebellum is the second most common location to see brain metastases.
Treatment includes: steroids, surgical resection, whole brain radiotherapy, and chemotherapy. The particular treatment will be very individualized.
As far as chemotherapy goes: only certain drugs will cross the blood-brain barrier (BBB) BBB is a tight epithelium with tight junctions in the basement membrane which is the material under the epithelium. This prevents large molecules to diffuse through into the brain and spinal cord. cisplatin, etoposide, vincristine are some of the drugs that cross the BBB. Taxol and carboplatin have not been reported to cross the BBB.
Ca 125 is a protein secreted by cells in the lining of the abdomen and lungs. This protein is usually more commonly associated with ovarian cancers. There are some ovarian cancers that do not make alot of this protein. It is possible that if indeed you have ovarian cancer spread to the brain, the reason for a lack of elevation of CA 125 is because of an intact BBB.
As far as a reliable marker: in taking care of you - everything should be looked at - exam, blood work, x-rays, your symptoms when making a determination of how you are doing or if there is a sign of recurrence. It is not sensible to rely on only one test for that. It was really good that you got that MRI. please let us know what happens. Best wishes to you.
I am so sorry to hear about your possible brain mets. There are 2 women that post on the support board that have had brain mets, Newlegallife and Freshair (I think those are their names, Freshair I personally know).
You may want to post on that forum as well to get there stories.
Best of luck to you and I hope that there is a benign explanation for the leisions.
Thank you for such a detailed response. I had 2 opinions, (one at the Mayo Clinic) on whether these lesions represented metastases. Both neurosurgeons felt they were mets and felt it was too risky to biopsy the lesions. One of the lesions was in the brain stem. I did undergo steroid therapy, gamma knife radiation and 15 treatments of whole brain radiation. I'll be having a follow-up MRI next month.
Last week I had a Chest and Pelvic CT scan which showed no indication of disease. I'm planning on a mammogram next month.
It seems that I'm really an odd duck with this recent development especially since I've only had the disease since 7/2005. At any rate, thank you for your helpful explanation.
For those whom CA-125 is a good test I think it is a great thing. Unfortunately it seems a bit overused as a diagnostic test. My mother has an MMMT fallopian tube cancer and had endometrial cancers as well. The CA-125 was always the choice as a follow up test despite the fact that she never had a high CA-125 during her first cancer. She now has many regional metastisis and still doesn't have a CA-125 above 10. CA-125 is not the test for everyone. I wish the oncology community would realize this.
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