Carboplatin

[Shawn B.]

Hello,

My mom was diagnosed with OVC in July. She was "blocked-up" for several weeks prior. She had emergency surgery on July 1st when her colon perforated. She had an ileostomy & colonostomy as well as her Omentum removed. Supposedly the tumor was pressing on her colon but did not spread into the clon, only the omentum. Dr's could not get to the tumor during her emergency surgery because she was so sick, so the plan was to do chemo (Carboplatin & ??) and then surgery in November to remove the tumor.  Unfortuneatly, the chemo didn't work and the tumor has grown.  She also now has nodules on her lungs.  The Dr. told her  she was incurable and that surgery was too risky right now.  Also, she would not be able to have additional chemo until after she healed from surgery.  She is now getting Doxcil and will receive it every 4 weeks.  It looks like there is no plan for surgery. I am worried that she may not have been presented with all of the options. If it were me I think I would roll the dice with the surgery and try to get the tumor out of me / have the hysterectomy. She is 64 and the initial chemo (carboplatin & ?) really wiped her out....could barely walk, eat etc. She still needs help walking and getting in and out of the house/car for the Dr. appointments. Of course her  initial surgery also wiped her out but she did get stronger before the chemo started. Should she get a second opinion or is it really a lost cause? She seems to think it is a lost cause.

This is a wonderful service you provide.  Thank you for your time and any input you can provide.

Shawn B.

[Annekathryn Goodman, M.D.]

Dear Shawn,
I am so sorry to hear about the difficult time that your mother has gone through. And her pain and suffering is also carried by her family. I know how hard it is for everyone and for you too.

Your mother sounds very ill. Her management sounds very appropriate. I definitely would recommend that she get a second opinion. This is not because I disagree with her treatment, it is because it may be very helpful to have another set of eyes take a look and confirm her reality.

Ovarian cancer can cause a bowel obstruction. Unfortunately, a blockage of the bowel and a perforation of the bowel is a life threatening, surgical emergency. Her primary surgery was absolutely appropriate. It is important to divert the intestine with  a colostomy or ileostomy (bringing the small intestine to the skin). It would not have been appropriate at that time to try to remove the cancer.

I agree with the plan of giving her chemotherapy with the idea of a second surgery once she has stabilized. If she had ovarian cancer, the standard chemotherapy drugs are carboplatin by itself or carboplatin plus taxol.

It is very concerning that she has had growth of her cancer with chemotherapy. I agree that if chemotherapy did not shrink the cancer, a second surgery is not appropriate. There is a term for that situation - "platinum resistant ovarian cancer". Unfortunately, that means that your mother's cancer is unlikely is respond to chemotherapy and she may not survive this year. I am so sorry. That is a terrible, harsh thought.

However, what a second opinion can offer her is a review of the situation:
-a pathology review to confirm that this is indeed ovarian cancer and not colon or pancreatic cancer or something else. There are different chemotherapy options for other types of
cancers.
-a review of the dose and schedule of the chemotherapy that she received. Sometimes, when someone is very sick, they are not able to get an adequate dose of chemotherapy. Perhaps if that is the case and she is feeling better now, a stronger dosing schedule of platinum could be considered.
-are there experimental or clinical trials that would be reasonable to consider for your mother?
-Finally, if indeed, there are no other good treatment options (and I think Doxil is an excellent choice for second line chemotherapy for ovarian cancer), it is also important to discuss what is coming up next. Should she have a consultation with the palliative care group at your institution? What home supports does she need and so forth.

I am sorry . This is a tough situation.
Best wishes to you and your mother.

[Shawn B.]

Thank you so much for your input, Dr. Goodman.  I will share this information with my family.  Again, this is a wonderful service you provide.   Many thanks!