Surgery for recurrence

[Amy51]

My doctor wants to remove a 2 cm. tumor firmly embedded in the rectal wall. We tried chemo and Avastin to shrink it (1.5 years) but it remains about the same. No other obvious disease after initial debulking and chemo starting in May 2003. Recurrence was June 2006. Surgeons will remove part of the rectum/upper sigmoid colon (with the tumor) and reattach. How complex or common is this surgery? Should I look beyond Winston-Salem, N.C., where I am receiving treatment to some place with possibly more experienced doctors? I am 51 and otherwise in excellent health.

[Annekathryn Goodman, M.D.]

Dear Kimchi,

If there is a question about the nature of a mass, the best approach is to biopsy the mass.  A mass in the rectum in the setting of a known diagnosis of ovarian cancer is usually related to the cancer. The rectum is a common area for a recurrence.  

A CT scan is very good at differentiating between a cyst ( fluid with a skin around it), fat (it has a very distainctive tissue density on scan), or an infection ( it is usually complex with solid and fluid components and sometimes some gas).

best wishes

[zueriheidi]

Amy, because of an adhesion of my sigmoid, I had a colostomy 4 weeks after my initial surgery last spring.  7 weeks ago, after 6 chemos, the colostomy was reversed and about 40 cm of sigmoid/intestine were snipped out.  The surgery took about 5 or 6 hours and I needed 1.5 l of blood.  Other than the major incision (the 4th in a year) still hurting when I cough or laugh, I don't have any major problems.  I was incontinent for a couple of weeks--but that is attributable to the sphincter not having been used in over 6 months.  
Best of luck.

[Annekathryn Goodman, M.D.]

Hi there,
it  sounds like you are in very good hands. I agree with the recommendation to remove an isolated tumor that is not going away. there is good data to suggest that surgical resection of isolated disease in ovarian cancer recurrence does improve survival.

There is a risk of getting a colostomy. The surgery that you will have is major. You may be in the hospital 1 to 2 weeks depending on when you are able to eat. But ultimately, if you are healthy, you will bounce back and be able to get back on chemotherapy.

It is important to wait 6 weeks from your last avastin dose before surgery as avastin can reduce the ability for the tissue to heal
please let us know what happens
take care

[Kimchi]

If Amy51 has had  1.5 years worht of chemo and Avastin to shrink these tumors, isn't it possible that they are not malignan/cancer? What other kinds of mass can one develop in the rectal wall? fatty tissue, cysts?? If it has not changed in size, why not leave them alone?