Recurrence so soon after surgery?

[Crickie]

Dear Dr,
You've helped me in the past and hope you can advise. To recap, I had inoperable ovarian cancer. Was told to go for palliative care in Nov 07, found a surgeon (in Feb 08)who performed posterior pelvic exenteration with colostomy,reconstructed rectum and partial vagina. He told me I had 80% chance of recurrence and surgery was not curative but since I was in pain and had been bleeding for 2 years he agreed to do it.

He knived my bladder during surgery but left it in. Since surgery I have not been able to urinate on my own. I alternate from self-cath and in dwelling foley. I had a CT scan in June to see if colostomy can be reversed but was told that there are 2 small fistulas that have grown. He wants to wait 4 months to see if they heal themselves. My next CT scan is set for October 1.

I finally got the final result of CT scan and was surgprised to read that along with the 2 fistulas there is 'diffuse irregular thickening of the perirectal fascia. There is also poorly defined soft tissue thickening along the inferior margin of the small bowel loops, which is inseparable from the mid left bladder dome, contiguous with the thickened perirectal and extends to the sidewalls, highly suspicious for recurrence'.

I showed this to my oncologist and he told me that I should 'forget the disease and live for today'. He told me that if this is in fact a recurrence there are no more chemos or surgeries for me, I had many chemos before the surgery and none worked. Avastin was also not an option for me.

My questions are:
1. Do fistulas heal themselves? Will there be a chance that the October 1st scan might show that they healed and I can have colostomy reversed?

2. From your experience, fo you think I'm having a recurrence so soon after surgery? Is it possible? Will the October 1st scan confirm this if it is indeed a recurrence?

Any advice you give will be apprecisted as you've helped me in the past.
Thank you.

[Annekathryn Goodman, M.D.]

Dear Crickie,
I hope that all goes well. Bleeding can be a tough problem. If it is possible to give more radiation, that can stop bleeding.
Another intervention that you can ask your doc about is embolization. Sometimes it is possible to plug up the arteries that feed the tumor.

best wishes

[Crickie]

Thank you Doctor,

I am seeing the radiation oncologist tomorrow and hope that radiation can be useful -I did have radiation in this same area two years ago.
As for recurrence, it has been confirmed with a smear taken by my gyno/oncologist coming out positive for cancer cells.
They seem to be more concerned about stopping the bleeding. I was told that if the tumour begins eroding a 'major' vessel I will likely die from hemmoraging.
I'm still not sure what I can do for my bladder, wearing a foley catheter is a 'pain' and I wonder I can keep on wearing it forever.
I did see a urologist, but he was not willing to remove it and have me have another 'bag'.
Thank you for all your help.

[Annekathryn Goodman, M.D.]

Dear Crickie

It is nice to hear from you. Thank you for the follow up.

My guess is as following:

-It is unlikely that the colostomy can be reversed. Fistulas especially in the setting of so much therapy do not heal very quickly. But it is not impossible.

-Yes you could have a recurrence or it may be inflammatory changes.  If it is a recurrence and it is isolated to the pelvis, you should ask your doctor if there is any role for radiation therapy.

-The bladder sounds tough. Commonly with radical surgery, the nerves to the muscles of the bladder do not function well.

best wishes to you. Please keep in touch