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re-occuring ovca concern

My 63 year old wife was diagnosed with Ovarian cancer in 2002.  She had successful debulking surgery followed by chemotherapy (paclitaxol and cisplatnum) and did well until 2007 when her CA 125 reached the high 70s.  It should be noted she was also found to be BRCA 2.   In 2007 she had evidence of enlarged lymphnodes in her chest (mediastinum).  She was retreated with the same chemo and again it was successful.  At this time her CA 125 is creeping up again (mid 40s) and the lymphnodes in the chest have grown.  Fortunately, her pelvis and abdomen appear to be clear.  Her gyn onco is taking a wait-and-see position.  My wife is in no discomfort and is not symtomatic.  We're both fearful that something needs to be done to prevent further growth of the cancer in her chest.  We're fearful that waiting until the nodes are creating a problem is too late to treat them.  Some helpful advice would be deeply appreciated.
1 Responses
242604 tn?1328121225
Hi There
thank you for your excellent questions.

here are a few things to consider:

--depending on the grade of the tumor, watchful waiting is reasonable for low grade tumors. There is an argument for - say - grade 1 tumors- that chemotherapy is not very effective and it is best to wait for symptoms

--if the cancer is estrogen receptor positive, consider an anti-estrogen such as tamoxifen and arimidex

--ask about clinical trials with PARP inhibitors
these experimental agents are designed to interact at the molecular level where the gene mutation occurs

--finally are you absolutely sure those lymph ndoes are from ovarian cancer and not some other process benign or malignant? have they been biopsied?

best wishes

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