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Ovarian Cancer (Expert Forum)
IS IT IN RIGHT TRACK????
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center
Boston - MA
This forum is for questions and support regarding ovarian cancer issues, such as: Biopsy, Chemotherapy, Clinical Trials, Genetics, Hysterectomy,Immunotherapy, Ovarian Cancer Types, Radiation Therapy, Risk Factors, Screening, Staging, Surgery.
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IS IT IN RIGHT TRACK????
by san2, Nov 04, 2008 03:55AM
Hi
I am wiritng this on behalf of my mom who has been recently diagnosed of ovarian lesions.
ABOUT THE PATIENT:
AGE - 53
MENOPAUSAL - YES - 2 years back
FAMILY HISTORY OF OVARIAN CYSTS/ BREAST CANCER/MALIGNANCY - YES
SYMPTOMS:
- acute lower abodminal pain for more than 4 months
- walking difficulties
- mild rise in temperature at nights
EXAMINATION:
- USG - OVARIAN CYSTS SIZING 3.8*3.6MM
- CT SCAN - LEFT OVARY - 4.cm ENLARGED ; RIGHT OVARY - 7cm*4cm GROSSLY ENLARGED ; BILATERAL OVARIAN LESIONS WITH POSITIVE NEOPLASMS ; PERITONIAL FOLLICULES SEEN/DOUBTED
- doctors feel that the ovaries contain MASS and the other is 50% cystic
- CA 125 - 145
SUSPICION:
- ovary - mailgnant / benign
- tuberculosis
After referring the physian and medical and surgical oncologist, they doctors have proposed to do a LAPAROSCOPY followed by STAGING LAPAROTOMY.
I wish to know for the following:
1. Is the above case suspected of OVARIAN CANCER? When does that come to a conclusion?
2. Is the treatment on right track?
I am wiritng this on behalf of my mom who has been recently diagnosed of ovarian lesions.
ABOUT THE PATIENT:
AGE - 53
MENOPAUSAL - YES - 2 years back
FAMILY HISTORY OF OVARIAN CYSTS/ BREAST CANCER/MALIGNANCY - YES
SYMPTOMS:
- acute lower abodminal pain for more than 4 months
- walking difficulties
- mild rise in temperature at nights
EXAMINATION:
- USG - OVARIAN CYSTS SIZING 3.8*3.6MM
- CT SCAN - LEFT OVARY - 4.cm ENLARGED ; RIGHT OVARY - 7cm*4cm GROSSLY ENLARGED ; BILATERAL OVARIAN LESIONS WITH POSITIVE NEOPLASMS ; PERITONIAL FOLLICULES SEEN/DOUBTED
- doctors feel that the ovaries contain MASS and the other is 50% cystic
- CA 125 - 145
SUSPICION:
- ovary - mailgnant / benign
- tuberculosis
After referring the physian and medical and surgical oncologist, they doctors have proposed to do a LAPAROSCOPY followed by STAGING LAPAROTOMY.
I wish to know for the following:
1. Is the above case suspected of OVARIAN CANCER? When does that come to a conclusion?
2. Is the treatment on right track?
Doctor's Answer
by Annekathryn Goodman, M.D., Nov 05, 2008 08:15AM
, Nov 05, 2008 08:15AM
Hi There
thank you for your complete information.
The proposed intervention of laparoscopy to see what is going on and then possible larger surgery to remove the ovaries is absolutely right.
After menopause, an elevation in CA 125 is very worrisome. There are other reasons for elevation such as infection, heart failure, liver disease. But if your mother has no other health problems then it is less likely.
The normal range for a CA 125 protein level in premenopausal women is under 35 and can vary with the menstrual cycle. After menopause, most women have a CA 125 level that is under 10.
Your mother's ultrasound is also concerning.Those are significant ovarian lesions. It is important to have a gyn oncologist involved with her surgery or a surgeon who is familiar with cancer surgeries.
I am not sure whether Lithuania has the subspecialty of gyn oncology.
Now while I am worried by the description that you give of your mother's condition, it is possible that she has another benign condition of the bowels called diverticulitis. This is a condition where small swellings develop in the wall of the large intestine (colon) that can become inflamed. This can cause pain. the colon is in close proximity to the ovaries and the ovaries can become inflamed and enlarged as well. The inflammation can cause an elevation in the CA 125.
Please let us know what happens with your mother.
best wishes
thank you for your complete information.
The proposed intervention of laparoscopy to see what is going on and then possible larger surgery to remove the ovaries is absolutely right.
After menopause, an elevation in CA 125 is very worrisome. There are other reasons for elevation such as infection, heart failure, liver disease. But if your mother has no other health problems then it is less likely.
The normal range for a CA 125 protein level in premenopausal women is under 35 and can vary with the menstrual cycle. After menopause, most women have a CA 125 level that is under 10.
Your mother's ultrasound is also concerning.Those are significant ovarian lesions. It is important to have a gyn oncologist involved with her surgery or a surgeon who is familiar with cancer surgeries.
I am not sure whether Lithuania has the subspecialty of gyn oncology.
Now while I am worried by the description that you give of your mother's condition, it is possible that she has another benign condition of the bowels called diverticulitis. This is a condition where small swellings develop in the wall of the large intestine (colon) that can become inflamed. This can cause pain. the colon is in close proximity to the ovaries and the ovaries can become inflamed and enlarged as well. The inflammation can cause an elevation in the CA 125.
Please let us know what happens with your mother.
best wishes
Your reply is indeed throwing light on the posible outcomes tht the surgeons may see after the laparosopy.
Sorry but i guess i didnt check my profile while signing in, FYI I am from INDIA, from a city in south of the country.
My mom's surgery is going to be done my a laproscopic surgeon and the staging laparotomy by a SURGICAL ONCOLOGIST.
Thanx for your wishes and sure shall update you s well.
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovarian lesions - confirmed - as shown in Ct scan
I couldn't ask him on whether there are positive lymph nodes.
right now the course of treatment was informed as follows:
1. have 3 sets of chemotherapy to allow optimum regression of the disease.
2. do again laparoscopy to find the extent of regression.
3. if satisfactory, then de-bulk the organs/tumors.
4. or else, in any case invasive surgery must take place. - DESPERATION SURGERY.
5. again 3 sets of chemotherapy.
Ur comments?
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovarian lesions - confirmed - as shown in Ct scan
I couldn't ask him on whether there are positive lymph nodes.
right now the course of treatment was informed as follows:
1. have 3 sets of chemotherapy to allow optimum regression of the disease.
2. do again laparoscopy to find the extent of regression.
3. if satisfactory, then de-bulk the organs/tumors.
4. or else, in any case invasive surgery must take place. - DESPERATION SURGERY.
5. again 3 sets of chemotherapy.
Ur comments?
I had my mom's laparoscopy done on Monday. I surgical oncologist informed me that he is not proceeding with the laparotomy/debulking of the pelvic organs/timors because:
1. the laparoscopy shows clusters of growth on the pertonium - specially on the RUQ above liver, on the mid right peritonium - the one that was seen in the CT scan as well, and on the sigmoid colon.
I confirmed with him whether it is diverticulitis, but he declined it.
2. bilaterial ovaria