Borderline mucinous tumor-ovary

[ravewaker]

I'm age 47 & I've had 2 large tumors of the ovaries, in '94 gyn. removed large soccer ball sized cyst, fallopian tube & ovary, that was declared benign. In May'09 I have another tumor removed by gyn/onc, this onsite path said benign, but 2nd opinion to Stanford said BMTO.  I had TAH but no appendectomy, omentum and aortic lymph nodes all left intact. All organs incl. appendix appeared to be disease free, but no path done on them.  No staging done due to onsite path stating benign. Also have had gall bladder removed in last yr., with colonoscopy/upper GI dx'ed w/ IBS, & diverticulitis.  3 CA-125's all came out clear, Stanford recmnd. CT scan after surgery, came out clear.  

Now I have abdominal distension again with diarrea, but don't know if it's due to other above listed digestive conditions. Iniatiated apt. w/ MD, (gyn/onc has retired & was only gyn/onc in my town), but offering advisory services to my long time MD for follow up care. I want another CT scan and CA 125 done.  What is your advice for my follow up care, as I'll bring this with me to my MD for my Jan 4th apt.?? Could my 2 tumors be related to each other or be related to psuedomyxoma peritonei? Gyn/onc said no fluid existed outside of ovarian tumor. Am retrieving all med records/path back to '94 to create a timeline.I couldn't bear to be reopend after 2nd path from Stanford to have appendix removed, but I'm very fearful that has returned due to current abdomenal distension. Asked gyn/onc about CEA or other tumor marker tests, but he seemd to think the reliabilty was questionable, said ex: smokers can come up positive on these at times and this can cause the patient unnecessary stress/expense.

So many different conditions to contend with: digestive, menopausal, and simple aging. Any advice how I can differentiate to observe what might be serious symptoms? Also have a few affective disorders, bipolar, ptsd and anxiety, which complicate all of this even furthur.

Sincerely, Kaye

[ravewaker]

Thank you very much for your complete and informed answer.  I'll bring this info along to my Dr. apt  At this sime I have the symptoms of abdominal distension, frequent diarrea but no pain, mostly just discomfort from the bloated "full" feeling, as if I've overeaten.  I have a CT scan scheduled this Monday, and a CA-125 also, then appt. w/ MD on Thurs.  I'll present this info to her, and suggest a CEA also, and post my results from the tests, hopefully to help others also dx'ed with this condition.

Thank you again, Kaye

[Annekathryn Goodman, M.D.]

Dear Kaye,
thank you for your complet information!

You are very smart and your approach is wise.
Getting all your records and making a timeline is very helpful to the next doctoir you will see.

My short answer is - I agree with what your doctor said.Just do follow up with exams and a CT scan maybe once a year.

However a few other things to consider:

-if you have not had a recent colonoscopy, get one
-if you are currently symptomatic with abdominal pain, a CT scan will very effectively rule in or out recurrence, pseudomyxoma peritonei, a tumor on the appendix
and
-CEA is a better tumor marker to follow for mucinous tumors than CA 125
see: http://www.tc-cancer.com/tumormarkers.html

and

Acta Obstet Gynecol Scand. 2007;86(4):484-90.

Is there a correlation between tumor marker panel and tumor size and histopathology in well staged patients with borderline ovarian tumors?
Ayhan A, Guven S, Guven ES, Kucukali T.

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

AIMS: To investigate whether there is a correlation between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well staged patients with borderline ovarian tumors (BOTs). METHODS: Four tumor markers (CA 125, CA 19-9, CA 15-3, and CEA) were analysed clinically in 60 well staged patients with borderline ovarian tumor, for this retrospective observational study. RESULTS: Most patients had serous histology and early stage disease, and the mean age at the time of diagnosis was 40.70 years (range: 19-73). Twenty-nine patients (48.3%) had high CA 125 levels (>35 U/l), 15 patients (25%) had high levels of CEA (>4 ng/ml), 12 patients (20%) had high levels of CA 19-9 (>37 U/ml), and 9 patients (15%) had high levels of CA 15-3 (>30 ng/ml) at the time of initial surgery. The positive rate of CA 125, CA 19-9, CA 15-3, and CEA in serous tumor were 57.9, 7.9, 7.9 and 15.8%, respectively. These figures were 31.8, 40.9, 27.3 and 40.9% in mucinous tumor. The positive rate of CA 125 in the serous group was statistically significantly higher than that in the mucinous group, while the positive rates for CA 19-9 and CEA in mucinous histology was significantly higher than those in serous tumors. In case of grouping the tumor size as 10 cm, the mean serum levels of tumor markers had significantly increased by increasing tumor size (p0.05 for CA 15-3, and CEA). CONCLUSION: The high levels of tumor markers, especially for CA 125 and CA 19-9, may indicate the larger tumor size. The elevation of serum CA 125 may suggest serous tumors, while the high level of serum CA 19-9 and CEA may indicate mucinous BOTs.

best wishes