Chemo or Without Chemotherapy

[bradleeyt]

Dear All Goodman Doctors, my wife 39 is diagnosed with only left mucinious cystadecarcinoma ovarian cancer upstaged to 1C due to rupture during the initial surgery. She had just completed another round of surgery with a total removal (Uterus, right ovary, appendix and omemtum) as advised by our surgeon.

Good news is all post-operative biopsies / fluids / specimens shown negative without any malignant cells detected except the only left ovarian which removed and diagnosed in the earlier surgery. CA125 testing and all form blood test and CTscan and MRI shows very good / normal levels and theres no any sign of spread or cancer cells. Bad news is our surgeon chosen to perform a total removal without prior consulting us for any chance of fertility preservation. Our question is ,base on all the positive results, does my wife still need to go for the adjuvant chemotherapy treatment?.  A protocol stated that any ruptured tumour despite all the negative results must undergo 6 cycles of chemotherapy treatment.

Our surgeon insisted but we are not keen after the first bad / sad incident. Can we choose not to go for the treatment but cautiously monitoring her condition and symptoms? After all my wife is healthy and did not experience any symptoms before and after the operations. Her ovarian cancer was found during her c-section ( first and now only child ) as initially confirmed as 10 cm cysts attached to her left ovary but turned out to be ovarian cancer so unfortunate. Any proven statistic that 1C ovarian cancer without any chemo treatment recurrence. Can she hold longer (years ) and back to her best health before performing the chemo treatment. Many saying, since she is now in good condition, is it worthwhile that she go for the treatment? And we understand that chances of chemo treatment may deteriorate her health and may lead to other illnesses if she is the unfortunate one again. We really hope that you would share your valuable sincere and professional advices.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
I am sorry to hear of your wife's illness. Fortunately, it was detected at an early stage, and the staging laparotomy results were all negative for malignancy.
In view of Stage 1C, and also the mucinous type of cancer on histopathology, I would not recommend a wait-and-watch policy. It is standard in cases such as this to prescribe 6 cycles of chemotherapy with a taxane (usually paclitaxel) and a platinum (usually carboplatin).
Standard guidelines governing oncology practice in USA (as formulated by the National Comprehensive Cancer Network, www.nccn.org) suggest that chemotherapy must be given to all stage 1C ovarian cancers.
Please feel free to post additional questions if you need any clarifications.
All the best, and God Bless!.

[ma06]

A related discussion, Carcinoma Cribriform need Chemotherapy? was started.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi Marie,
Thankyou for your valuable comments. I hope you are now in good remission, and that you remain disease free.
Good luck!

[marie3B]

As a mucinous cystadencarcinoma patient I agree 100% with Dr.Kamal Saini.  Mucinous cancers are very difficult to deal with.  They often can't be monitored by the CA125s or other tumor markers.  My CA125 is under 2, yet I have active cancer.  She should do fine with the standard chemo for 6 cycles. Some of my tumors don't even show up on th CT or PET scans.  I did well getting through 1st line treatment and I am sure she will, too. As far as the loss of fertility, I know that must be hard.  But that one child will need a mother for a lifetime and this was the best way to ensure that.  My thoughts and prayers are with you.  I wish you all lives of good health free of the ovca monster.  Marie