Stage 1a diagnosed - what did you do?

So sorry to hear your news, but at least it was caught at an early stage. What does your gut tell you to do? I would pray about the obtions and then go with my gut.

I know people who have done both, and if it were me I would opt for the chemo just in case some little cells are floating around.

I am sure you will get many answers and they will probably swing both ways. Again most importantly is what and where you are the most comfortable with.

My prayers are with you. Bonnie Stage 3c,grade3

amcgrath said:

Thanks ladies! I've heard from three doctors so far, two say chemo isn't necessary, and my surgeon says he normally wouldn't recommend chemo, but the tumor on the ovary was so large, the he thought it would be extra "insurance". We're going to talk to one more doctor, and have another pathologist look at it, and then I'll decide. My feelings are, if the cancer cells were truly only inside the ovary, and it has been removed, then it's not necessary to fill my body with chemotherapy. That was also the opinion of the second doctor I'm working with.

I'm not worried about doing the chemo, I've been to "chemo class" and know what to expect. My gyn/onc has a chemo area in his office, and the chemo nurses are great! But I think I'm going to take a little time to think this through, and make sure I have all the facts. I don't have all the information I need yet.

Please look into the possible after effects and long term effects of chemo. It really is a rough thing to put your body through.

Once you have it, the same type of chemo would not be considered for a second-line treatment, because the cancer cells become resistant. That's another reason to be cautious about fewer cycles of chemo - if the cancer should come back, it would be more difficult to treat.

"Gilda's Disease" describes a couple of studies in which no treatment had roughly the same results, 92 - 95% after five years. I recommend this book because it's helped me understand staging and treatment, and how they work. Even though it was published in 1990, I haven't found it to be "dated" - yet.

Gosh, your message made me nervous. I am just about to start chemotherapy on the 24th after undergoing a hysterectomy a month ago and being diagnosed as a 1a ovarian cancer patient. I consulted a gynecological oncologist and got two second opinions from medical oncologist. All said the same thing: get the chemo. The gyn-oncologist suggested 4 cycles; the medical oncologist I am going with suggested 6. The rationale is that if indeed some cancer cells escaped and we just did not see them, I would be 1c and for 1c, they recomend chemo. I was told that without the chemo, my long term survival rate was 80% and with chemo it increased to 90-95%. I don't know where he got these stats but they were confirmed by the other oncologist I consulted.

I don't know what to tell you in terms of what you should do. I am too scared NOT to do the chemo but I may be very wrong. I certainly have had my doubts.

Good luck!

It is likely that surgical skill is a more important determinant of prognosis than the aggressive nature of the cancer or its stage at diagnosis. You are more likely to get a good surgeon at a major, NCI cancer center. Local hospitals are much more iffy, especially if the surgeons there are not board certified in Surgical Oncology and/or have not performed surgeries on MANY patients with successful outcomes. Some surgeons view chemotherapy as a remedy for "bad" surgery. Chemotherapy just isn't good enough to make up for surgical mistakes (e.g. failure to get good margins, tumor spills during surgery, etc.). "The most important prognostic factor is the surgeon!"

The jury is out on how ovarian cancer spreads. As less is known about this disease than other cancers this has not been definatively answered and there is controversy among the ranks of researchers and clinicians. Many believe it does not spread via the lymph and spreads through cells shedding into ascites in the absominal cavity and then seeding in distant sites. It does spread this way but is probably not the only way as it is found in lymph nodes as well. It has long been believed that it does not metastasize to the brain - however in recent years - women living longer are developing brain mets. One school of thought believes that platinum and taxane drugs maybe weakening the blood brain barrier but that does not explain every instance.

Based on clinical trials, results showing no difference between single agent platinums (cisplatin or carboplatin) versus platinum/Taxol (GOG Trial # 132, ICON3), the British National Institute for Clinical Excellence (NICE) determined that platinum/Taxol should no longer be considered as standard therapy.

(http://www.oncolink.upenn.edu/resources/article.cfm?c=3&s=8&ss=23&id=9263&month=01&year=2003)

and

(http://www.weisenthal.org/first_line_ovarian_rx.pdf)

and that a range of therapies are equally acceptable. In the USA, where the administration of platinum/Taxol has been much more profitable to the treating oncologist than single agent platinum, there has been the dogged insistance that platinum/Taxol remains standard, despite clear lack of support for this position, based on the entirety of the clinical trials literature.

The ICON-4 trial took patients who relapsed with so-called "platinum sensitive" disease (relapse > 6 months following last chemotherapy). They were randomized between platinum/taxol and single agent platinum. More than 80% of the platinum/taxol group got carboplatin (as opposed to cisplatin). These all got carbo at a dose of 5 (AUC), which was the same dose given to the single agent platinum group. Also, a lot of the patients had been treated with single agent platinum as first line therapy. The advantage of the combination was modest (10% improvement in progression free survival at one year). Plus, the combination group got more intense therapy (same dose of carbo plus the addition of another drug). Plus, a lot of the patients were "seeing" Taxol for the first time.

The problem with this study is the complete irrelevance to the question of first line therapy. This question has been asked and answered. Twice. GOG-132 and ICON-3. Platinum-Taxol is NOT superior to single agent carboplatin and single agent cisplatin.

For information about one the most important solid tumor drug combination introduced during the past fifteen years:

http://weisenthal.org/gem_cp.htm