Stage 3C Ovarian Cancer

Christina1318

My mom got diagnosed with Stage 3C ovarian cancer (age 54) on December 21st, with spread to the omentum with ascites with one lymph note involvement. Per doctors recomendation, my mom completed neoadjuvant chemo before surgery (4 rounds of dose-dense of taxol and carboplatin). Symptom wise she has been great, with the only side effect being constipation (which we were able to get under control)!

CA125 at time of diagnosis - 850; After 1st round - 280; 2nd round - 80; 3rd round - 18; 4th round -16

CT scan was completed - with the chemo results being favorable but incomplete (monumental shrinking within pelvis area; but omentum did not really change). Surgery is still scheduled for June 7th!

What does an incomplete response to chemo mean, does that mean she's platinum sensitive? Has anyone experience neoadjuvant dose-dense before surgery? What should I expect for after-care after her surgery?

Thanks so much!

 

 

 

Tethys41

Your Mom

Hi Christina,

It sounds like your mom's treatment is working great!  The goal of chemo is to have the CA-125 drop by at least half each time.  Her last one probably didn't drop by half because she is in the normal range and it may not go much lower.  It sounds like the results are saying that the chemo did not eliminate all of the cancer.  That is not really surprising and is why she is going to have surgery next.  The omentum is tough.  Cancer loves the omentum and I would be surprised if chemo alone would rid that area of the cancer.  Typically, during a debulking surgery, the omentum is removed.  I wonder why more doctors don't recommend chemo before surgery.  The thoroughness of the surgery is critical for the patient's long term outcome.  Clearly, the more cancer that can be eliminated prior to surgery, the easier it is to get a good result from the surgery itself.  It does not sound at all as if your mom has cancer that is resistent.  If it was, her tumors would not be consistently shrinking and her CA-125 would not still be coming down.  

After surgery, she will need to recover in the hospital for a number of days and then take it easy at home.  It's not unlike a hysterectomy done via laparotomy, incision, except the incision is typically vertical, rather than across the top of her pubic bone.  She will likely have a full hysterectomy, her omentum removed, any lymph nodes that might still be involved, althought that didn't show up on her scan and, often, the appendix is also removed.  For the first few days, her bowel might not start working right away and she may have a tube inserted through her nostril into her stomach to allow the bile to drain and give her bowels a rest.  Then she will start on clear liquids, and work her way up to solid foods.  

Once she is at home, it is rather individual.  She should be able to take care of her own needs.  But the chemo drugs tend to be cumulative.  So as she receives more doses, she may start having more side effects.  It is very individual and treats everyone differently.  Her taste buds might change from the chemo and she may find herself able to eat and enjoy fewer foods, but that is temporary.  I recommend a booster seat for the toilet, so that it is easier for her to get up from sitting, without engaging her abdominal muscles.  She will be put on pain medicine after surgery and that, as well as the chemo, causes constipation.  So she will need to keep a close eye on it.

It sounds like you mom is on the right path and the treament is working great.  I wish her luck for her surgery. 

Take care

Christina1318

Tethys41 said:

Your Mom

Hi Christina,

It sounds like your mom's treatment is working great!  The goal of chemo is to have the CA-125 drop by at least half each time.  Her last one probably didn't drop by half because she is in the normal range and it may not go much lower.  It sounds like the results are saying that the chemo did not eliminate all of the cancer.  That is not really surprising and is why she is going to have surgery next.  The omentum is tough.  Cancer loves the omentum and I would be surprised if chemo alone would rid that area of the cancer.  Typically, during a debulking surgery, the omentum is removed.  I wonder why more doctors don't recommend chemo before surgery.  The thoroughness of the surgery is critical for the patient's long term outcome.  Clearly, the more cancer that can be eliminated prior to surgery, the easier it is to get a good result from the surgery itself.  It does not sound at all as if your mom has cancer that is resistent.  If it was, her tumors would not be consistently shrinking and her CA-125 would not still be coming down.  

After surgery, she will need to recover in the hospital for a number of days and then take it easy at home.  It's not unlike a hysterectomy done via laparotomy, incision, except the incision is typically vertical, rather than across the top of her pubic bone.  She will likely have a full hysterectomy, her omentum removed, any lymph nodes that might still be involved, althought that didn't show up on her scan and, often, the appendix is also removed.  For the first few days, her bowel might not start working right away and she may have a tube inserted through her nostril into her stomach to allow the bile to drain and give her bowels a rest.  Then she will start on clear liquids, and work her way up to solid foods.  

Once she is at home, it is rather individual.  She should be able to take care of her own needs.  But the chemo drugs tend to be cumulative.  So as she receives more doses, she may start having more side effects.  It is very individual and treats everyone differently.  Her taste buds might change from the chemo and she may find herself able to eat and enjoy fewer foods, but that is temporary.  I recommend a booster seat for the toilet, so that it is easier for her to get up from sitting, without engaging her abdominal muscles.  She will be put on pain medicine after surgery and that, as well as the chemo, causes constipation.  So she will need to keep a close eye on it.

It sounds like you mom is on the right path and the treament is working great.  I wish her luck for her surgery. 

Take care

Thank you so much Tethys41,

Thank you so much Tethys41, for your well thought out and thorough reply! While the doctors, along with google, have been able to provide me with a lot of my questions; sometimes it is necessary to hear from people who have experienced it!

My mom has done exceptionally well during the first four cycles of chemo, so much so that the PA didn't think she was the patient. So going from the euphoric movement of "Oh yeah, she's kicking cancer's ****!!" to reading "incomplete response" was a complete 360. I am glad to hear that her 'lack' of results on the omentum is normal; and that isn't unlike to be platinum-restistance!

Thanks for providing me with what to expect for her upcoming surgery. The doctors provide you with so much information of what can happen; you don't really receive a clear idea of what will probably happen! 

Also, great heads up on the booster seat; I'll be sure to pick one up before she returns home!

Wishing you the best as well
Christina

rejoycew

I would like to add to

I would like to add to Telhys41 great comments.  You should  not  worry about being resistant to plantin chemo.  There are many more choices of chemos out there.  I developed the resistance and was started on Gemcitabine which was ineffective and I have just now finished with the prescribed dosage of Doxil which did hold a fairly stable CA125.  After genetic testing and another  CT scan we will decide on whats next.  So theres lots of hope out there for a happy good qualitity of life.  Good luck with your moms surgery.  I just read an article about chewing gum after abdominal surgery and the good results of getting everything in the bowels moving again especially after a C-Section.  Yes  your mom surgery is different but gee it couldn't hurt and I wish I had known about it after my surgery.  Heres the link:http://www.livescience.com/59299-chewing-gum-c-section.html.  I told my RN yesterday about my increase in passing gas at my last chemo  and she said thats a good thing.  (I'm not sure those around me think so) but its a sign that the bowels are working.  I have done well on all of the chemo ie: very few side effects, but everyone is different.  Prayers for a sucessful surgery and easy recovery for your mom.  Keep us posted.