Tumour markers

Hi all,

I had 4th chemo yesterday for metastatic OC and oncologist said I was responding very well to chemo (Taxol/Carboplatin) and my tumour markers are now within normal range (they had been 550 at diagnosis in early June this year) . The initial plan was 4 chemos, then debulking surgery 4 weeks later, and then the more chemo after surgery (3 or 4 sessions). I also had CT scan yesterday and the medical team will review the results next week. My oncologist said yesterday that he might continue with the chemo (another 4 sessions) and then have surgery later.

I am thrilled that the tumour in the ovary is responding so well, but wondering why chemo will continue now, instead of doing surgery as planned.

Any thoughts anyone??

Thanks!

[andrew12341]

I would have thought that they need to see the CT results before deciding about surgery. If they think they can get at all of the tumour then they will do the surgery; if not, they continue with chemo to try to shrink the tumour more.

This is what's happening with my mother. She is also having carboplatin and taxol with surgery planned for October. But it will also depend on how she responds to the chemo and what the CT scan in a few weeks shows.

[Hidden in reply to andrew12341]

Thanks Andrew.

You're correct, a decision will not be made re timing of chemo/surgery until the team meet next week to discuss CT results. I was just wondering why the change of plan from the initial one (surgery done mid -chemo sessions) and if this was a positive or negative sign. The initial CT scan showed a 9cm tumour in my ovary with cancer in the peritoneal and masses outside the liver and spleen. I had thought the oncologist said I was stage 4 but he has since said it can't be staged until after surgery. However, I was also under the impression that when the the ascites was drained in June upon admission to hospital that staging information could be taken from that........as it was almost like a biopsy! Quite confusing !

Juliet

[Whippit in reply to Hidden]

Hi Juliet

It's good the surgeon thinks chemo is working and by having more of it the tumour will continue to shrink and hopefully give you a better outcome from surgery. The ultimate goal would be no evidence of disease after surgery if that is possible which gives us the best chance.

I was told staging is done after surgery when they send the tissue for analysis. I had visible tumours on my lymph nodes and the surgeon wanted the tissue checked as it could have been an unrelated cancer rather than mets linked to ovarian cancer.

I hope your treatment continues to go well. xx Annie

[Hidden in reply to Whippit]

Thanks Annie - that helps my understanding!

[andrew12341 in reply to Hidden]

I might be misunderstanding what you have written, but seems like there hasn't been a change of plan. Isn't the oncologist just saying that he could re-evaluate after seeing the CT scan? If so, I don't think that is a change of plan (or is either a positive or negative sign), because the decision to do surgery is always conditional on what the latest CT scan shows. We have been told that surgery will *probably* happen mid-chemo, but the decision will only be made after a CT scan later on.

Biopsy tells you the grade of tumour (my mum's is high grade serous, which is the most common type). Surgery gives the clearest indication of the stage (i.e., where it has spread to) as some cancer might not show on a CT scan. Biopsy won't tell you the stage. It just tells you the grade.

[Hidden in reply to andrew12341]

Hi Andrew

The original plan was to have the surgery after 4th chemo (regardless of result of CT scan that I had on Thursday 13th August) and now there is a possibility of continuing with chemo when the medical team review the CT scan next week, and then have the surgery at end of chemo sessions.

Do you know what the highest grade is? I was under the impression that the grades went from 1- 3, but have been told the range is 1-4.

I hope your mother's treatment goes well .

Juliet

[andrew12341 in reply to Hidden]

I think grades go from 1-3 (see here for example: nhs.uk/chq/Pages/3169.aspx?... but people most commonly talk about high grade (which I assume is grade 2-3) and low grade (which I assume is grade 1). Maybe when you were told that grades go from 1-4 they were talking about stages?

How often are you having chemo by the way? Is it every 3 weeks or every week? My mother is having it every week, but with a lower dose.

[andrew12341 in reply to andrew12341]

the previous link was mistyped. This is the link:

nhs.uk/chq/Pages/3169.aspx?...

[Hidden in reply to andrew12341]

Thanks Andrew - I am having chemo every 3 weeks.

Juliet

[Cre27]

Like the others have said it all depends what the scan shows. Perhaps your results are encouraging so they think more chemo will shrink it more and therefore make surgery outcome more successful. I had 3 chemo of carbotaxol then a scan. But as my consultant wanted a bowel surgeon present as the tumour was affecting the bowel had 4th chemo whilst a date was sorted. Worth it as the tumour had been 'killed off' and was not able to be analysed. Biopsy at start of treatment showed it was 3c. No visible sign of cancer but had final 2 chemo. Final scan showed no evidence of disease!!!! Great news although this doesn't mean it won't rear its ugly head sometime in the future! So good luck sounds as things are going well for you x

[Hidden in reply to Cre27]

Great news on your final scan! And thank you for your reply.

Juliet