Low grade stage 3c omental cake

[Seshat2]

Dear all,

I have been reading all your posts for a while and appreciating all the support and information you share in this wonderful community. Today I decided to post for the first time about our situation:

My mum (56 years old) was diagnosed in May 2018 of low grade OC, stage 3C, while on surgery to remove ovaries after finding a mass in the ovary and CA-125 levels of 188. They found a huge peritoneal carcinomatosis that was also extended to the surface of intestines, liver and diaphragm, and concluded it was not operable. She had 3 cycles of neoadjuvant Carboplatin-paclitaxel-bevacizumab and after that the CT scan showed a mild response (did not expected more as she is low grade...) and also a reduction of CA-125 levels to 78. Then she was scheduled for an exploratory laparoscopy to see deeply inside the abdominal cavity and evaluate if she was now candidate for debulking surgery and HIPEC. However, the omental cake is so thick that surgeons could not even enter, so we have just been told it is still not operable. Most probably will receive 3 or 4 more rounds of chemo and re-evaluate, fortunately at least she handles it really well, with almost no side effects. But as chemo has not done much until now, I really do not expect a huge improvement... Any experiences with low-grade second line therapies? I have read about hormonal therapy and we are still waiting for the results of BRCA tests. Any advice will be very much appreciated.

Thank you all for your kindness and support!

Sara.

[Ge0rg1na]

Sorry to hear about your mother's situation. I'm afraid I'm high grade and cannot help but you might be able to do a search using key word/s as there might have been a conversation on here a while back that's still relevant. It sounds as though she getting good treatment though so I wish her (and you of course) all the best. Gina

[Seshat2 in reply to Ge0rg1na]

Thank you Ge0rg1na! All the best to you too

[RonLitBer]

Have they tested her tumour?

[Seshat2 in reply to RonLitBer]

Hi RonLitBer, do you mean histologically? To be fair it was quite controversial at the beginning, since after surgery they told us it was a high grade serous carcinoma. However after a more exhaustive analysis they determined that it was low grade... Which I think is true according to the little response to chemo. We are waiting for the BRCA analysis, apparently she won't be tested for hormone receptors, here it is only done for breast cancer.

[RonLitBer in reply to Seshat2]

Yes, the histopathology report tells you what the cancer looks like under the microscope and I guess that is what determined it was low grade.

The BRCA 1&2 testing is a genetic test for hereditary ovarian cancer (BRCA classification means that you have impaired repair of DNA double stranded breaks). There are now additional genes besides BRCA 1&2 but they don't typically test beyond BRCA 1&2. This site would be able to give you more information on the additional genes as well as BRCA 1&2.

facingourrisk.org/understan...

I was thinking along the lines of testing whereby abnormalities or mutations that occur in the cancer cells themselves (in the tumour) would be looked at. Basically genetic alterations in the tumours.

Her tumour may be BRCA-like (BRCAness) which is a somatic rather than a germline BRCA mutation. I am actually not sure if this happens in low grade tumours but it does in high grade.

This may be helpful.

cancer.gov/about-cancer/tre...

[Seshat2 in reply to RonLitBer]

Yes, the histopathology confirmed it was low grade serous. However, surgeon took an additional sample from last laparoscopy to further analyze it. And we will have the results of the BRCA mutations analysis in a few days. If frontline chemo finally fails or she becomes platinum resistant, we will ask to be referred to a phase I unit and se if the samples can be tested for MEK and BRAF mutations, which I have read that are more common in low grade, and search for trials with targeted therapies. Thank you!

[RonLitBer in reply to Seshat2]

Why just phase 1?

[Maus123]

Hi there. Sorry about your mom's situation. My second line treatment for low grade oc was carboplatin/paclitaxel chemo plus avastin and now Letrozole (anti hormone).

Might be worthwhile asking about anti hormone therapy especially if her tumour is hormone receptive. All the best. Maus

[Seshat2 in reply to Maus123]

Thank you so much Maus123. Yes, I thought about hormonal treatment too. We just had an appintment with the oncologist and she decided to go on with carbo-pacli-bevacizumab for a couple more cycles and then another scan, and then we will see.

[Heidi-CA]

Hi Sara,

I had Grade 3c borderline OC and huge surgery where fortunately they could remove all of it. However, it still could turn into low grade and my oncologist said if it did that he would refer me to MD Anderson in Houston TX as they are best in the world for low grade OC, may be a consideration for your mom. Best wishes for your mom and hopefully it can be controlled.

Heidi

[Seshat2 in reply to Heidi-CA]

Hi Heidi. We are in Spain, so Texas is quite far to us fortunately we have a wonderful public healthcare system here, and if nothing works we can also ask in the MD-Anderson Madrid hospital. I had read it is specialized in low grade too. Thank you!