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Isolated Late Ovarian Cancer Recurrence: Curable?

By September 22, 2008

I was perusing the latest case reports and smaller case series out there and found this one. A patient in Japan who had undergone surgery and platinum-based chemo had a recurrence approximately 3 years after initial treatment, in the spleen. This was identified by elevating CA125 and a subsequent CT scan.

So, they proceeded to surgery, which is a very reasonable for what is known as "platinum sensitive" disease. Just as a quick review, sensitive means that the recurrence was pretty late, certainly more than a year down the line. The interesting thing is that this was an isolated "parenchymal" recurrence....meaning, it was the only one that was identified and in an organ (the spleen in this case). The result, after a little more chemo, the patient has now gone more than 10 years. Most excellent!

What can we learn from this? Well, most of the time ovarian cancer recurrence is not in one spot only. But it does occur. And, when it does, it is still curable! Is it possible that she may recur again? Of course, but TEN YEARS! If the assumption was that it is probably incurable just because it was "recurrent", and the surgery were never done, it is highly likely that this patient would have just been another statistic.

The moral of the story is that in each individual situation anything is possible. All options should be considered towards the hope for a GREAT outcome. Clearly, in some cases, surgery is just NOT a good idea for many reasons. Many, if not most recurrences, are multiple or some patients just may be too sick for surgery. However, it is highly individual and no options should be closed without careful individual consideration. Keep that in mind and don't give up. I know of at least several of my personal patients who might agree......
December 23, 2008 at 10:57 pm
(1) Joan W. says:

My recurrence (17 months after last chemo)is in lymph nodes deep in pelvis. All organs are cancer free. Can this be treated as any lymphoma or is it still treated as ovarian CA?

December 24, 2008 at 2:19 am
(2) Dr Steve V says:

While it is possible to get a completely different cancer, if this is a recurrence of ovarian cancer it is treated with the same chemo as ovarian cancer rather than lymphoma.

After treatment for ovarian cancer, it is more likely that lymph node enlargement on any scan is recurrent ovarian cancer than lymphoma. However, the only way to know for sure is biopsy. The pros and cons of needle or surgical biopsy is something to talk about with your physician. Hopefully a gyn oncologist is involved in the decision making..

Dr Steve

January 15, 2009 at 5:26 am
(3) indrasis says:

My mother has had clear cell carcinoma that was diagonosed after total hysterectomy in march 2006. She was disease free for 21 months after receiving Cisplatin and Taxol. them a small mass in her omentum which was surgically removed and received doxil +cycophosphamide. Now after 7 months She had Isolated recurrence in her 1 lymph node (3c,x2cm) anterior to Aorta.Doc did not bother to treat and waited 3 months and CA 125 elevated to 536 from 128. Node became 3.2x4cm with another 2 very small nodes(1.5×2.2). She is now under Gem+Carbo.
Would she need a surgery for better prognosys Or Chemo can do the work alone as She is totally against surgery now.
Please Help.

After the first recurrence, which was almost several years after the initial treatment, the surgery that was done may have been helpful. After a second recurrence, especially when it is less than a year later, surgery is of dubious value. However, everyone is different. In general in a setting like this, cure is no longer possible. On the other hand, if the nodes are removable without too much risk (requires a professional assessment of the scans) and CT and PET show no other disease, AND chemo looks like it is working (shrinking the nodes), then surgery is not completely out of the question. The benefit is a very long shot at a longer time before another recurrence, but the risks can be substantial. This is something that requires a long risk/benefit discussion with the gyn oncologist taking care of your mom.
Dr Steve

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