Posts by Jamie Chase

Seeking assistance if anyone has insight

My mother is fighting an ovarian tumor. Since the backstory is far too long, I will attempt to provide a condensed chronology:
2013 - January: First surgery in Mostar. Dr. Knežević removes a "tumor plaque" from the abdomen and removes the right ovary; reaching the left one is impossible due to specific complications. The tumor is Stage 4 and has caused abdominal adhesions, making the ovary inaccessible. Following this, she undergoes 9 cycles of chemotherapy. Lung imaging shows no metastasis, and after a certain number of treatments, the fluid recedes. Markers drop from 3000 down to the normal range. The remaining tumor on the left ovary measures 3 cm.
2014 - May: Dr. Ćorušić (Washington, D.C.-Mostar). My mother’s condition is almost excellent. She tolerated the therapies well, aside from rapid fatigue and pressure on her shoulders; everything else seems fine. During this surgery, Dr. Ćorušić was intended to remove the remaining ovary and the tumor. However, upon opening and seeing the state of the intestines, he made the decision (his own words) that it was better not to touch it. He determined the procedure would be too high-risk and would require removing significant portions of the bowel—not because the tumor is on them, but because the adhesions are so extensive they prevent access to the ovary. To reiterate: his decision was to leave it alone.
After that operation, during a meeting with Dr. Knežević and Dr. Ćorušić, Knežević used the phrase, "If I were to operate on her, it would be like signing her death warrant."
2015 - January: We perform a second PET-CT, which shows the tumor growing. It went from 3 cm (02/2014) to 13 cm (01/2015). We arrange a meeting with Dr. Haller (Rijeka-Mostar). After the examination, Dr. Haller stated that the tumor must be surgically removed, even if it means terminal outcomes follow. When my mother explained that Knežević and Ćorušić said the "intestines are fused" and therefore they cannot or will not operate, he responded, "It can be done." Throughout the entire meeting, based on how Dr. Haller spoke, I walked away with the impression that he knows it is possible. He was quite confident and certain of a positive surgical outcome. He noted that while the tumor does not kill quickly, it is growing, and it is only a matter of days before complications arise. While we spoke in the room, Dr. Soldo (Mostar) was also present—he attended the previous surgery performed by Dr. Ćorušić. He said nothing; he neither confirmed it was impossible nor claimed it was possible... he simply remained silent.
Haller stated he cannot perform the operation in Mostar, but rather in Rijeka where he has a specialist team, including urologists, etc., noting that the postoperative care there is superior. He admitted the surgery is demanding and complex, yet he sounded capable. I suspect he was somewhat guarded because Dr. Soldo was present, and he likely didn't want to appear as though he were undermining him.

So, here is what I am wondering. Given that we have heard nothing but praise for Dr. Haller's expertise, but we have also heard great things about Dr. Ćorušić, has anyone here had experience with these doctors? What is the quality of gynecological care in Rijeka? Or perhaps someone has had similar experiences? We are truly at a crossroads regarding what to do. Haller also mentioned that we could look into Washington, D.C. or Split, as the procedure can be performed there as well. We aren't sure if Dr. Haller is truly the best, or if there is a third option in Washington, D.C. or Split that might be superior.
Thank you

I am writing once again regarding my mother's situation. She underwent surgery a little over a year ago and handled her chemotherapy quite well. Her initial markers were soaring above 3000, but they have since dropped to 24. We explored various alternatives alongside standard medicine; the fluid in her lungs cleared up, and she recently saw a gynecologist who provided a diagnosis. He noted that there had previously been metastases in the uterus and the outlook was grim, yet now those are gone, which has left him puzzled. Her primary oncologist—who is pleased with the recent results—reviewed the CT scan and suggested a laparoscopic removal of a 31x16 mm mass on the left ovary. However, a second oncologist (the first was away on vacation) argued that if the chemo is working, it might be wiser to leave it alone. A few days ago, she had a PET-CT performed in Miami, where the recommendation was that if the tissue is necrotic, it should be removed, but if it is active, we should stick to the chemo.
Who is one supposed to listen to in this scenario?
Also, if it isn't too much trouble, could someone please review the PET-CT results and provide a brief summary?

http://www.sendspace.com/file/027qso

Thank you.

Greetings.
My mother is experiencing red patches on her hands and legs due to chemotherapy, along with intermittent redness on her scalp. Her doctors prescribed a B-complex vitamin and suggested the issue stems from sun exposure. However, she isn't out in the sun; the only time she’s exposed is during the drive home from the clinic, and even then, her legs aren't catching any sunlight. Is there something specific we should purchase, or is this simply a normal side effect?

Angela Wright said:That is excellent news, as there appears to be a positive response to the therapy. Get her some beta-glucan; she is clearly exhausted, and it should provide the necessary boost for her recovery.

So, is it safe to administer beta-glucan before the final round of therapy? Is there any risk of a counter-effect?

Angela Wright, you might remember me—I’m talking about my mother. She just finished five rounds of chemo, and the markers have dropped from 3000 down to 75 prior to this latest stretch. Even better, the fluid isn't pooling in her lungs anymore. Is she feeling better? Relatively speaking, yes. Compared to how things were, there is a noticeable improvement, though I suppose "better" is a relative term when dealing with this. The most difficult part is the exhaustion. She has zero strength left; even a few steps around the table leaves her completely spent. Most of her time is spent sitting or lying down. Now that she’s approaching her final treatment, I find myself wondering: should I pick up more beta-glucan for her? I've seen discussions here suggesting it's more effective to use it after the therapy is complete.

ruggedmarlin2 said:Mom isn't doing well at all.... she's in constant pain now (she had surgery on March 27th—they removed everything they could in her abdomen: ovaries, glands, peritoneum, part of the intestine), and now her back hurts, her stomach hurts, and there's pain on the right where the ovary used to be.... she's running a fever again too—it hits 100.4 in the evening, she sweats through the night, and then it's gone by morning. She’s weak, mostly just lying down, and if she tries to walk even a little bit, she gets exhausted immediately. She's drinking everything she can find—beta-glucan, raw propolis, zinc, selenium, and beet juices.... she eats normally.
Her abdomen is swelling again—we suspect fluid is building up. Her next round of chemotherapy protocol isn't until May 27th.

Since we aren't quite sure who to turn to for help, I am posting here... does anyone have any advice? Is this state normal?

I am fully aware that this is a severe illness and that the actual treatment hasn't even truly begun, but still, it is difficult to watch her like this...

It's the same situation with my mother... except they removed less in her case... since the metastases are everywhere, they left the uterus in. She is also weak and sometimes barely manages to walk. She recently underwent chemo, though they gave her a lower dose specifically because of her weakness... she's scheduled for another one on May 20th.
My mother feels better when they perform a thoracentesis to drain the fluid from her lungs... perhaps you should ask the doctors to do that for her?

wanderingcobra76 said:Perhaps they apply a topical anesthetic cream first, followed by the local anesthetic injection—which actually stings quite a bit during infiltration.
She likely wouldn't even feel the subsequent needle prick.

She mentioned she doesn't feel any puncture at all until the actual procedure starts. That's why we suspected they might be skipping the local anesthetic entirely. We aren't certain about the pain level of the puncture itself, so it's hard to say; the puncture seems to be rather painful for her.

Just one question. Mom underwent another lung puncture today, and they drained about a quart. I’m curious about something: the doctors claim they administer an injection to numb the area—essentially local anesthesia—yet she doesn't feel the needle at all; they just rub the site and perform the puncture. I'm asking because she experiences significant pain during the procedure, arguably more than she should. Given that we know how much certain hospitals in San Antonio struggle with medication shortages and tend to cut corners wherever possible, is it plausible that they are skimping on the anesthetic here? Or is this procedure simply meant to be this agonizing?

vividsailor7 said:The chest CT scan shows pleural effusion and lymphadenopathy.
The abdominal CT reveals metastases in the lymph nodes (likely ovarian), fatty liver, and ascites associated with the spleen.
What is absolutely necessary here is diuretic therapy. Titrate the Lasix dose based on blood pressure readings and serum potassium levels.
A hepatoprotective diet is also required.
As needed per clinical indication, a thoracic ultrasound of the pleura can be performed, followed by a guided therapeutic needle aspiration of the fluid.

If I am understanding this correctly... she had tests done on the lung fluid, which came back negative for tumor cells. They punctured her lungs two or three times, if that is what you meant.
And this diuretic therapy—what is the Lasix dosage? Is it for the ascites?

Angela Wright said:Wait for the tumor markers and the CT results before making any calls. In my view, if there is an opportunity to remove something, one should always take it. Take those CT findings to a specialist in Boston for a second opinion. There is no need to rush into anything immediately.

The CT scan was completed today. Interestingly, the marker levels have dropped by half since the surgery.
I have the scan results here; would anyone be willing to help me "decode" them?

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Angela Wright said:My own reasoning follows a similar path. When dealing with women in menopause, isn't it often better to simply remove the ovaries and uterus if they are functional or potentially problematic? I recall a late aunt of mine from the States who underwent a full removal. She told me her doctor described the uterus during menopause as nothing more than a sponge soaking up toxins. Was that his universal medical opinion or just specific to her situation? I cannot say. Yet, I frequently get the impression that this is indeed the reality for many women.

We have a CT scan and marker tests scheduled for this Tuesday, per the oncologist's instructions. We are currently debating whether to take her to a major medical center in Chicago. Is it even possible for them to perform a follow-up surgery to remove as much as they can, or would it be wiser to see if she can tolerate chemotherapy first? Then we decide.

Jamie Chase said:My father’s cousin faced a similar crisis: markers at 11,000, metastases throughout the abdomen, and doctors claiming only God could save her. Yet, in Venice, they operated on her—removing part of the intestine, both ovaries, the uterus, and what I believe was a portion of the liver... she underwent chemo, and remarkably, she is still alive six years later.
Now we find ourselves in a dilemma. Since everything was handled in Phoenix, we are relying on a surgeon who is supposedly highly skilled. During the procedure, a surgeon who had spent years working in New York—even serving as a department head—was present; he specializes in intestinal issues. He advised against touching the intestines because removing them would require taking out about two feet of tissue, and since the colonoscopy showed the interior looks healthy, he felt it was better to leave them alone.
It seems to me that these surgeries depend entirely on which doctor you see. We are worried that if we went to New York, they might have removed more of the affected organs. Now, should we take her to New York? (Which isn't impossible.) Our fear is that we are wasting precious time. Given her current lack of strength, they won't administer chemo. She is taking all sorts of natural supplements to build her strength up, but after three weeks, she is still quite weak, though she is taking beta-glucan. It also concerns us that they haven't performed a CT scan since the operation.
She felt particularly unwell a few times when fluid accumulated in her lungs, requiring them to drain it three separate times. Now she is on diuretics, and after taking those, she seems somewhat stable. I should note that fluid in the lungs does not possess carcinogenic properties.
The fact that they didn't remove the uterus and the second ovary is also weighing on us. Thinking logically, if the amount of cancer is greater, isn't there a higher risk of faster or wider metastasis?
What is the move here... do we wait for her to regain strength, then take her to New York or Los Angeles for a PET-CT, or pursue some other path?

And now I read this:

In patients with abdominal tumors, we often encounter large masses of tumor tissue and significant ascites; thus, the rule holds that as much tumor mass as possible must be removed. This is known as "debulking" or cytoreductive surgery, which is followed by continued treatment via chemotherapy. While controlled, randomized studies do not exist in the literature that objectively prove the efficacy of such surgical interventions in advancing disease treatment, the literature is nonetheless filled with retrospective and prospective studies supporting the theory of maximal cytoreduction during the initial surgery.

Dietl, in his review article, outlines the hypotheses that provide the theoretical foundation for primary cytoreduction: 1) surgical debulking potentially removes cell clones that are resistant to chemotherapy, 2) removing large tumor masses allows for better blood flow to the remaining tumor, facilitating easier access for chemotherapeutic agents, 3) a smaller volume of disease requires a lower dose of chemotherapy, thereby increasing efficiency, and 4) removing large tumor masses improves the patient's nutritional and immune status. Retrospective studies have shown that patients in whom the tumor tissue was completely removed or significantly reduced have significantly longer survival rates compared to patients where a large residual mass remains.

Now my dilemma is even greater—logic dictates it would be better to remove the uterus and the other ovary... wouldn't it?

P.S. Her strength is returning, slowly, but it is returning...

Angela Wright said:Unfortunately, pleural effusion is never a positive sign, even if the fluid itself isn't cancerous. It indicates that the kidneys and liver aren't functioning optimally, which places additional strain on the heart. Any attempt at mechanical drainage only leads to more fluid accumulation down the road.
You should take her to a major medical center in a city like Chicago or New York, because frankly, based on your description, it sounds like she is entering the terminal phase of the illness. Regarding the surgery and everything mentioned—it isn't necessarily a mistake by the doctor in Mostar. When metastases are spread that extensively, a more invasive surgery wouldn't have made a significant difference. From the beginning, the goal here was about improving quality of life. That comes down to physician strategy and clinical experience.
And one more piece of advice: stop comparing her case to others. A massive number of variables change the outcome—cancer type, malignancy grade, stage, location of metastases, types of therapy received, and so on. You are simply creating unnecessary stress and frustration for yourselves without actually knowing all the critical data. Focus on her and how to make her most comfortable.

She’s been on diuretics for a week and a half now, and that heavy burden of lung fluid is gone. We are planning to take her for a lung scan sometime in the next few days.
You mention taking her to a big city, but if she is in the terminal phase, why bother with the travel? Are we not just causing her more suffering? After the surgery, the doctor estimated three to five years, so nothing makes sense to me... if we take her to a major hospital, I highly doubt they will suggest another surgery after just three weeks.
How does an entire situation escalate this much in just three or four months!?

Here it is. I am just going to copy and paste this, if only to remind everyone what we were actually discussing...

Jamie Chase said:She underwent surgery today. The doctor claims she tolerated the procedure well, though he noted that her overall condition remains far from ideal. Is anyone actually surprised?
The tumor had partially encroached upon the large intestine, an area they chose not to touch just yet. Their plan was to complete six rounds of chemotherapy before determining if a follow-up procedure was even feasible. They managed to excise most of the mass from the thorax—it appeared somewhat plate-like in structure. Additionally, one ovary was removed, though they couldn't reach the second one; apparently, it’s small enough that it doesn't pose an immediate threat. Before the surgery, they noted that her intestines appeared fused, and today, they confirmed that this condition is simply a consequence of the tumor.
I asked if getting a CT scan after surgery is actually worth it. He told me no, claiming they get the best possible view during the procedure itself. But is that even realistic? Is it truly possible to see everything clearly during a standard operation? I mean, it isn't like they’re just "lifting" everything up to inspect all the way down to the spine or the lungs, is it?

Angela Wright said:You probably won't be able to catch the afternoon broadcast of Dr. Oz, but you should definitely tune in for the evening rerun. He's discussing ovarian cancer—specifically why it’s such a nightmare to diagnose and the early symptoms that doctors often overlook. It's quite compelling.

I watched the episode, though unfortunately, I was far too late to catch it...

Angela Wright said:Perhaps it would be prudent to schedule a chest CT and, more importantly, a bone scan. It honestly baffles me that the doctor didn't suggest those immediately, though I suppose an oncologist will eventually get around to it. If there happens to be any metastasis in the bones, radiation should be administered without delay. Otherwise, the chemo protocol remains the same for everything else. Now follows a recovery period of perhaps two to three weeks before the actual treatment begins. It is truly a shame to be facing such a situation.😢

Jamie Chase said:It has been five days of recovery. There isn’t any acute pain to report, but the lack of bowel movements over these last five days is clearly causing her distress. Furthermore, she is struggling with a significant lack of strength. Since I am aware that fatigue can be a symptom of a tumor, I have to wonder: could this weakness actually be a byproduct of her gallbladder surgery just before Christmas? She was strictly following a bile-restricted diet leading up to that procedure. Additionally, she was diagnosed with diverticula in her intestines prior to the holidays, necessitating yet another specific diet. When she commits to a dietary regimen, she does so with absolute discipline; she actually lost 10 pounds between her intestinal imaging and this latest surgery. This persistent weakness and lack of stamina have been present since the gallbladder operation and haven't subsided. Her grip strength remains quite robust, yet even simple movements, such as lifting her arms or legs above her head, prove difficult.
Can anyone suggest what we should give her to boost her immune system now that she's out of the hospital?
When I asked the doctor if a CT scan was necessary, he claimed there was no point since he could see everything clearly during surgery, and that's the best way to assess it. But I am concerned about the rest of her body—her back, lungs, and so on. How can he possibly know the state of those organs without a CT or other imaging equipment?

Angela Wright said:It makes sense that she lacks strength; after all, she just had surgery. If she is losing weight rapidly, the doctor might prescribe nutritional shakes like Ensure. To bolster her immunity during this phase, she could even take a Multivitamin, which might help. For other things like Immune support supplement or Propolis, you should ask at a pharmacy, especially since her digestion isn't quite back to normal yet.

It has been three weeks since the surgery. There is no pain, but there is absolutely no strength either. She walks occasionally and eats somewhat—weakly, but she isn't refusing food entirely. We are still waiting on the pathology report (it’s been 22 days), and the delay is worrying. We called, and they just told us we aren't the only ones waiting and that it might arrive this week.
During our last talk with the doctor, I asked why the uterus and the second ovary weren't removed. He argued it wouldn't achieve anything more if the chemo works; he said the chemo will kill the cancer everywhere regardless. But thinking logically, wouldn't it be better to "remove" everything and then clean up the rest? He stated there are metastases throughout her abdomen—in the liver, intestines, etc. They are small, but they are there. I also asked him how it's possible that while checking her gallbladder during surgery, he noted a "pale liver," yet didn't see any metastases? His response was simply, "That's a two-month difference."
That answer doesn't hold much water for me, but that's where we stand.
My father's cousin went through a similar situation—markers at 11,000, abdominal metastases, and doctors telling her that only God could save her. Yet, they operated on her in Miami, removing part of her intestine, both ovaries, the uterus, and part of her liver, I believe... then chemo, and she is still alive six years later.
We are currently in a dilemma because everything was done in Mostar, and the surgeon is reputed to be good. A surgeon who worked in a major metropolitan hospital for a long time was also present during the operation; he is an expert on intestines. He stated they shouldn't touch the intestines because they would have to remove about two feet of them, and since the colonoscopy showed the interior looks good, it's better to leave them alone.
To me, it all feels like these surgeries depend entirely on which doctor you get. We worry whether a doctor in a major city like Chicago would have removed more of the affected organs. Now, if we take her to Chicago (which isn't impossible), we fear wasting precious time. With her current lack of strength, they won't even allow her to start chemo. She is taking various natural supplements to strengthen up, and she's been taking Beta-glucan for three weeks, but she's still weak. We are also worried that they didn't perform a CT scan after the surgery.
She felt particularly poorly a few times when fluid built up in her lungs, requiring them to drain it three times. Now she takes diuretics, and after that, she's doing okay. I should note, fluid in the lungs itself isn't carcinogenic.
The fact that they didn't remove the uterus and the second ovary also haunts us. Thinking rationally, if the amount of cancer is greater, isn't there a higher risk of faster or wider metastasis?
What should we do... wait for her to regain strength, or take her to a major medical center for a PET-CT or something else?

Angela Wright said:Look, a lack of strength is entirely possible, especially since she's undergone surgery. If she starts losing weight too quickly, her doctor might suggest nutritional supplements like Prosure or Ensure. To bolster her immune system during this stage, she could even take Nature's Bounty—miracles do happen—but for other things like Emergen-C or propolis, you should probably check with a pharmacist, especially given that constipation is becoming an issue.

She's barely eating anything at all. She constantly complains about feeling overly full, as if she's going to burst, and mentions her stomach feels hard. The doctors haven't even performed a physical exam; they just prescribed Dulcolax. She claims she’s excessively bloated, which is what has us worried.

Angela Wright said:Perhaps it would be wise to schedule a chest CT and definitely a bone scan—I find it quite odd that he didn't recommend one, though an oncologist likely will... If there is a target on the bones, radiation should begin immediately. Otherwise, for everything else, chemo remains the standard. Now comes a recovery period of perhaps two to three weeks before treatment actually starts. I am truly sorry to hear about this situation. 😢

The recovery period has only lasted five days. There aren't any specific pains, but she is struggling because she hasn't had a bowel movement in those five days. The lack of strength is particularly bothersome; since I know that is also a symptom of a tumor, I wonder if this weakness could be due to her gallbladder surgery just a few days before Christmas, which required her to stick to a bile diet until this operation. Additionally, she was diagnosed with diverticula in her intestines before Christmas, requiring that specific diet as well. She is very disciplined when following a diet; she lost 10 kg between the intestinal imaging and this surgery. This weakness has been present since the gallbladder surgery through to now. Her grip strength remains the same—quite strong—but lifting her arms or legs above her head has become difficult.
Could anyone suggest what I might give her to boost her immune system once she is discharged from the hospital?
When I asked the doctor if a CT scan was necessary, he claimed there was no need because he saw the condition of things during the surgery and that this provides the best view. But how can he be certain about the rest of the body—the back, the lungs, etc.? How can he know the state of those organs without a CT or other diagnostic tools?

Angela Wright said:A Pap smear is strictly for detecting cervical changes. It won't show anything happening in the ovaries or elsewhere within the abdominal cavity.

She underwent surgery today. According to the doctor, she handled the procedure well, though her overall prognosis remains uncertain.
The surgeon moved partially toward the large intestine, which they chose not to touch. The plan is to complete six rounds of chemotherapy before determining if a second surgical intervention is feasible. They managed to remove a significant portion of a tumor—something plate-like located near the A... (not the abdomen). One ovary was removed, while the other remains untouched because it was too difficult to reach; apparently, it's small enough that it doesn't pose an immediate threat. Prior to the operation, they noted that her intestines appeared adhered, and today they confirmed this is a direct consequence of the tumor.
I inquired whether a post-operative CT scan would be worthwhile. The doctor suggested it isn't necessary, claiming the surgical view provided the clearest insight. Is it even possible to visualize everything during a standard surgery? Surely one cannot simply "lift" everything to inspect the area all the way down to the spine or lungs.

vividsailor7 said:Do the results definitively point toward a tumorous process on the ovaries?
I haven't seen the CT scans for the chest and abdomen yet; if she hasn't had them done, she really should.
Furthermore, we need to review the findings from the pleural effusion puncture and the ascites.
Laparoscopy is also being considered as an option.
Has an EGD/gastroscopy been performed?
Regarding therapy, she should be taking Furosemide + Spironolactone. Doses must be determined or adjusted based on blood pressure, potassium, and sodium levels.

After two separate tests, the fluid results came back negative for tumor cells.
Her surgery is scheduled for tomorrow; please wish us luck.
p.s. I still can't wrap my head around how three gynecologists, three ultrasounds, plus a Pap smear yielded absolutely nothing.🙂

Angela Wright said:Jamie Chase
Unfortunately, everything points toward ovarian cancer. 😢 All these elevated markers share the exact same underlying cause. That high CRP level? It’s likely just an inflammatory response from the effusion itself.
The fact that some markers didn't flag anything suspicious isn't unusual at all when dealing with ovarian cancer. We are talking about an incredibly insidious disease—one that hides easily and often gains significant momentum before anyone even notices. My assumption? They will likely move to perform a total hysterectomy and bilateral salpingo-oophorectomy very soon. Once the pathology report is back, they can determine the next steps and the actual prognosis. There really isn't much other way to play this. Three typical elevated markers combined with a gynecologist's positive finding constitute a definitive indication for surgery. They will probably order a PET-CT and a bone scan as well, just to rule out any metastasis.

Thanks for the reply. Just one question: on the cytology report from the clinic, it says "Dg. Tm ovarii I. utg. verosim Ca." Does that indicate a specific stage? And how precisely can a stage be determined using just a gynecological exam and a color Doppler ultrasound?

PS. The results from the lung fluid analysis just came in. It was negative for tumor cells.

Greetings.

I am looking for some assistance, perhaps a bit of comfort, or just some perspective.
My mother is 58. Over the last few months, she’s been dealing with abdominal bloating and general discomfort. It wasn't really an issue until recently. The concern is heightened because we have a history of cervical cancer in the family—her sister passed away from it, and my grandmother also died young following severe pain and bleeding. We don't have the exact diagnosis for my grandmother since it was so long ago, but we suspect it was the same thing.
Suspecting something might be wrong, my mother went for a Pap test and a gynecological exam about three months ago. That doctor insisted everything was fine. She then visited a different gynecologist at a local clinic for an ultrasound and exam, but again, nothing was found.
While she was undergoing physical therapy for back pain, she caught pneumonia after cooling down too quickly. Alongside the pneumonia, she still had the bloating and lower abdominal discomfort. This led to a gastrointestinal workup, including a colonoscopy, which revealed diverticula and fluid buildup in her system. She has been taking various medications and underwent scans of her stomach and small intestine, yet they found nothing there. Another ultrasound and gynecological exam yielded no results. In the meantime, they discovered gallstones, which required surgery. Despite all the testing—X-rays, ultrasounds, and CT scans—nothing "serious" was detected, aside from the fluid that keeps returning despite medication. However, the discomfort and bloating persist, even though her bowel movements remain regular. A few days ago, they discovered fluid in her lungs. They performed a puncture and drained one liter of fluid, which has been sent for analysis. We are currently waiting for those results, but for our family, this has been a total nightmare. The doctor who performed the puncture checked certain markers—things we hadn't thought to check before, and frankly, I don't understand why the previous doctors didn't mention them. Her CA 125 level is at 3065, while a normal level is around 35. I won't list every other marker here; I will attach the images of the lab results below.
Following these results, she was referred to a gynecologist at the major hospital here in town, but even he found nothing during his exam. Refusing to settle for "nothing," we sought out a private gynecologist. Upon performing an ultrasound and a physical exam, he actually felt a tumor. He told us the situation isn't good and expressed confusion as to how the previous doctors missed it. We then traveled to a specialized clinic in a nearby major city for a second opinion, and they confirmed what the private gynecologist found (see findings below). However, the local private gynecologist says he cannot make a definitive call until he operates; he believes he needs to see for himself. He mentioned that due to the state of the intestines—which seem almost fused together—he has to perform surgery to truly understand the extent.
Now we are facing another dilemma. The specialist in the city suggests we wait for the lung fluid results. If those results show the presence of cancer cells, he recommends skipping surgery for now and starting with chemotherapy. If the chemo lowers the markers, then surgery might be safer and easier to perform.
The local gynecologist is a bit blunt, but he is a highly skilled expert. He simply said, "Who knows when those fluid results will be ready?" He wants to run a CT scan of the abdomen and pelvis before proceeding with surgery. I have searched the internet extensively; I can see this is bad, but if anyone has any insight, I would be deeply grateful. Is there any hope that it hasn't metastasized? And what is the wiser path: operating to see the extent, or doing chemo first to shrink it?
Results are attached below.

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