Angela Wright said:It’s definitely possible. Remission is achievable, really—you just have to find that specific drug that actually hits the target. The issue here is that from what I can gather, Mom is already on her second line of therapy. Her markers are all over the place right now, which isn't good at all because it clearly shows the treatment isn't working. She needs a more thorough workup immediately—a bone scan is a must, plus an MRI or a PET-CT. Honestly, dear, I think it’s time you started looking into clinical trials she could join. Don't wait until things get complicated and we're forced to react; my internal alarm bells are already ringing.
Here are those ovarian cancer studies I mentioned—they're all open for you to look through: I was looking through some clinical trial data on ClinicalTrials.gov earlier—you know how deep those rabbit holes go—and I stumbled upon some results regarding lung cancer research. It’s heavy stuff, really. Just sitting there, scrolling through the data, thinking about all the people out there waiting for a breakthrough. The study details are pretty dense, but basically, they're looking at specific markers and how different treatments respond. It's that constant cycle of testing, testing, and more testing. You see these numbers and you realize how much work goes into just one single step forward in medicine. It makes you think about the sheer scale of the effort involved in fighting this kind of thing. Just a lot to process, honestly.
In the app, there’s this world map that shows you exactly where all the open clinics are located—you can even click on them to see the specifics. Right now, nothing we've found here in the States seems like a good fit for Mom, but there are some options available in the surrounding countries.
Just tell me exactly what the diagnosis is—it should be right there on the pathology report. Also, let me know if she has the BRCA mutation, everything she’s received for chemo so far, and how many doses.
Mom had her surgery on May 22, 2014. Here is how the surgical protocol went down: They found a solid tumor with an irregular surface located in the lower pelvic area. It was pretty messy—the loops of the small intestine and the omentum were basically stuck all over the top of it. The surgeons worked on gradually freeing the intestines and the omentum away from the mass. Once they cleared the top surface, they moved in to address the entrance to the pelvic cavity, which the tumor had completely taken over. It actually originated from the left adnexa. They managed to remove the entire tumor, though the pelvic walls were still covered in some brittle, necrotic tumor tissue. That had to be cleared out too, mostly from the rectovaginal septum and a bit above the ureter, near where the iliac vessels and the sacrum are located.
The diagnosis came back: malignant neoplasm of the ovary/adnexal area, FIGO stage IIIC. It’s after undergoing HAT (highly aggressive treatment), and they've already done a total omentectomy and an appendectomy.
So, I just got the pathology report back. It’s a mixed epithelioid tumor, stage T3bNxMx. Basically, the cancer has spread to the omentum and the appendix, and there was also a fibromyoma in the uterus (they took three samples at the time). Looking at the histology, about 65% of the tumor is made up of these strips and clusters of atypical epithelial cells—they have this really bright cytoplasm and dark, irregular nuclei, and you can see a lot of pathological mitoses under the microscope. These cells are forming tubules and papillary structures. Then, the other 35% is made up of serous-type atypical epithelial cells, also with those dark, irregular nuclei, forming more tubules, papillae, and some solid clusters. The tumor cells are showing up in several lymphovascular spaces and on the surface of the fallopian tube. They were also found on the surface of the tube they removed. The uterus itself shows a split portion with an empty cavity; the endometrium is 2 mm in the body. There’s also a well-defined, white, partially calcified nodule measuring 33 mm. They sampled the ecto and endocervix along with the cervical glands. That nodule in the myometrium is actually made of whorled smooth muscle fibers and calcifications. And yeah, that same tumor mentioned earlier was found on the serosa of the uterine body. The adnexa they removed looks grayish-yellow and soft, kind of cystic in the middle, with the ovary stretched out on the surface. Histologically, 80% of the tumor in that tissue is composed of those serous-type atypical epithelial cells with the dark nuclei and lots of mitoses, forming solid clusters, tubules, and papillary formations. The remaining 20% is made of tubular and papillary structures lined with epithelial cells that have bright cytoplasm and dark nuclei, again with plenty of mitoses. This tumor is sitting right on the surface of the ovary and the fallopian tube, and it's also visible in many lymphocapillary spaces. Finally, the omentum is filled with grayish nodules up to 20 mm in size. When they looked at them histologically, those nodules are metastases from the primary tumor described above.
MSCT Scan Results (Sept 17, 2014)
The non-contrast MSCT of the abdomen and pelvic area, followed by contrast administration (we had to use a much lower dose because her IV line blew), shows several hyperdense masses on the liver. They’re up to 33 mm in diameter. After the contrast, they show minimal, slightly uneven uptake, which most likely means they're secondary growths. There's also a thin layer of fluid—ascites—measuring about 11 mm along the edge of the liver. The liver itself is slightly enlarged and extends just past the bottom of the rib cage. No significantly swollen lymph nodes were found. There's also some fluid buildup, specifically ascites, in the pelvic cavity near the Douglas pouch. The aorta and arteries show signs of sclerosis. Everything else looked normal on this scan.
Ultrasound Findings.
Sept 01, 2014.
The ultrasound shows the liver is a normal size with regular contours, though the texture looks a bit coarse and grainy. In the left lobe, more toward the middle, there's a hypo-to-anechoic nodule about 33 mm wide; based on how it looks, it could be a cyst, but we can't rule out anything else. There's also a small 10 mm subcapsular cyst in the lower part of the right lobe. The rest of the upper abdomen and both kidneys look normal.
Nov 17, 2014.
The liver size is within normal limits, but the structure is diffusely coarse and granular. In the right lobe, there are several sharply defined areas that are mostly dark on the scan, which could be cysts according to ultrasound characteristics. There's also a 33 mm dark area in the left lobe that looks like a cyst too. But, given what the MSCT from Sept 17 showed—where those masses were flagged as suspicious for secondary growths—we have to consider that. The pancreas looks fine, normal shape and texture. The spleen looks normal on the ultrasound. There is a hypoechoic node measuring 17 mm near the aorta, which might be a swollen lymph node.
Her chemo schedule:
Three rounds completed (first cycle): Taxol + Gemzar at 280 mg and Carboplatin at 550 mg, along with the usual hydration and meds.
What she's on now: Day 1: Ifosfamide 7g, Adriamycin 110mg, Mesna 7g. Day 2: Mesna 2g, plus hydration and meds.
Here are the markers:
Before surgery in April 2014, CA 125 was 463 and CA 15-3 was 57.
CA 125 was 836.2 (July 03, 2014) after her first dose of Cycle I chemo.
CA 125 was 686.7 (Aug 12, 2014) after her second dose of Cycle I.
CA 125 was 767.4 (Sept 01, 2014) after her third dose of Cycle I.
CA 125 was 855.8 (Sept 25, 2014) after her first dose of Cycle II.
CA 125 was 1327 (Oct 13, 2014) after her second dose of Cycle II.
CA 125 was 1215 (Nov 04, 2014) after her third dose of Cycle II.
CA 125 was 1086 and CA 15-3 was 63.25 (Nov 24, 2014). Tomorrow (Nov 26, 2014), she gets her fourth dose of Cycle II.
First off, sorry for the long post.
Angela Wright, what can you make of all this? Please, don't sugarcoat it—I need to know what I'm facing. What are the actual prospects for my mother?
And what does it mean that her CA 15-3 is elevated too? Isn't that usually used for breast cancer, or am I wrong?
If you were me, what would you say those spots on the liver are? Cysts or metastases?
I hope you aren't annoyed by all these questions, I'm just desperate for answers.
Thanks in advance.
Best,
Mary
