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CT scan showed soft tissue nodule anterior to urinary bladder. What does this mean?

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Dr. Manjunath L Ramarajapalli

OBGYN, Gynecologic Oncology

Practicing since :1984

Answered : 99 Questions

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Posted on Tue, 11 Dec 2012 in Cervical and Ovarian Cancer
Question: I am currently being treated for ovarian cancer. Had hysterectomy, and awaiting chemo treatment to begin shortly. My latest CT scan results revealed this, XXXXXXX ..stable enlarged calcified supra diaphragmatic and para aortic lymph nodes, and soft tissue nodule anterior to urinary bladder suspicious for peritoneal deposits .. XXXXXXX I am v concerned, and would like to know what the above statement means? Could you comment on the severity of the condition based on the above? Is the report implying the likelihood/presence of cancer cells? Post the hysterectomy surgery, my cancer marker indicates 18, which supposedly means "normal". In your opinion, is it necessary to do the chemo treatment based on the above? Could you kindly comment on my conditions based on the above facts. Am concerned, and most thankful to you.
doctor
Answered by Dr. Manjunath L Ramarajapalli 3 hours later
Hello,
Thanks for writing to us.
I suppose CT scan report you have mentioned is after surgery.This shows there are remaining lymph nodes and soft tissue nodule near bladder.This means there is still some tumor remaining.
These findings mean probably you have stage 3 or 4 disease.
The report implies the presence of cancer cells in these areas
Cancer markers are non specific (only few histological types of ovarian cancer secrete this) and indicates prognosis to some extent.
You definitely do require the chemotherapy.
Let me know if you have any more questions.
With best wishes
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Manjunath L Ramarajapalli 10 hours later
Thank you, Dr Ramarajapalli, for your response.

You mentioned that XXXXXXX .. Cancer markers are non specific (only few histological types of ovarian cancer secrete this) and indicates prognosis to some extent XXXXXXX I am unsure of what you meant and wishes to clarify. Are you suggesting that Cancer markers, specifically the CA-125 test here, may not be a conclusive indicator, ie the fact that my most recent reading of 18 does not indicate that i am clear of cancer cells? I have read literature that says up to 20% of ovarian cancer patients do not in fact show elevated CA-125 readings, is that generally correct?

Noted that my cancer cells could be the "grade-1" type, ie the "slow-growing" type. Generally, this would mean the chemo treatment could be less effective vis-a-vis one used against the "fast-growing/aggressive" cancer cells? To what extent would your opinion be on this?

Lastly, given my current condition, is there any advice you could suggest that i do/not do, and anything you feel i should know that could help me?

Thank you for your time. And much appreciated.
doctor
Answered by Dr. Manjunath L Ramarajapalli 1 hour later
Hello,
Yes CA-125 is not the conclusive indicator and does not indicate that you are clear of cancer cells.
You are correct that in some patients of ovarian cancer CA-125 is not elevated.
Cancer cells "grade-1"type (what is the histopathological variety and other details?) does indicate that they are slow growing cells,
but we do not have any other option except to go ahead with chemo treatment. We could consider Intra-peritoneal chemotherapy, if the facility is available nearby (which has shown better chances of cure).
I suggest a PET scan if possible,that may indicate where all the tumor tissue is still remaining.
Good luck

Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
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Follow up: Dr. Manjunath L Ramarajapalli 1 hour later
Thank you Dr. Yes, I heard about IP chemo and I will just follow the advice of my chemo doc as we progress wih IV chemo .What is the difference between CT and PET scan? I had CT scan done prior to chemo and also because of my current condition , kidney infection(infection I got during hyster op). I had a Dj stent put into my ureter on my right kidney( during the op, because they found my right ureter was compressed). Thus, while looking out for my kidneys in the CT scan,found nodules in other areas.i am currently in IV antibiotics, outpatient clinic in hospital.

My right kidneys appeared enlarged on the scan.results said , ' persistent areas of wedge shaped hypodensity in the right kidney,suggestive of ongoing/resolving pyelonephritis. The cystic area is now no longer seen.' And 'increased prominence of pelvicalyceal system despite the presence of DJ stent' . my infectious diseases doctor told me not to worry about my kidney scan,because I look well and bloodwork results were normal. Still I do worry, is it normal to have such findings on a kidney who had infection since 5 weeks ago, on IV antibiotics ever since, or should I check w a doctor whether my urine is draining properly / normally? I read that kidney bloodwork doesn't show any bad results until if both kidneys were almost 70% damage. In this case, my left kidney is doing strong, so I have this worry that my normal blood results came mostly on the 'good' kidney? Please advice. Thank u.

XXXXXXX
27,Ovarian cancer stage 3
Papillary serous carcinoma grade 1.
doctor
Answered by Dr. Manjunath L Ramarajapalli 1 hour later
Hello,

The difference between CT and PET scan is that, the PET gives the information of the whole body regarding the metabolic activity at different regions. Metabolic activity is the set of chemical reactions, which takes place in every cell of the body. In cancer cells, the metabolic activity is higher. The PET scan picks it up easily, while CT does not. (Please ask your doctor for more details).

The problem regarding your kidney as you have mentioned has to be evaluated further. It would be difficult for me to comment on the issue as I have limited information on your present kidney status. Please discuss with an urologist regarding the same.

Papillary serous carcinoma gr.1, stage 3-sounds better. It should respond to chemotherapy.

Good luck

Above answer was peer-reviewed by : Dr. Mohammed Kappan
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