Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

124 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Suggest treatment for ovarian cancer

Answered by
Dr.
Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1466 Questions

default
Posted on Tue, 19 Aug 2014 in Cancer
Question: Cancer of Unknown Primary: Female patient, age 50, diagnosed with ovarian cancer in July 2013; ovarian chemo on right ovary started immediately. An operation took place in Nov. 2013 but surgeon only successful in getting a piece of the tumour along with a piece of fallopian tube. The pathologist’s report said that the primary was unlikely to be ovarian cancer, but more consistent with upper gastro-intestinal. Surgeon said that the patient’s cavity was like a shag carpet and it should have been like glass. Patient has had numerous tests and her organs seem to be fine….the cancer seems to be in the cavity of her stomach/ovarian area.
On Dec. 24th patient received Upper GI chemo, Oxaliplatin? and fluoritine? (not sure of the spellings). She had 3 sessions of that, once every 2 wks. It was killing the nerve endings in her fingers and feet and starting to impair mobility. So, they quit that chemo and now they have given her 2 rounds of another chemo (Patient said this last chemo is more related to colon cancer and she had colonoscopy and it was fine). This past week (July 2014) they did another CATSCAN and told her the cancer was growing and they will stop chemo. They are going to put her on antibiotics.
Are there other treatments that might help? Is a definitive diagnosis possible?
doctor
Answered by Dr. Indranil Ghosh 7 hours later
Brief Answer:
sometimes it is difficult to pinpoint the primary

Detailed Answer:
Hi
Thanks for your query.
It appears that cancer from some other source has invaded the ovaries and also caused lot of adhesions in the abdominal cavity which precludes extensive surgery.
You said that the colonoscopy was normal, what about the upper GI endoscopy ? Is it also normal? Then the primary may be unknown.

In some patients, may be 5-10% of all, the primary cannot be localized in spite of best of efforts. The pathologist may give some insights based on some special tests on the biopsy. Sometimes a whole body PET-CT scan helps.

However, even in these cases we can give some treatment based upon various insights from pathology and clinical cues. Like in her case the chemo was changed to something which can attack the GI cells. Some chemotherapies can target both colon and upper GI cells so these are good choices. probably she received one of these at the last rounds.

But if the cancer is growing despite all possible options being tried then there is no other option except stopping chemo and giving symptomatic treatment. This does not stop the tumor from growing but can give comfort to the patient.

Hope I have answered your query. I will be available to answer further followup queries, if any.


Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
default
Follow up: Dr. Indranil Ghosh 8 hours later
Thank you very much for your answer.
Yes she had the Upper GI endoscopy July 2013 and it was normal.
Patient now weighs 152 lbs.
To clarify: the 2nd round of chemo was 5FU and Oxyplatin. These are the ones that did the nerve damage. Are there any other chemotherapies that target both colon and upper GI cells that wouldn’t cause nerve damage?

The patient is looking for a doctor in Canada who specializes in cutting edge treatment for Cancer for Unknown Primary (CUP). Do you know whether there would be any in Canada?
And would they be willing to look at her medical records? Does your agency look at medical records?
Would it be helpful for her to find another Dr. to see if they would operate again and try to "debulk" (for instance, a hysterectomy) ? Is it not advisable or possible to operate if adhesions are plentiful?

Thanks again.
doctor
Answered by Dr. Indranil Ghosh 29 minutes later
Brief Answer:
please refer below

Detailed Answer:
My answers....

Q.Are there any other chemotherapies that target both colon and upper GI cells that wouldn’t cause nerve damage?
A. Irinotecan can be tried

Q. The patient is looking for a doctor in Canada who specializes in cutting edge treatment for Cancer for Unknown Primary (CUP). Do you know whether there would be any in Canada?
A. You can look at Dr XXXXXXX XXXXXXX at Winnipeg, Manitoba. If you mention the city I can suggest somebody else.

Q. And would they be willing to look at her medical records?
A. Probably yes

Q. Does your agency look at medical records?
A. Yes we can look at some reports if you upload or send by mail

Q. Would it be helpful for her to find another Dr. to see if they would operate again and try to "debulk" (for instance, a hysterectomy) ? Is it not advisable or possible to operate if adhesions are plentiful?
A. Not a good idea at this stage. Likely to be unsuccessful


Hope this helps.
regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Indranil Ghosh 4 hours later
Thank you very much Dr. XXXXXXX Very helpful.

The patient lives very close to Edmonton, Alberta. Could you supply a doctor's name there or in general vicinity? I think even the city of Calgary would be possible for her to travel to.
doctor
Answered by Dr. Indranil Ghosh 17 hours later
Brief Answer:
You can consider Dr XXXXXXX Chua

Detailed Answer:
He practices at at University of alberta, department of Medical Oncology
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,  
Drug/Medication
Medical Procedures
Medical Topics

Recent questions on  Fallopian tube

doctor1 MD

i am 25 year female with one blocked fallopian tube......one week before when i di sex with my husband.after 1 hour i feel so uncomfortable due to pelvic area discomfort an now also feeling so much urge for pee and also when i pass urine it gives me burning an discomfort.kindly help me

doctor1 MD

I am a relatively healthy 49 yo woman 5 4 140lbs. In March I had a large ovarian cyst and both fallopian tubes removed. I am having periodic sharp pains at or near the incision sites. Generally it is just above the incision sites. How long should the pain remain? The pain gets worse closer to my cycle.

doctor1 MD

Yes. I unfortunately had an ectopic pregnancy left Fallopian tube.. when I was 6 weeks pregnant and had laparoscopic surgery and they also has to do a D and c.. Come to find out I had a blood clot as well by ectopic.. Was doing fine and was conservative with progression as far as activity. However, I am still having stabbing pain in left side and it only has gotten progressively worse..the surgery was over two months ago.. What are some possible scenarios with that.. I ve tried to play by the book but at a loss

doctor1 MD

Hello! I got Acute Salpingitis which was misdiagnosed by my Gyno before a month ago, who told me I got a normal Bladder Infection and gave me Zinnat for 5 days. The Salpingitis went down but didn t dissapear. Now a week ago, which was 3 weeks after taking Zinnat, the pain came back so I went to a different Gyno. Now he saw scars,swelling and wounds in my right Fallopian Tube. Now I m 3 days in, taking 3 times daily Metronidazole 400mg for 5 days and 2 times daily Doxycycline 100mg for 10 days. I also take 2 times daily Paracetamol 500mg and 3 times per day Cataflam. My concern now is I also have Abscence Epilepsy and Tremors. I had a weird seizure yesterday, were I couldn t really talk, had spasms in my tongue and somehow my mouth didn t say the words I actually wanted to say. I also have swollen and warm Breasts, which hurt to the touch. Is all this normal? Or does it sound off to you? Thanks a lot, for the help!!

doctor1 MD

I had unprotected sex with a young lady on Nov 21st On Dec 11th she called me claiming she’s 5 weeks pregnant I did the math and that doesn’t add up, is it possible for her to be 5 weeks pregnant by me due to us having sex only 20 days from the...

doctor1 MD

I had to undergo an lapro hysteroscopy in Sep 2017 and got my two tubes removed. Attached are the reports: 1. Surgical Notes 2. Discahrge Summary 3. Histopathology Report MY QUERY IS WHAT DO I INFER FROM THE HISTOPATH REPORT?? My medical history...

doctor1 MD

My daughter has a huge mass,on ovaries and fallopian tube . I have pictures of the MRI taken yesterday and would like to forward for your opinion. It's an 18 cm mass and her doc is taking her time. It took 4 weeks for MRI after mass discovered in...