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Suggest treatment for ovarian cancer

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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?
Posted Tue, 19 Aug 2014 in Cancer
 
 
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
 
Follow-up: Suggest treatment for ovarian cancer 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.
 
 
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
 
Follow-up: Suggest treatment for ovarian cancer 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.
 
 
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
 
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