Oncology (General Cancer)/Ovarian Cancer
QUESTION: Thank you for this public service.
Wife 62 OC operation early 2001,numbers did not go down enough...2nd operation 12/2001 both operations were followed by Chemo. 3rd operation, end of 2012. Pre op diagnosis: orange size cyst in vaginal canal, possible liver problem, possible tumor/cyst in anal canal opposite vaginal cyst. Liver surgeon found no problem, but took a small chunk. No anal problem. Cyst contained two small tumors..removed. Post op surgeon said he did not do Pathology (!!??). Successful operation. Post op/happiness/did not pursue doctor. Radiation was ordered. Would not do w/o pathology???
Alternative-MRI,CT,PET,Needle biopsy. All neg. Now
6 months post op no treatment. Was pathology optional in this Ovarian Cancer op ???? Increased
risk w/o Radiation or Chemo???? Note: Onc. Surg. rated upper 1% nationally... Appreciate your comments. Thank you. Len
ANSWER: There are two reasons for not doing pathology on suspected masses. One is when the patient is known to have metastatic cancer, in which case a surgical procedure might be done to relieve pressure, etc, but not cure. A second would be if it is quite clear that cancer is not the case. An experienced surgeon might see something that he knows is not malignant. That being said, the second situation would be extremely rare. Now, in your wife's case, going from 2001 to now without a recurrence of ovarian cancer would mean to me that she probably doesn't have that. Ovarian cancer almost always recurs within a short period of time. Whatever the surgeon took out, , going another six months without any problems would suggest to me that she did not have a malignant process when the operation was done. I also think that it's unlikely radiation or chemo would be helpful in the long run this late. (when used to cure microscopic residual disease, it should be applied within six weeks or even sooner, of the surgery.) Also, your studies were all negative. At this point I wouldn't go for additional therapy unless the original tissue is examined by a pathologist -- and even then I'd probably hesitate. Bottom line, if she had cancer in 2012, it almost certainly wasn't ovarian cancer; and if there is no evidence of cancer now, it's unlikely that what she had in 2012 was a malignancy; and if it was, it was probably cured by surgery.
I've dealt with surgeons who think they can tell if something is malignant or not just by looking at it. They've been wrong about 50% of the time, and as a medical oncologist, I insist on pathology before committing the patient to chemotherapy or radiation. Hope this helps.
---------- FOLLOW-UP ----------
QUESTION: Doctor: Thank you ever so much for your professional, insightful,
comprehensive comments. Let me assure you our exchanges are observations
that I consider very personal. Your words are clear and understood (of course limited by my own knowledge and experience).
Anne,s 2001 operations were for Ovarian Cancer, I thought the surgeon said a subsequent event(2012)in the same general area retained the original designation - Ovarian Cancer. Otherwise, with the orange size cyst being on the wall of the vaginal canal-I would think"Vaginal Cancer"
To my point: I agree with your treatment; and can't fathom why a true
Oncology professional would leave the conservative path - given the
potential risks of a mistake; and potential ultimate risk for the patient. Frankly, why would a doctor not be interested in the Pathology or any other measure(s) that could possibly put the patient on the best/
most likely course to a successful outcome? For me, skipping pathology
should not be optional. Anne's physical recovery is moving slowly and mentally she is stretched out, despondent. Day to day living is difficult. She is waiting for the follow up doctor's visit on 6/18. Can you, would you suggest a line of questions (for that visit) that would put us all on the same page (if possible).
Your comments (above) represent the very best patient review that either
of us have ever received - bar none.
Again - Thank You, very much.
Here are some questions:
The operation in 2012, what was found? Was it malignant? (If he says yes, ask him what the pathology showed.) (If he says there was no pathology, you can ask, "How do you know it was malignant? I'm not being snarky here, because sometimes they can tell, but you want to be convinced. I've had surgeons who misinterpreted scar tissue from previous surgeries as evidence of malignancy)
If he says this is ovarian cancer, you can ask whether it is clear cell, papillary, or follicular. They all have different prognoses, but require microscopic examination.
If he recommends further treatment, ask why -- given the negative studies just done, the fact that almost six months have gone by. Also, if treatment is recommended what are the odds of cure compared to no treatment at this time? I suspect the odds are about the same, and given that, I'd wait.
The cyst on the vaginal cuff isn't necessarily cancer; again, such things can be benign.
Finally, don't commit to anything until you get another opinion -- I would look for a Medical Oncologist. (gynecologic oncologists usually administer their own chemotherapy; a medical oncologist might be able to give you a different perspective, and they are in my opinion much more in tune with the supportive care and psychological issues that go with having cancer). I hope this helps.