Where could patient stay for free while on active cancer treatment?

The  West Clinic and a few other organizations have supported the Amercian Cancer Society in building the Memphis Hope Lodge.   This lodge allows patients and their care givers who are on active cancer treatment in Memphis but lives 40 miles or further away to stay in Memphis Lodge for free.  It has guest suites with private bathroom.   The Lodge also provides free shuttle service from the Lodge to the West Clinic offices.  There are several requirements to qualify for this free stay that you could find out by calling 1800 227 2345 or 901 524 5500. 

What are the symptoms to know if my ovarian cancer recurs?

Recurrent of ovarian cancer is usually not symptomatic.   If you are not seen periodically by your oncologists who usually order Ca125 periodically, then by the time you have recurrence, you would have symptoms with your cancer recurrence.  Ca125 blood test is still the most sensitive test in detecting ovarian cancer recurrence.  This Ca125  test is commonly ordered every 3-6 months for patients after completing their adjuvant chemotherapy.   However, a recent randomized trial study published in Lancet recommends no Ca125 should be ordered since no difference in survival is noted whether the patient is diagnosed early versus late for cancer recurrence.   This study seems to be initially illogical.   I would think that the earlier you are diagnosed, the smaller the tumor is found and perhaps the higher chances of curing the recurrence.  However, this study found the opposite.


My medical experience seems to suggest that when my patient has early recurrence and localized, she has a better chance of cure if the disease is localized.   Last week I have such patient that i discharged from my practice.  She had cancer recurrence next to the spleen after her initial surgery and chemotherapy.   I went back to debulked this cancer and retreated her with carbo and taxol (patient was platinum sensitive).  Now she is cancer free for 5 years.  

My current thinking is some patients with localized disease and platinum sensitve would benefit from regular check of Ca125.   However, patients who are platinum resistant and wide spread recurrent, may not benefit from regular Ca125 as noted in the Lancet paper.   Since medicine is an ever changing science, I wait for more study confirmation of the study's recommendation.

REFERENCE:

Early versus delayed treatment of relapsed ovarian cancer: a randomized trial. Rustin GJ,et al.

Lancet. 2010 Oct 2;376(9747):1155-63.

My ovarian cancer recurs - What's next?

Unfortunately, majority of advanced stage ovarian cancers recur.   The usual scenario is patients undergo initial surgery to remove the cancer.  Then they receive the adjuvant chemotherapy (usually Carbo and Taxol IV or Cisplatin and Taxol IP IV chemo).   When the cancer recurs after this adjuvant chemo, the recurrence is classified to be "platinum sensitive" (if recurred more than 6 months after last carbo or cisplatin treatment) or "platinum resistant" (if recurred less than 6 months after the last carbo or cisplatin treatment).

If your recurrence is called "platinum sensitive", it is a better recurrence (if there is such word) than being "platinum resistant".    Being platinum sensitive means you are being retreated with either cisplatin or carboplatin combination.   In my opinion as the date this is being written in August 2011, carbo + Doxil combination has the best response rate in platinum sensitive based on the CALYPSO study.   Patients with platinum sensitive disease may live many years, albeit on multiple chemotherapies. Being platinum resistant means you are usually retreated with non-platinum drugs (Doxil, Topotecan, Gemzar, Avastin, etc).  Unfortunately, many platinum resistant patients die within a year or so after recurrence.  

As we continue our vigorous research in this disease, I am cautiously optimistic that we will hit a "jackpot" someday.   In my short professional life, I am fortunate to meet many highly intelligent men and women who are dedicated in finding the cure of ovarian cancer.   One of them, someday, would win that Noble prize for conquering this dreadful cancer.

What's new - cervical cancer chemoradiation 2011

Treatment of advanced cervical cancer with a combination of chemortherapy and radiation is well accepted.   However, the search to find the better chemotherapy agent continues.  A randomized trial published in Journal of Clinical Oncology 2011 showed that a combination of Gemcitabine + Cisplatin + radiation has better cure rate (hazard ratio of 0.68) than Cisplatin + radiation but at the cost of more toxicities (87% vs 46%). 

Unfortunately, this is a common pattern in cancer research where the cure rate increases with more drugs but accompanied with more side effects.   As a patient, you should always discuss risks and benefits of each treatment with your oncologist.

Reference:

Dueñas-González A, et al. Gemcitabine and Cisplatin Versus Concurrent Cisplatin and Radiation in Patients With Stage IIB to IVA Carcinoma of the Cervix. J Clin Oncol. 2011;29(13):1678.

                                                                       

What's new - ovarian cancer chemotherapy 2011

The role of bevacizumab (trade name: Avastin) for advanced ovarian cancer continues to evolve.   A preliminary report of Gynecologic Oncology Group study #128, presented at the 2010 ASCO meeting, showed a better cure rate for the addition of bevacizumab to first-line paclitaxel and carboplatin in women with advanced epithelial ovarian cancer.    A more recent study of bevacizumab (ICON7) trial which was presented at the 2011 ASCO meeting also showed an increase interval of progression free survival (time interval between stopping initial chemo to the time when the cancer recurs again). However, bevacizumab did not alter the cure rate.   These data support the practice that bevacizumab can be used in the front line therapy (i.e., the chemo treatment after the initial ovarian cancer surgery)  However, it is not yet the standard of care.   

As a patient, you should discuss with your oncologist of the risks and benefits of using bevacizumab in your cancer treatment.   Because of the high cost, some insurance companies may put some hurdles on allowing this chemo.  However, I found that when both patient and oncologist work together to call the insurance companies, as well as providing with the appropriate literature, I have been successful in getting most of patients this chemotherapy.

REFERENCE:

Kristensen G, et al. Result of interim analysis of overall survival in the GCIG ICON7 phase III randomized trial of bevacizumab in women with newly diagnosed ovarian cancer (abstract LBA5006). J Clin Oncol 2011; 29:781s.

Can we screen for ovarian cancer?

Ovarian cancer is a dreadful disease since it is mostly detected at late stages.   Its symptoms are non specifics (bloating, weight gain, increasing abdominal girth, etc).   By the time the patient has these symptoms, the cancer is already stage III or IV (stage is how spread the cancer with stage I is early and IV is the last stage).

Despite tremendous amount of research, we still do not have the "pap smear" for ovarian cancer.  Tumor markers such as blood test Ca125 and Ultrasound are not yet effective in screening for this cancer.   The main challenge in developing ovarian screening test is due to the low prevalence of the disease.   Even if we have a test that is very sensitive and specific, we would ended up taking many women to the operating room removing benign ovarian mass, not cancer (false positive).  The new Ova1 blood test is indicated to triage women with ovarian mass whether she should be operated by a gynecologist versus a gynecologic oncologists - not for screening.

However, Ultrasound is very helpful to get if you start to have new symptoms as mentioned above.  Blood tests such as Ca125 and HE4 are very helpful in monitoring how ovarian cancer responding to chemotherapy.   It is still important for women to be aware of her body.   If she starts to gain weight without good explanation, feeling full easily, vague abdominal and pelvic symptoms, it is good idea to see your physician for examination.