Patient: Description of the condition (onset time, main symptoms, hospital visited, etc.): Last September, she underwent a total uterine ovarian and greater omental resection at the First Hospital of Qiqihar for ascites and ovarian tumor. The preoperative CA125 test result was 1470. The postoperative test result was 40. The pathology report showed: plasmacytotic junctional papillary cystadenoma with regional carcinoma on the surface of both ovaries and in the right ovary. Cancerous mass implantation was seen in the greater omentum. I was given a stage 1 ovarian cancer. Six chemotherapy treatments were done 21 days after surgery and the six chemotherapy treatments ended on January 20 this year. CA125 result was normal. The doctor told me to review regularly, and the review was normal in 2 and 3 months. The doctor told me to review regularly. In June of this year, the ultrasound showed ascites and the ca125 figure was over 121. The doctor told me to continue the chemotherapy and changed it to docetaxel plus cisplatin abdominal chemotherapy. As a result, the ca125 dropped to 45 and the ascites was gone. He is currently receiving chemotherapy with paclitaxel, cyclophosphamide and cisplatin. After two rounds of chemotherapy, the ca125 is now down to 20 and 24. I am currently off chemotherapy and my doctor has asked me to follow up every month. What is the reason for my recurrence nine months after surgery and five months after chemotherapy? Was the surgery incomplete? Or is the chemotherapy regimen inappropriate? Is it necessary for me to go to Beijing to see a doctor in my current state and treatment? If so, is it easy to register? How much time do I need to get tested? Do I need to take some Chinese medicine besides chemotherapy? How can I treat a recurrence? Can I go to Beijing to get a treatment plan for recurrence? What is the cause of my severe insomnia and night sweats at the end of chemotherapy? What can I do? I’m not sure what to do.
Ren Tong, Department of Gynecology, Peking Union Medical College Hospital: We can’t say how thorough the surgery is, it depends on the surgery records. If the tumor recurs within six months after surgery, it may be because the tumor is not sensitive to chemotherapy. The chemotherapy regimen is the same all over the world, and the first-line chemotherapy regimen is paclitaxel + carboplatin. You can’t be sure it is recurrence now. There are many factors for ca125 increase, we need imaging evidence of your recurrence, such as ultrasound or CT results. A review every three months is sufficient. Chemotherapy is not needed. The Chinese medicine you decide, Western medicine is not very understanding, but to increase appetite to enhance body resistance or help, as for whether there is no direct anti-tumor effect I do not have the right to speak. The reason for insomnia and night sweats is that you have had your ovaries removed. If the symptoms are serious, you can take hormone supplementation treatment.
Patient: Thank you very much for your prompt and precise reply. You said I can’t be sure that it is a recurrence, but is the ultrasound showing ascites and ca 125 index over the limit a sign of recurrence? Do you think it is necessary for me to go to Beijing to see a doctor?
Ren Tong, Department of Gynecology, Peking Union Medical College Hospital.
The presence of ascites along with rising tumor markers can be considered as evidence of recurrence. There are many drugs that can be used for second-line chemotherapy, such as platinum oxalate, liposomal adriamycin, TOPTICON, etc., which are available in major hospitals all over the world, and the protocols are similar. The need to come to Beijing is not great. The cost of food, accommodation and travel is very high and there is no special treatment plan. Unless a resectable lesion is found, your situation will be re-evaluated at the time of another tumor cytoreductive surgery.
Patient: Thank you very much for your reply which is very helpful to me.
Ren Tong, Department of Gynecology, Peking Union Medical College Hospital: You are welcome. My answer may not be 100% correct either. It would be best for you to communicate closely with your doctor to determine your treatment plan. Every hospital has different treatment plans for the same patient with the same condition, and there is no right or wrong. For example, our hospital generally does not advocate chemotherapy until there is imaging evidence of recurrence, but many hospitals will give chemotherapy to patients, each has its own advantages and disadvantages, and there is no evidence to prove that method is better.
Patient: Understandable. At present, there is no cure for cancer in the medical field, only surgery and chemotherapy and experience to control it. As a patient, it is very gratifying to get a serious and timely answer from a doctor in Beijing through the Internet. What you have done is a good deed. I am very grateful to you. I wonder if the biologic therapy currently being promoted by some hospitals is credible and effective?
Ren Tong, Department of Gynecology, Peking Union Medical College Hospital: Biological therapy should be the hope for curing tumors in the future. However, this problem has not yet been overcome worldwide. And you have to be cautious about the propaganda in China, especially in private hospitals. Even if it is a public hospital, playing the brand of the Chinese People’s Liberation Army Academy of Military Medical Sciences, it is not always effective. Nowadays, economic interests are tempting to all people. It’s not that biological therapy is bad, it’s just that it’s still immature, the efficacy is not certain, and in order to make money, some things with uncertain efficacy have entered the clinic.
Patient: I understand, thank you very much for your reminder and timely and useful help.
Ren Tong, Department of Gynecology, Peking Union Medical College Hospital: I hope you enjoy your life