Here we go again, again, again

I guess each time I can just repost what I wrote at the beginning of the last recurrence, "Things have been quiet for a few years, but now I'm dealing once again with this ovarian cancer.  I don't see it as a life sentence, rather a chronic disease which I'll probably have to deal with the rest of my life. "  It's been 2 years, 2 months since the last one was diagnosed.  Not as long as before, but still really pretty good.  I'll take it!  I had been taking a daily parp inhibitor called Zejula, or Niraparib, which may have helped with the time span. 

In the meantime, here we go again.  Ca125 went up to 12 which was still well below 35 which is considered the "normal" upper limit.  Retested a month later and it was 45.  Shit...  Did a scan, which found some masses in the same place as last time, between my liver and kidney.  Last time was in the Morison Pouch, this time in the Hepatorenal Fossa.  (Maybe it's the same?) A 2cm mass and a series of things described in the report as an "increase in size and number of soft tissue nodules in the hepatorenal fossa, now crawling along the capsule of the right hepatic lobe."  My oncologist said that radiologists are the poets of the medical field!  Last week did a biopsy.  Not really to see if it's cancer since we knew it was, but to gather genetic info to use for future treatments.  I was accompanied once again by Melanie, who really went above and beyond since we hit rush hour on both side of my appointment!  Wasn't thrilled with my care this time around.  Many little things, but the ones that bugged me the most was when the nurse asked me which size needle she should use to access my chest port.  !!  Her not knowing this did not instill confidence.  One of the doctors who had introduced himself to me a few minutes before came by and asked how I was feeling and that I'd be discharged soon.  !!  Also did not instill confidence.  Then when I was ready for the procedure, on my stomach in the CT scanner tube ("superman pose"), I could hear voices which I figured out was the doctor who thought I was a different patient earlier, talking to another doctor.  Then felt things on my back, so I quickly let them know- HEY, I AM NOT SEDATED YET!  Turns out they were just marking my back with a pen, but they could have let me know first, and could have said hello...  It was pretty upsetting.

Now on to treatment.  My oncologist is recommending chemo without surgery or radiation.  I am pretty stressed about this since my bone marrow doesn't seem to like chemo.  I pushed back on this decision a few times, but they had a good reason for it- that since there were multiple spots this time, there's likely microscopic bits too, and chemo will help get rid of them.  I made an appointment for a second opinion with UCSF, but it's not until the end of February.  Which by the way makes no sense to me!

So, chemo- carboplatin, doxil and avastin.  Only once a month though, starting this Tuesday.

More treatment...

   
Surgery went well.  Really well!  There were no other random bits of cancer and they were able to completely remove the tumor with clear margins.  I spent one night and was discharged midday, with 4 small incisions on my belly.  This was a couple of weeks ago already.  Recovery was quick, and I am already feeling back to my old self, which is why I was more floored by the news delivered at yesterday's visit with the oncologist- I still need to do chemo...  I'll be doing 6 rounds of carboplatin and doxil once a month for 6 months.  Followed by a maintenance therapy of daily oral PARP inhibitors to prevent the cancer cells from repairing the damage done by the chemo.

                                                  ( ↑ Carboplatin )

Update on the update

Surgery has been moved one day forward, to Wed. November 1, which is just fine by me.

Unfortunately, Updates

Things have been quiet for a few years, but now I'm dealing once again with this ovarian cancer.  I don't see it as a life sentence, rather a chronic disease which I'll probably have to deal with the rest of my life.  Going many years in between episodes has been great, and it's what I'm hoping for in my future. 




(http://accessemergencymedicine.mhmedical.com/data/books/ma2/ma2_c018f002.gif)


The latest started back in July.  I was feeling something not quite right in my lower abdomen so got a ca125 blood test which came back 10.  Under 35 is "normal", but my usual is 5,6,7.  We redid it in August and again it was 10.  I was still feeling some pressure and cramping, so a CT scan was ordered and a very small mass was found in my Morison's Pouch, the space between my liver and right kidney.  Next, a biopsy which confirmed ovarian cancer, and a recommendation by my oncologist to have this thing removed.

This Monday I met with a surgeon.  The plan is to start with a diagnostic laparoscopy using a video camera to see if there are other bits of cancer that didn't show up in the scan.  If there is, they stop the procedure and I'll talk to my oncologist about treatment options.  If there isn't, he will remove the mass.  75% chance this can be done laparoscopically, otherwise it might end up being an open surgery.  Date is set for Thursday Nov. 2nd.

6 months later... Good news!

Last week I did a PET scan, and this week got back some fabulous results!

IMPRESSION:

1. Previously demonstrated hypermetabolic lesions in the liver and retroperitoneum have resolved. Findings are compatible with complete metabolic response. 

My ca125 numbers had remained low over the last 6 months, so things were looking really promising, but getting this scan result really lets me exhale and relax.  I have an oncologist appointment in a few weeks, and I'm guessing we'll just go back to monitoring, with more and more time between visits the farther out we go.  :)  I am so thrilled!!

Wait and Watch

My appt. went well. The radiation oncologist was happy with the way things are on the scan (although he didn't see the scan itself, only the report). But the fact that they shrunk makes him believe we are on the right track, they may still get smaller. He doesn't even think we should scan again for now, just follow the ca125.

Wow, that's great. So does that mean no more chemo?

I think so. But now I need to relay what he said to my oncologist who will have the final word. Not scanning, and not doing anything when there may be cancer cells still in me, makes me (and Ethan) nervous. But maybe this is the new normal and I'll become more comfortable with it.

It is certainly some hard decisions to be making.

More work to be done

Radiation therapy works by damaging DNA, especially of rapidly dividing cells like cancer.  It keeps working after treatment is finished, so I had to wait 3 months before doing a scan to see what was actually happening.  Of course our insurance company denied the PET scan, so I did an abdominal/ pelvic CT a couple of weeks ago, and it showed that the tumors are still there.  Smaller, but still there... 

Now I'm waiting for my appointment with the oncologist.  All I know so far, is that it looks like the plan is to continue treatment.  I did 2 of the 6 rounds of chemo before the radiation, so maybe I'll be picking up where I left off. 

I'm feeling surprisingly level about all of this.  These tumors were pretty small to begin with, and now they're smaller.  Chemo sucks, but I can deal with it.  Meditation helps and so does the tremendous amount of support being continuously offered by family and friends.