nynessie wrote:New to all this. Diagnosed in late May with large masses on rectum and left ovary. Sigmoidoscopy showed almost completely filled sigmoid with cancer cells, and so was diagnosed with colon cancer. Put on FOLFOX for 12 weeks. Told there was not a cure, and the goal was to decrease the size of the masses and prevent further growth. Also told 1 in 5 people lived five years. I did not see the ONC for the first 4 treatments, and at the 4th asked the PA what would happen. He said if the rescan looked good surgeons might consider de-bulking surgery. Hmm.
It was not a fun time for me, and was completely depressed and upset for the first 4 treatments. My oncologist left the hospital, and I am assigned a new one - who tells me that he is not convinced this is a colon w/mets to ovary, and that it might be two cancers - ovarian and colon. Both, he says, very well might be curable. He has reached out to another hospital (larger) for second opinions, and I am to be referred to doctors there. I believe this will happen after the 6th chemo, and the re-scans are done.
I had my 5th treatment the next day and felt the fog lift. For the first time since May I was hopeful.
Surely immunohistochemistry was performed, at least on the ovary. If ovary was CK7-/CK20+, in all likelihood it represents spread from a colonic primary. If CK7+, almost certainly ovarian. Very, very rarely primary ovarian so-called borderline mucinous tumors of intestinal type can swap phenotypes and come to resemble colonic primaries.
If you haven’t had surgery, I strongly believe “neoadjuvant” chemo before metasectomy of isolated ovarian secondaries is a mistake. (Non-SoC metronomic chemo with immunoadjuncts may be OK.) The vast majority of CR/gyne surgeons would agree, if only for palliative intent, since ovarian secondaries can notoriously get very large and cause all sorts of problems. Is there evidence of carcinomatosis? Have you had a laparoscopy? Do you have values for CA125, which is an especially good indicator of carcinomatosis / cancer of intraperitoneal organs. (I suspect you have, hence the reason your onc might incorrectly be surmising that an elevated CA 125 value favors a diagnosis of a secondary ovarian primary.)