So, wife had surgery on June 29. Other ovary ostensibly had cancer, but nothing else. Having evaluated the CT scans and PET beforehand, that is precisely what I expected; oncologist was certain she had diffuse peritoneal carcinomatosis and insisted that surgery was futile (only was willing to recommend palliative chemo of FOLFIRI and cetuximab; having personally spent hundreds of hours in the last year reading postoperative scans, I politely disagreed—because of the manner of my wife's initial presentation, I was chary enough not to assume that the presence of ascites was a likely indicator of diffuse disease—which he didn't take kindly to, so now he's our former oncologist), and surgeon was pretty adamant that there were metastases in the liver (strangely insisted that he operated on a different part of that liver segment in December—which was a foreign body granuloma—when I suggested that the areas of avid FDG uptake, which didn't correlate with any morphological abnormalities on CT, were most likely suture granulomas [lo and behold, they were suture granulomas]). The hospital now seems to be pretty paranoid that we're going to sue—they even spontaneously called us in to have a two-hour chat in a conference room—but I don't have the energy for that . . . Anyway, cancer hasn't come back, and I'm starting to think it never will. (Having thoroughly reviewed all 29 documented cases of pseudo-Meigs' from colorectal primaries, I'm increasingly convinced that there is a subtype of colorectal cancer that frankly has no realistic metastatic potential except to the ovaries. How else does one account for the roughly 90 percent progression-free survival among a patient subset [i.e., ovarian secondaries] that would ordinarily have a dismal prognosis?) Anyway, nobody is currently recommending chemo, but that's moot since my wife wouldn't consent in any case. She knows full well that, were the cancer to return, she would be a goner (since it would certainly recur in the peritoneum), and what would be the point protracting life by at best a few months? We've already lost nearly everything . . . Come what may, we're planning on leaving this godforsaken country behind us and returning to Italy in the new year, so that's something to look forward to.
Wife Age 33
02/17 dx Ovarian mass, ascites, pleural effusions
03/17 Resection of 16 x 20 cm ovarian mass; CEA = 10, CA125 = 180, CA19-9 = 36
04/17 Emergency surgery, diastatic perforation, purulent peritonitis, extended right hemicolectomy, well-differentiated adenocarcinoma in splenic flexure, 1/16 lymph
11/17 CT = NED, CEA < 1
12/17 CRS (peritoneal nodules of foreign body giant cell reaction, no evidence of malignancy; liver resection—1 cm FBGCR and .5 cm focal nodular hyperplasia), HIPEC