Ovarian Cancer 2: After Recurrence She Again Refused Chemo. Why?

Lucy was asked to undergo chemotherapy after the cancer had recurred. She again declined and came to seek our help on 7 September 2012. We cautioned Lucy to seriously consider undergoing chemotherapy.  After all the cancer had spread and she should not expect much from us. Also, please don’t blame us if things don’t work out the way she wanted!

She was not receptive to chemo. Listen to our conversation that day.

The doctor in the government hospital asked Lucy to undergo chemotherapy immediately. She hesitated and asked for some time to think over it. The doctor also queried why she did not do chemotherapy the previous year after she had the surgery.

Lucy asked the doctor what would happen if she do not want to do the chemo. The doctor said he would not see her again if she declined chemo this time. Next time when it becomes serious, sorry! Don’t come and see me.

In spite of this stern warning, Lucy was adamant and refused chemotherapy. She came to seek our help on 7 September 2012.

Chris: Okay, let me ask you. You have been taking the Sabah Snake Grass – did it help you?

Lucy: If it helped me, I don’t have to come and see you anymore. See, the good of this plant has been published widely in the papers!

C: The problem is just because it is published in the newspapers, you beiieve it all. I never read the newspapers these days.

Surgery did not cure,

Sabah Snake Grass did not cure,

Chemo would not cure,

My herbs would not cure!

Why don’t try chemo then?

Please don’t blame me if things don’t work out the way you want!

This is what I told Lucy:

Lucy was again adamant. She said, Today I come here, of course, I am not going to go for chemo. And of course, I am not going to blame you if something went wrong.

Lucy admitted that before this she had been taking all kind of food. After meeting us, she decided to take care of her diet and change her lifestyle. Yes, this we hope she would do!

Why Do You Not Want to Undergo Chemotherapy?

I did not ask Lucy specifically this question. It was not one year later that I got to meet up with Lucy and learnt the answer to this question.

Lucy had a friend who underwent surgery and then chemotherapy. After the treatment – and after much suffering from the side effects – the cancer came back again. So according to Lucy, why go for chemo if it would not cure? Why go through all these and suffer?

Then probably more relevant was her father’s experience. Lucy’s 60-yer-old father had nose cancer. He underwent radiotherapy and then chemotherapy.  After two cycles of chemo, he was not able to withstand the treatment anymore. The family stopped the treatment. One month later, he died.

To this I told Lucy, I understand you.

Comments

Those who do not know anything about chemotherapy could not understand Lucy. If you have a family member or close friend undergoing this treatment, there is no need for anyone to say much. You know the difficulties and agony.  I too have not gone through such experience but from my readings, I learnt from other people’s experience to be able to know what it is like. Some told me it was HELL.

The following are information and data obtained from the internet and oncology text books regarding ovarian cancer.

What You Need to Know About Ovarian Cancer

http://emedicine.medscape.com/article/255771-overview#aw2aab6b2b5aahttp://www.acancer.net/ovarian_cancer/stage3.php

http://health.nytimes.com/health/guides/disease/ovarian-cancer/chemotherapy.htmlhttp://www.webmd.com/ovarian-cancer/features/ovarian-cancer-chemo-options?page=2

http://www.malaysiaoncology.org/article.php?aid=10

  • Around the world, more than 200,000 women are estimated to develop ovarian cancer every year and about 100,000 die from the disease.
  • According to the National Cancer Registry, ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia, making up five per cent of all female cancer cases.
  • Epithelial tumors represent the most common histology (90%) of ovarian tumors. This type of cancer often spreads on the peritoneal surfaces –  e.g.,  undersurface of the diaphragms, paracolic gutters, bladder, surface of the liver,  mesentery and serosa of the large and small bowel, omentum, uterus, and para-aortic and pelvic lymph nodes.
  • Most ovarian cases are diagnosed in an advanced stage and their prognosis is closely related to the stage at diagnosis. Overall, prognosis for advanced-stage patients remains poor. Overall 5-year survival of ovarian cancer is 45 percent.
  • As I have always told patients – we don’t have to believe this statistics but we also don’t want to bury our heads in the sand and pretend that everything will be okay. We need to know the reality and then try hard to beat the odds. 

Treatment:

  • Currently, the standard treatment for stage 3 ovarian cancer consists of both surgery (surgical debulking) and chemotherapy.
  • Unfortunately, less than 40% of patients experience long-term survival following standard treatment.
  • Approximately 60-80% of patients with stage 3 cancer will experience a recurrence of their cancer, even after complete surgical removal of cancer.
  • Nearly all patients with stage 3 disease have small amounts of undetectable cancer that have spread outside the ovary and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests and are referred to as micrometastases. The presence of micrometastases causes cancer recurrence.

Chemotherapy for Stage 3 Ovarian Cancer

  • The chemotherapy drugs used to treat ovarian cancer are fairly standard. Typically doctors combine a platinum-based drug such as carboplatin or cisplatin with a taxane such as paclitaxel (Taxol) or docetaxel (Taxotere).

Perez, C.P. et. al, (in Clinical Oncology, 8th Edition, Health Science Asia, pg. 489) wrote: The combination of paclitaxel plus a platinum compound is considered by most to be the first-line adjuvant chemotherapeutic regimen in patients with advanced ovarian cancer.  The pathologic complete response is only 20 to 26 percent (Table below).

Clinal-Trial-of-chemo-for-o

Source:   Thigpen, J.T. (in Clinical Oncology Pt.2, 2nd Ed., Harcourt Asia, pg. 2026)

  • Ovarian cancers are very sensitive to chemotherapy and often respond well initially. Unfortunately, in most cases, ovarian cancer recurs.
  • Fewer than 20% of patients treated with a platinum compound and paclitaxel survive without evidence of cancer recurrence 5 years following treatment.
  • Unfortunately, even in patients who respond, the disease eventually becomes resistant to the first-line drugs, and the cancer returns. Some ovarian tumors are resistant to platinum drugs. Once cancer recurs or continues to progress, the patient may be treated with more chemotherapy.
  • Despite the development of several new chemotherapy drugs over the past few years, there is no substantial evidence that any of the treatments have increased the number of women cured of ovarian cancer.
  • Gemcitabine (Gemzar) is also used in combination with carboplatin for women with advanced ovarian cancer that has relapsed. Other drugs include doxorubicin (Adriamycin, Doxil), etoposide (Vepesid), and vinorelbine (Navelbine).

Side Effects of Chemotherapy

  • Chemotherapy can cause side effects during and after treatment. The type and severity of these side effects depends upon which chemotherapy drugs are used and how they are administered.
  • The most common side effects are nausea, vomiting, mouth soreness, temporary lowering of the blood counts, and hair loss.

Surveillance After Treatment

  • At the end of treatment (both surgery and chemotherapy), a patient is considered to have a “complete response” if her physical examination is normal; there is no evidence of cancer on imaging studies (such as a CT scan); and the blood level of the tumor marker like CA-125 is normal.
  • However, even when all of these criteria are met, microscopic amounts of residual cancer (i.e., not visible on imaging studies) can still be present. Growth of these microscopic tumor cells is probably responsible for tumor recurrence at a later date.
  • To monitor for the possibility of recurrence, blood tests, physical examinations, and imaging tests are to be done.

Signs of Recurrence

  • The likelihood of a tumor recurrence is highest in women with more advanced-stage disease at diagnosis, particularly if the initial debulking surgery was unable to remove all visible tumor.
  • The earliest evidence of recurrent ovarian cancer can be indicated by a rising blood level of one of the tumor markers (CA-125)  and symptoms such as abdominal pain or bloating with or without back pain, or presence of pelvic mass.

What Can I Expect After Chemotherapy Treatment?

  • Surgery plus chemotherapy drugs can get rid of ovarian cancer, but often they can’t keep it away forever.
  • Surgery and chemotherapy are usually effective in treating the cancer so it will go away for a while, but in most cases the cancer ends up coming back.
  • Often, the cancer will return within one to two years after treatment is finished. If  the cancer does return, another round of chemotherapy is necessary.

 

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