From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: alt.support.cancer,sci.med.diseases.cancer,sci.med
Subject: Re: Best hospital in North America for ovarian cancer?  (mom just 
	diagnosed)
Date: 6 Jun 2004 07:57:50 -0500
Message-ID: <40c313e1$0$3567$45beb828@newscene.com>

<PaulF@NoSpamPlease.com> wrote in message
news:1XDwc.16999868$Of.2827052@news.easynews.com...
> "Guesswho" <guesswho@guess.com> wrote in
> news:9fCdnWgKd5wdCF_d4p2dnA@comcast.com:
> > http://www.usnews.com/usnews/health/hosptl/rankings/specihqgyne.htm
>
>
>      Thank you for this link, it's been very useful.  And thank
> everyone else who have so quickly responded and already given
> me such valuable information.
>
>      I see that the Memorial Sloan-Kettering Cancer Center
> ( http://www.mskcc.org/ ) is very highly rated.    Does
> anyone here have any experience with the center or any of
> it's doctors?   I'm seriously considering bringing my mom
> there, or at least asking for a second opinion by mail.
> They seem to have a very well developped program for
> giving preliminary consultations from afar and for admitting
> patients from far away.  (A big plus for us since we'll
> need to fly in to NY.)
>


Naturally, the first step from here is to make a definitive diagnosis. It's
important to know  a) if it is ovarian cancer  b) what type of ovarian
cancer it is  c) the extent of the ovarian cancer (staging). Diagnostic
laparoscopy with biopsies and washings is reasonable as a next-step (based
on what little I know from your description of the case so far), but whether
or not this is done at the same time as definitive surgical treatment would
be something to be discussed with the surgeon.

Sloan-Kettering is one of many, many centers in the US capable of competent
treatment for ovarian cancer, if that is indeed what she has. Such
treatments are fairly standardized and from an oncologist point-of-view
there is very likely someplace within a hundred miles of where you live that
could do as good a job as anywhere.

With most ovarian cancers, the most important part (and perhaps the hardest)
is finding a surgeon that will aggressively and competently debulk the
tumor. IMHO, the first place to concentrate is an oncologic surgery program
with a lot of experience in this area. That might be a more important reason
to travel to Sloan-Kettering / MD Anderson / Mayo Clinic etc etc etc than
the subsequent adjuvant treatment.

It's very important for you all to be confident in your choice, and I
applaud your nation-wide investigation. It is possible, however, to
overthink such a choice.

HMc

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: alt.support.cancer,sci.med.diseases.cancer,sci.med
Subject: Re: Best hospital in North America for ovarian cancer?  (mom just 
	diagnosed)
Date: 6 Jun 2004 18:21:07 -0500
Message-ID: <40c3a603$0$3599$45beb828@newscene.com>

<PaulF@NoSpamPlease.com> wrote in message
news:xJFwc.16912695$Id.2798053@news.easynews.com...

>      I hadn't even considered the idea that there might be a Diagnostic
> laparoscopy and then a treatment one.  I thought it would have to be
> two in one.

> > With most ovarian cancers, the most important part (and perhaps
> > the hardest) is finding a surgeon that will aggressively and competently
> > debulk the tumor. IMHO, the first place to concentrate is an oncologic
> > surgery program with a lot of experience in this area.
>
>      Luckyly, in her case, no tumor masses are apparent.  So perhaps
> surgery skills are not as important a variable?
>
>     I want the treatment to use the latest drugs / dosages
> as established by peer reviewed studies.  I've started my
> internet research, but it's hard to find these things out
> at the level of detail that I want.   At least with MSKCC
> I would know that they set the standard.

Sloan-Kettering is certainly one (of many, many) place that participates in
the various cancer and chemo trials.

As to tumor masses, you mean that there are none that have been detected.
One won't know definitively until one takes a look. I have been fooled many
times and never make assumptions about operative findings based on xrays.
She needs a diagnostic laparoscopy with ovarian biopsies or removal,
subdiaphragmatic washings for cytology, omentectomy. Many gynecologists
won't do this laparsocopically.

Ovarian cancer is nasty business. I wish your mother and family the best of
luck.

HMc

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: alt.support.cancer,sci.med.diseases.cancer,sci.med
Subject: Re: Best hospital in North America for ovarian cancer?  (mom just 
	diagnosed)
Date: 7 Jun 2004 07:29:06 -0500
Message-ID: <40c45f0a$0$79746$45beb828@newscene.com>

<PaulF@NoSpamPlease.com> wrote in message
news:ARNwc.16944344$Id.2802528@news.easynews.com...
> > As to tumor masses, you mean that there are none that
> > have been detected. One won't know definitively until
> > one takes a look.
>
>     Yes.  But I think that at least I can be somewhat
> confident that any masses are small or flat.  Surely the CT
> scan would pick up a 1cm mass.  (I understand it's resolution
> is down into the millimeter range).
>
>
>
> > She needs a diagnostic laparoscopy with ovarian biopsies or removal,
> > subdiaphragmatic washings for cytology, omentectomy. Many gynecologists
> > won't do this laparsocopically.
>
>      That you for this bit of very valuable info.  I'll be sure
> to ask about it.
>
>    I don't know if the surgeon will opt to do it laparsocopically
> or by laparotomy.  She may also choose to just do a single
> operation to diagnose and remove tissue.   I understand
> that it's even possible to make the tests "live".  (as in:
> open the patient, do washings/sample tissue, get an answer
> from the lab while patient is still on the table, and decide
> on what tissues to remove immeditely)
>

Yes, there are a number of good ways to approach the abdominal exploration.
If the surgeon has a reasonable expectation that masses will be present, or
that laparoscopy may compromise the exploration for technical or experience
reasons, then laparotomy is certainly within the range of acceptable
practice, and in many circumstances may be preferable.

HMc

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: sci.med
Subject: Re: Ovaries And Uterus Question
Date: 18 Aug 2004 15:46:11 -0500
Message-ID: <4123bf8f$0$52533$45beb828@newscene.com>

"Darkwing" <Darkwing@MorganasMansionxoxoxo.com> wrote in message
news:jVNUc.10758$k63.571@trndny03...
> My 58-year old mother had a cyst on her ovary, and had surgery to have
> both ovaries removed. After removing the ovaries, the surgeon told my
> mother that the ovary with the cyst was cancerous, but the cancer had
> not spread. However, the surgeon also says that she should now have her
> uterus removed, and take chemotherapy.
>
> Before the surgery, my mother had been given a pap test, and the results
> came back negative. She was not bleeding, and was not experiencing any
> pain. Now she is confused and surprised by what the surgeon is telling
> her should be done next.
>
> What is your suggestion about this situation? Thank you.

Ovarian cancer is nasty business and it tends to spread inside the abdominal
cavity.  It's important to be aggressive.

It can't be known if the cancer has spread until the entire abdominal cavity
is carefully examined, with removal of the organs where it tends to spread.
This includes the greater omentum, washings or biospies from under the
diaphragm, and removal of the rest of the pelvic organs (uterus). Ovarian
cancer cells tend to implant in those intraperitoneal organs and their
removal is important for staging of the cancer and especially to remove all
potential residual cancer tissue. This is called cytoreduction or debulking
and is a basic concept in the management of ovarian cancer. Adjuvant therapy
(chemotherapy post-op) is also done to try to kill additional or residual
cancer cells. That are likely to be left behind.

Additionally, a "second-look" operation is often done some months after the
original operation, with additional biopsies and washings to try to
determine is the cancer is still present.

Best of luck to your mother.

HMc

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: sci.med
Subject: Re: Ovaries And Uterus Question
Date: 18 Aug 2004 17:35:28 -0500
Message-ID: <4123d8f5$0$82995$45beb828@newscene.com>

"Darkwing" <Darkwing@MorganasMansionxoxoxo.com> wrote in message
news:22QUc.21694$iE3.6759@trndny09...

> According to the surgeon, it is a Type 1-C Cancer. I think I should also
> note that a biopsy of the ovary has not been done yet- this is  based on
> a what they called a, "preliminary dianosis". Can a prelinary diagnosis
> really show enough for her to figure out what type of cancer it is?
> Also, the surgeon wants the additional surgery to be done as soon as
> possible. Is Type 1-C Cancer a cancer that must be operated on very
> quickly? My mother had her ovaries removed yesterday, and she really
> doesn't want to be cut open again so quickly after just beginning to
> recover from yesterday's surgery.

If the ovaries were removed yesterday, and the uterus wasn't removed, nor
was the omentum, nor were there any cytology washings done, then the ovarian
cancer hasn't been staged at all. The only thing the surgeon can tell you is
that there was no *gross* tumor spread that he could *see*. This is simply
not sufficient to draw any definitive conclusions about staging yet. If,
when he finally removes the uterus, they find microscopic tumor in the
uterus, it would be stage II. If the peritoneal washings, when they are
finally done, show tumor cells, (or if there is tumor in the greater
omentum) then it would be stage III. These things can only be determined
after those organs are finally removed and available to the pathologist for
microscopic examination. The other very important thing we don't know is the
histologic grading (aggressiveness) of the cancer. That can only be
determined by microscopic examination and would have significant
implications for additional treatment and prognosis too.

Chemotherapy may not be done for  Grade I, Stage IA or IB tumors. If he
called it I-C based only on his preliminary observation, what he's saying is
that he didn't *see* any gross evidence of tumor spread elsewhere, but that
it did indeed look like the ovarian capsule was ruptured by the tumor. My
guess is that chemotherapy would be recommended for a I-C cancer in a 58
year old woman. I don't know - I'm not an oncologist and I don't know the
histologic grading.

The main point here is that if this tumor is indeed an ovarian cancer, the
additional surgery her sugeon recommends has to be done to provide most
accurate diagnosis to guide additional treatment (chemotherapy) and provide
the best possible outcome.

I'm sorry that your mother has to go through this. I can understand her
reaction to yet another operation. Generally, surgeons try to accomplish all
of this at one operation. Preoperative identification of an ovarian mass
greater than 3 cm diameter in a 58 year old always has the potential for
being a malignancy, so the patient is advised preoperatively, and
preparations made for the initial operation to go on to hysterectomy,
omentectomy and peritoneal washings if the tumor is determined at operation
to be an ovarian cancer. I'm not trying to second-guess her surgeon -- I
don't know your mother's particular situation, and it may very well have
dicated this particular approach.

It's very hard, I know, but more information will have to wait for the
pathologist. Some of that information will come after he/she looks at the
tumor, and the rest of the information will come after he/she examines the
structures removed at your mother's upcoming second operation. Once
accurately staged, treatment can be determined.

HMc