Re: CA 125 of 103
From: art fougner, md (evsono@pipeline.com)
Sat Feb 11 16:09:05 2006
Joanne
Her family may be carrying a cancer gene. Have you considered genetic
counseling? Even though it overwhelmingly appears that your patient has
benign disease, family history alone might warrant prophylactic surgery.
Art
At Sat, 11 Feb 2006, S Osterling M.D. wrote:
>
>Joanne,
>
>I am a non-gyn/onc. We just took a 50 y/o lady with a 4 cm solid tumor
>to the OR - ca-125 of 42. We expected an ovarian fibroma. We got
>epithelial ovarian cancer. I'm glad I booked my gyn/onc to come to OR.
>
>On Feb 10, 2006, at 10:27 PM, Joanne Bulley, MD wrote:
>
>> Excuse me John, if this case (or its management) seems offensive to
>> you!
>>
>> She had DUB for which the first ultrasound was ordered.
>>
>> Additional history is that both her mother and sister have breast
>> cancer
>> and her maternal grandmother died of ovarian cancer.
>>
>> I have done at least one laparotomy in my career where there was an US
>> with findings of ovarian abnormalities that were non-diagnostic, CA 125
>> done day of surgery normal ... stage 3C Ovarian CA, patient dies of
>> disease.
>>
>> I am currently following someone who has been treated for Stage IIIc
>> Fallopian tube CA whose CA 125 was 125 or 150.
>>
>> This current patient has had no cesareans.
>>
>> Remember - the original US was done for DUB. The follow up US was done
>> because the radiologists thought the left ovary had two cysts and one
>> was septated.
>>
>> I reviewed all the possibilities and probabilities - and she is
>> scheduled for a laparoscopy by me with curgery as indicated by
>> findings.
>>
>> Joanne
>>
>> At Fri, 10 Feb 2006, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
>> wrote:
>>>
>>> 1.) Gyn oncologists up here are to busy doing real Gyn onc surgery to
>>> take a ca 125 of 103 and a small cyst in 40 y.o. seriously,; I do ca
>>> 125 also ,as I hand them the lab req I tell them if it comes back 1000
>>> its probably not good, if it comes back 100 its probably not cancer
>>> but
>>> you will end up with an operation.
>>>
>>> 2.) sure do the laproscopy, most of my ca 125 of 100 cases have had at
>>> least 2 preious c-sections and end up with a laparotomy(which is not
>>> the
>>> end of the world.)
>>>
>>> 3.) MRI will tell you she has a cyst, you already know this, it was a
>>> mistake to do the U/S don't compound it with another mistake.
>>>
>>> 4.) Tell her that if you find severe endometriois that you would
>>> reccomend a hyst BSO.Tell her if its hydrosalpinx left over from her
>>> tubal you will remove it.
>>>
>>> --
>>> Take care, John
>>>
>> --
>> Joanne Bulley, MD
>> Keene, NH, USA
>>
>S. Osterling M.D.
>California
--
art fougner, md
Buy Danish!
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