Fallopian Tube Cancer Recurrence
• What Does A Recurrence Mean?
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|What Does A Recurrence Mean?
Recurrent fallopian tube cancer means that cancer has come back after it has been treated. There is no clearly defined timeline as to what constitutes a recurrence. When cancer recurs it can come back to the same area of the body, or to other parts. There is however a difference between a recurrence and progression of disease. Progression is where cancer becomes worse, but it may be difficult to tell which is which. If cancer seems to be gone for 3 or 4 months and then comes back, is it a recurrence or was it ever really gone? In other words, is it progression or recurrence? Most doctors agree that symptoms of fallopian tube cancer which recur within a few months are likely to be a progression. In such instances it may be that surgery left behind some small cluster of cancer cells which were not large enough at the time to be picked up by tests. These cells grow and eventually cause symptoms to recur. Alternatively it may be that the cancer was resistant to treatment. It may be the chemo (see Chemotherapy Guide) or radiation therapy killed some, but not all of the cancer. Generally the less time between cancer treatment and disease coming back, the more serious the situation. Most doctors agree that for cancer to be considered a recurrence there has to be no sign of it for 12 months. Otherwise it is considered that it never really went away and treatment was not successful. See also, what does cancer remission mean?
As it is such a rare disease there is little statistical data on the subject of recurrences. However what is known is that most recurrences are found outside of the pelvis within 2 or 3 years of the original fallopian tube cancer diagnosis. That means most recurrences are at an advanced stage and the disease has metastasized (spread). The cancer will probably need to be re-staged so that doctors can understand as much as possible about it (see fallopian tube cancer staging).
What Are The Symptoms?
Although studies show that blood tests to monitor for levels of the CA 125 tumor marker demonstrate little benefit in prolonging life expectancy, most women with fallopian tube cancer will be monitored by a gynecologic oncologist for a few years after their original treatment. If CA 125 levels start rising this may be an indication of a recurrence. Levels may even rise while the patient is exhibiting no symptoms. The gynecologist will carry out a physical examination and order imaging studies such as CT scan or MRI scan - but even these may not be able to identify the location of the recurrence. Investigative laparotomy surgery is usually necessary.
There is an ongoing debate about the benefits of what is termed second look surgery for fallopian tube cancer. That is - a laparotomy after the initial cycle of chemotherapy to determine the efficiency of the treatment. Between 70 and 80 percent of patients who have a negative result second look surgery after debulking (cytoreductive) surgery and platinum-based chemotherapy (meaning they appear cancer-free) remain disease free. If disease does return after a negative result it is likely to occur in distant sites such as the brain, lungs or kidneys. However one of the main reasons doctors do not recommend second look surgery is because of the lack of effective second-line treatment (treatment given after the first line of treatment) in patients with persistent disease. In other words, if effective treatments are not available, why put the patient through the unnecessary emotional and physical distress of further surgery?
The options for fallopian tube cancer treatment in persistent cases is constantly changing as results from clinical trials are reported and new innovations and drugs are developed. Generally if fallopian tube cancer returns it is treated with either chemotherapy alone or in combination with further debulking surgery (removal of as much cancerous tissue as is safely possible).
Considerations for determining treatment will include length of time since the first line of treatment has finished (termed progression free survival). If cancer comes back within 12 months it is usually treated by chemotherapy alone. If the original chemo treatment used platinum drugs, carboplatin regimen and Taxol then the patient is referred to as platinum resistant. Alternative chemo drugs will need to be tried. If the cancer comes back between 6 and 12 months platinum drugs may be deemed successful and tried again. When choosing which drugs to use consideration will be given to their side effects such as neuropathy (nerve damage which causes numbness and tingling). Cancer clinical trials which are investigating new therapies may also be recommended. Intraperitoneal chemotherapy (IP), that is placing drugs directly in the affected area, is not usually given in cases of recurrence because of the possibility that it will cause scarring and adhesions.
If you have received fallopian tube cancer treatment and are haunted by the prospect of it coming back, it may help to talk to your doctor about what will happen in such an instance. Some find the information reassuring, others may find it unsettling. However unpalatable the thought may be, a recurrence is possible so it is important to be on the lookout for symptoms (particularly in the first 3 years). Questions to consider asking your doctor include:
• Has cancer returned? And if so, do you classify it as a recurrence or progression?
Can it be prevented? See: Fallopian tube cancer prevention.
|Related Articles on Fallopian Tube Cancer
For more general guidelines, see the following:
• Cancer surgery recovery: Recovering after surgical intervention.
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WOMENS HEALTH ADVICE: ABOUT FALLOPIAN TUBE CANCER