Patient aged 48, developed adeno carcinoma of the left ovary, has a
strong history of cancer on mother's side. Diagnosed about 5 months
back as stage IV (pleural effusion). FNAC showed cells of papillary
adeno carcinoma. The CA-125 test read 322. USG showed a large SOL
(Space Occupying Lesion) about 12.5cms * 10.5cms.

Patient was treated with Taxol (Paclitaxel) +Carboplatin in three
cycles with 3 weeks gap in-between the cycles. Consequent scan
indicated a slight increase in the size of the tumour but the CA-125
reading had come down to 78.

Since the tumour size had not decreased the doctors went for the II
line of chemotherapy with cisplatin+lipodox. After 2 cycles of it with
21 days in-between the doctors on clinical examination felt the size
of the tumour had shrunk. But paradoxically, the CA-125 read 416.

However, now the surgery is completed and the tumour weighing over
5kgs is removed. The patient has a fairly good sense of well being
with reasonably good appetite, sleep, normal {*filter*} counts, ability to
take-up small works, mentally stable condition and no serious side
effects of chemotherapy.

No CT scan is taken so far. Surgery has not revealed any fresh and
apparent lesions.

Can somebody throw light on the following queries?

1. Why CA-125 came down from 322 to 78 while the tumour did not
shrink. When the doctors felt shrinking of tumour on physical
examination why CA-125 went up from 78 to 416?

2. What is the chemotherapy option left now?

3. Are there any other options?  

Regards,

-Satish