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School of Medicine
The following case studies represent interesting or challenging cases seen at the Johns Hopkins Ovarian Cancer Center of Excellence. Where permission was given, we have included testimonials of our patients.
Case Study #1
At 38 years old, Janice was diagnosed with Stage IIIC ovarian cancer and underwent successful surgery followed by 6 cycles of chemotherapy with carboplatin and taxol. She achieved a complete remission and did well for 18 months before her CA 125 level began rising even though CT scans revealed no evidence of disease. Eventually, the CA 125 level reached 60U/ml, but her CT scans were still normal. Without any radiographic evidence of disease, Janice's original physician did not recommend any further evaluation but rather watching and waiting. Janice sought a more proactive approach from the Johns Hopkins Ovarian Cancer Center in August of 2001 and underwent a combined PET/CT scan, which revealed an apparently localized recurrence in the pelvis. Janice then had successful secondary cytoreductive surgery in September 2001 to remove the mass and received 6 more cycles of carboplatin and taxol chemotherapy. Surprisingly, only 6 months after completing her second round of chemotherapy treatments, Janice's cancer recurred again in the pelvis, not far from the previous site of recurrence. Because the recurrence again appeared to be localized, in July 2002, Janice underwent tertiary debulking surgery, with successful removal of the recurrent ovarian cancer mass. At this surgery, a portion of the tumor was submitted for an extreme drug resistance assay. The assay indicated that this time the tumor cells had developed resistance to the drugs that Janice had just been treated with (carboplatin and taxol). Consequently, a different chemotherapy drug (Gemcitabine) was chosen for the third round of treatment. Janice completed her last round of chemotherapy in December of 2002 and today remains cancer-free.
- Use of combined PET/CT to diagnose occult recurrence.
- Use of secondary debulking surgery. Most patients only will be given the option of additional chemotherapy.
- Use of the extreme drug resistance assay to direct chemotherapy.