Treatment options for a 40 yr woman whose biopsy reports are suggestive of her having serous cystadeocarcinoma

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Treatment options for a 40 yr woman whose biopsy reports are suggestive of her having serous cystadeocarcinoma of ovary after cystectomy of right ovary? a 40 year old nulliparous(childless)woman (widow in first marriage lasting 5 to 6 years and married to a widower 6 months back) with no serious medical history in life underwent ovarian(right ovary) cystectomy 3 weeks back and diagnosed(as per biopsy report) of having 'serous cystadeocarcinoma of ovary'; she is,however,desirous of bearing a son for the second husband who is having 2 daughters(of 10 and 4 years) and whose wife died of hydatid cysts in lungs a year ago. What are the treatment options for her now ?(18/10/2006)
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Yet another biopsy report received on 19/10/2006 states,after gross examination of six slides and blocks of ovarian cyst(post-operation) and microscopic examination,that sections show ovarian tissue with tumour tissue,which is arranged in glandular pattern lined by multilayered anaplastic epithelial cells thrown into papillary fronds,in solid nests separated by fibrous stroma,in cords and discretely infiltrating into the stroma.The cells are round to oval to spindloid with round to oval to elongated nuclei showing moderate to severe degree of pleomorphism,prominent nucleoli's and abundant eosinophilic cytoplasm.The stroma shows desmoplastic reaction with areas of necrosis and inflammatory cell infiltration.The impression: Picture is suggestive of two possiblities:-1.Malignant Brenner tumor 2.Poorly differentiated papillary serous cystadeocarcinoma of ovary. Advised clinical correlation

Answer 1

Wow harsh. The biopsy sounds malignant. Brenner Tumours are a type of Surface Epithelial Stromal tumour (usually of the ovary)

Big picture:

options are (1) Adopt or (2) try to have your own biological children

(2) could be easy or hard depending on the nature of the remaining ovary.

Is there any evidence to suggest the LEFT ovary is cancerous? You mention a biopsy but do not tell us if this is the pathology from the excision of the RIGHT ovary or if someone has taken a sample of the left and this is the biopsy result.

Furthermore, the other missing bit of information is if the margins of the biopsy are clear of cancer. If they are not, this implies that there are cancerous cells still present in her pelvis.

If there is no cancer in the left ovary and the margins are clear-
she should try to have children the usual way.

Some doctors would argue that she should have a full screen to make sure she has not gotten spread of her disease (CA-125 level, CT abdo/pelvis, urine dipstick)

If there is cancer in the left ovary or the margins are not clear- there is little chance for her to have children the usual way. She might be able to seek the opinion of an assisted reproduction specialist but their assistance in these matters might not help.

The only way I can see her having her own biological children in this last scenario is quite an arduous process:

FIRST - harvest eggs and store them (with or without fertilisation)

THEN deal with the tumour - incl perhaps removal of the remaining ovary. Perhaps her uterus might have to be removed as well. Chemotherapy may be needed.

ONCE the dust has settled:

If her uterus is spared, the ova/embryos can be implanted (they would have to be fertilised, of course)

If her uterus is gone, she would have to seek a surrogate to carry the embryo.

This is a long and arduous pathway with little guarantee to have a healthy son at the end of it. Given her age, there is the additional risk of chromosomal abnormalities.

Which brings us back to adoption.