Last Update: 11 March 2010

Information about Karen

This page was developed to spread the awareness of Overian Cancer. Particularly Carcinosarcoma cancer. There are no known tests at this time to find this cancer, just women intuition

Patient Description

Health Background

Excellent - Prior to this, patient never had any health issues

Allergies - None

Medication - None

Age - 53 years - at time cancer was discovered.

Height - 5' 7"

Weight - 145 pounds

Four (4) Pregnancies - 3 natural, one miscarriage

Carcinosarcoma Ovarian Cancer - Stage III C

How the cancer was found

2009 - Around Labor Day, Karen was not feeling good and a week later (Sept. 18th) she went to our family doctor (Dr. Peters). The Doctor told her she was having gas problems and to come back in a week. Sept. 25th Karen went back to the doctors office, looking about 6-7 months pregnant. A Pap Smear (papanicolaou) was done with negative results. Doctor once again stated it was gas and to come back in two weeks.

Over the weekend(Sept 26,27), Karen and I did some searches over the web (Yes!! google ) and decided to go back to the doctors on Monday Sept. 28 and ask the doctor to perform tests.

Monday Sept. 28 Karen went back to Dr. Peters insisting that her blotting "was not normal" and requested other tests be done. Reluctantly, Dr. Peters offered a cat scan. On that same day at 7pm, Karen had her cat scan. Since Dr. Peters believed it was still gas, he only authorized a cat scan from the breast to the top of the pelivs. Luckily, the radiologist spotted the top of an unusual object. The radiologist suggested to Dr. Peters that a second cat scan be done below the pelvis. A second scan was done, however, only a front view and not sectional view. Therefore, we did not know how large the largest tumor was until the operation was done. Four tumors were found. The largest was about 6 inches in diameter.

Wednesday, October 7, Karen had surgery. One day before her 53rd birthday. On Oct 8th, Karen received a birthday card from the hospital. I told Karen that is probably the most expensive birthday card she will ever receive. Our surgeon (Dr. Hicks) was great. Besides the tumors, Dr. Hicks took out 9 liters of fluid and 12 inches of the Colon.

On Oct. 30, Karen had a "port" place in her and we started chemotherapy Nov. 9. The chemo is 86 hours a day, 5 days in a row per month. At the end of three and six months they will determine if the chemotherapy is working. From Dr. Hicks past experience using these drugs with this type of cancer is stated as either the body response good or not good. There is no in-between.

Lesson learn - Doctors are not always right nor do they always listen. Like any other professional group of people, there are some good ones and some not so good ones. Doctors are the same way. Make sure that if you ever feel blotted and you are not passing gas, get a check up for ovarian cancer. A simple x-ray in the pelvis area should show something.

Surgical Pathology Report

Diagnosis /History

Pelvic mass

Procedure

Total abdominal hysterectomy, bilateral salpingo-oophorectomy, staging

Specimen(s) Received

A. Right ovary

B. Omentum

C. Right pelvic lymph node

D. Uterus, cervix, bilateral tubes, left ovary and recto sigmoid colon with tumor

E. proximal and distal donuts

Final Pathologic Diagnosis

A. Carcinosarcoma (malignant mixed mullerian tumor).

B. Metastatic carcinosarcoma, omentum

C. Right pelvic lymph nodes (2), negative for metastatic carcincoma

D. Uterus, bilateral fallopian tubes, and left ovary;

Metastatic carcinosarcoma involving uterine serosa and surface of left ovary, Endometrial polyp.

Rectosigmoid colon with metastatic carcinosarcoma involving serosal surface.

E. Adhesions, full thickness colonic tissues.

Comment: Tumor stage is pT3c pN0 pMx, Stage grouping is IIIC.

Addendum Diagnosis

Immunohistochemical stains were preformed. The poorly differentiated neoplasm has areas that are pan-keratin positive. In addition, there is sarcomatous area that are CD10 positive, thus indicating an endometrial stromal component to the sarcomatous.

10/12/2009 - 12:04 Gross Description:

A. Container labeled right ovary. The specimen is a 490 gram granular, hemorrhagic ovary, measuring 13x11x9 cm. sectioning reveals gray-tan, glistening, soft tissue with scattered hemorrhagic areas present. Representative sections are submitted for frozen section and placed in block FS1 and FS2. Remaining representative sections are submitted in cassettes 3-8.

B. Labeled omentum, and is congested omental-like adipose tissue, 60cm long, varying from 10 to 4 cm wide, and up to 1 cm thick. The surface is covered with some fibrous adhesions. Within the omentum is a single gray-white nodule, 2 cm. Representative sections in five cassettes.

C. Labeled right pelvic lymph node. The specimen is adipose tissue, 4 x2 x 0.3 cm containing three nodules or nodes, 0.5, 1.4 and 1.3 cm, respectively. All in one cassette.

D. Labeled rectosigmoid colon with tumor, uterus, bilateral tubes, left ovary, cervix. The specimen is uterus, attached left tube and ovary, detached right tube, adherent segment of colon and separate fragments of soft tissue and tumor. The uterus is 121 grams, is 9 cm from fundus to ectocervical surface. The corpus is symmetrical, 6.5 x 5 x3.8 cm, covered with mostly smooth serosa, roughened by some nodules near the uterine neck. The cylindrical cervix is 3 cm long and 3.8 cm across the vaginal surface. The ectocervix white and smooth and surrounds a slit-like external cervical os, 1.5 cm long. The cervical canal is patent and has a trabeculated lining. The uterine cavity is triangular and lined by thin, tan endometrium, 0.1 cm thick. There is a plaque-like endometrial polyp that measures 1 cm. The myometrium is pink-tan, soft, 1.5 cm thick. The right fallopian tube is 4 cm long, 0.5 cm in diameter. The serosa is roughened with fibrous adhesions. The fimbria is not recognized. Attached to the fallopian tube is membranous tissue covered with gray-white tumor tissue.

The left fallopian tube is 7 cm long, 0.5 cm in diameter. The serosa is smooth. The fimbria is unremarkable. The attached left ovary is 4.3 x2 x1.3 cm and has a surface roughened with some fibrous adhesions. The attached colon is 14 cm long, 5.5 cm in circumference. The mucosa is grossly unremarkable. The serosal surface of the bowel is congested and covered with some hemorrhagic adhesions and gray-white tumor tissue. Separate fragments of gray-white, necrotic tumor tissue is received, 9 x 7 x 2 cm.

Representative sections in 17 cassettes as follows:

1-2: cervix

3: uterine serosal adhesions

4-6: endometrium

7-8: right fallopian tube and attached membranous and tumor tissue

9: left fallopian tube

10-11: left ovary

12-13: margins of colon

14-15: colon, serosal adhesions and attached tumor

16-17: separately submitted tumor

E. Labeled proximal and distal donuts. The specimen is two complete rings of bowel, 2 cm in circumference and 3 cm in circumference, each containing metal staples. The mucosa of each is grossly unremarkable. A section of each in two cassettes. LW

Intraoperative Consultation

Frozen section diagnosis:

Poorly differentiated carcinoma with sarcomatous elements. /GB

Microscopic Description

A. The sections are of a malignant mixed mullerian tumor (carcinosarcoma). There is extensive necrosis. The majority of the neoplasm is composed of undifferentiated epithelial cells with minimal glandular differentiation. There are areas of malignant cartilage differentiation.

B. Omentum contains similar tumor as that described in part A.

C. There are two lymph nodes and neither contain metastatic tumor.

D. The cervix is unremarkable. Both fallopian tubes are unremarkable. There is an endometrial polyp present. There is a tumor similar to that described above on the uterine serosa and on the surface of the left ovary. Similar tumor is on the serosa of the colon.

E. There are adhesions on the serosal surface of otherwise unremarkable full thickness colonic tissues.

History of Events

Scales - There are two scales used. One for tiredness and one for pain. Scales are 1-5 with 1 not being tired or no pain and 5 being extremely tired or painfully. The suffix "t" is for tiredness and suffix "p" for pain.

scale 1- Running around like a little kid
scale 5 - Tired and thinking like a teenager

Up until after surgery patient was "not in pain" but was discomfort.

September 2009

Labor day weekend

Sept. - Saturday - not feeling well, pale look, "just not feeling good", slight temperature

Sept. 6 - 18 Bloated still not feeling right. looked 3 months pregnant

Sept. 18 - Visited doctor. Showed Dr. the bloating and had Dr. check for urinary infection. Dr. stated it was gas and to come back Sept. 25.

Sept. 25 - Visited doctor 2nd time. Dr. preformed Pap smear, pelvic exam. Found nothing, patient still bloated. Dr. stated it was gas and to come back in two weeks

Sept. 26 - Still bloated, now hard and looking about 6-7 months pregnant

Sept. 28 - Visited Dr. again. Insisted on some other exam method. Dr. approved cat scan.

Sept. 28 - Evening had cat scan that showed four tumors

Sept. 29 - Visited Dr. Hicks for scheduling surgery. Date Oct. 14.

October 2009

Oct. 5 - Surgery moved from Oct. 14 to Oct. 7.

Note: From Sept. 29 - Oct. 5 stomach grew by 4 inches.

Oct. 6 - Took medication to clean out system - Over the counter laxative

Oct. 7 - Surgery early afternoon. Surgery lasted 3 hours. Move to intensive care for one week. Right after surgery, epidural reduced from scale of 10 to 6

Oct. 8 - ICU eating ice - 2 units of blood to stabilize blood pressure

Oct. 12 - Starting walking while in ICU

Oct. 14 - Moved to standard care floor. Eating ice and drinking fluids

Oct. 21 - Passed Gas. epidural was to be removed. The Dr. asked if the patient eating. The patient answered "yes", was ready to remove epidural, however, I questioned the Dr. to define "what does eating mean?" Patient had eaten only about 1 spoon of solid food in which case the Dr. left the epidural in place.

Oct. 23 - Left for home after having successfully urinating.

Oct. 23 - No walking up/down stairs until Nov. 21

Oct. 23-27 - Unable to hold food down. stopped eating. drank electrolytes

Oct. 27 - Started slowly eating foods. Eggs, cheeses, peanuts, drinking electrolytes.

Oct. 28 - Blood tested for something. Not sure what.

Oct. 30 - Port in place for chemotherapy - Right-hand side below shoulder blade

November 2009

Nov. 1 - Started eating full meals.

Chemotherapy Nov. 9 - 13, 8am-4pm. Chemo is Cisplatin, Ifosfamide, Mesna

Nov. 9 - Day 1 - Ok tired from surgery - walked while taking chemotherapy rate t1

Nov. 10 - Day 2 - Still ok - walked around while taking chemotherapy rate t1

Nov. 11 - Day 3 - Still ok rate t2

Nov. 12 - Day 4 - Started to feel tied. Appetite gone. Cereal morning and 3 eggs for dinner. rate t4

Nov. 13 - Day 5 starting to feel tired. Appetite gone. Cereal morning and 3 eggs for dinner. rate t4

Nov. 14-15 Extremely tired. 3 eggs for both morning and dinner. rate t5

Nov. 16-18 Walking around but tired. rate t4

Nov. 19-30 Tiredness rates slowly improved to t3 and t2. Has remained at t2

Nov. 25 - Blood for white cells. - Nothing came back so white cell counts are good. White cells protect against infections.

Nov. 30 - Starting to lose hair

Medications for Nausea

Prochlorperazine (Compazine, Stemzine, Buccastem, Stemetil, Phenotil) Every 12 hours.

zofran ondansetron Every 4-6 hours. This drug seemed have work the best for this chemo application.

Note:These drugs are not taken together. Either one drug of the other

December 2009

Dec. 1 - Blood CA 125

Chemotherapy

Dec. 7 Day 1 - t2 before the chemotherapy started

Dec. 8 Day 2 - Paracontesis (Drain fluid) 6 liters, t2

Dec. 9 Day 3 - Nothing unusual t2

Dec. 10 Day 4 - Started to feel tied. t3

Dec. 11 Day 5 Starting to feel tired. t3

Dec. 6-7 -Tired t4

Dec. 22 - Paracentesis - removed 5 liters of fluid. Hair lost slowed down and the amount of fluid may indicate Chemo may have stopped working

Dec. 23 - Blood CA 125

Dec. 25 - Tired t2 - tiredness comes and goes with the type of activity

Dec. 31 - Due to fluid build up, unable to eat solid foods without vomiting. Decided to go to emergency. Heart rate was 150bpm, blood pressure 125/99. X-ray of lungs and heart area. Lungs looked good, however, fluid (moderate amount) build up around heart.

Dec. 31 Paracentesis - Doctors removed 7.2 liters

Spent night in hospital. Dr. Hicks and his inter stopped by the hospital, on new years eve - unbelievable... nice touch...

Note:It is not common to have some fluid build-up around the heart while doing chemo.

Medication for heart

Inderal Propranolol

At this time, we have only filled the prescription but are not taking it. The reason, we believe the less medication you use, the better off you are. The body is a wounderful machine and can learn to correct itself.

January 2010

The current chemo does not seem to be working. In January, we will try using a different mix of chemo. Taxol and Carboplatin

Jan. 1 - Still in hospital. Nothing going no.

Jan. 2 - 11:00am from hosptial. Fluid still by heart, no action not enough fluid to worry about at this time.

Jan. 3 - Eating samll amounts of food. vomited once in the morning

Different Chemo - 1/2 liter Taxol, 250mg Carboplatin, 50mg Benadryl - Help control nausea

Jan. 5 - Started new chemo. One 8 hour treatment. Very tired. t4

Jan. 6 - Still tired t4. Not eating solids.

Jan. 7 - 9:00am Arrive for Paracentsis - 10 liters. Very tired sleeping most of the day and night.

Jan. 8 - Tired and slightly nausea. Drinking Powerade. Unable to keep alot down.

Jan. 9 - Tired and slightly more nausea. Drinking Powerade. Unable to keep alot down.

Jan. 10 - Rough day. Extremely weak nausea (current nausea drugs not working). Drinking Powerade. Unable to keep alot down.

Jan. 11 - Rough day. Extremely weak nausea (current nausea drugs not working). Drinking Powerade. Unable to keep alot down.

Jan. 12 - Request a different nausea drug at 10am. 11am received kytril granisetron The "BIG GUNS"

Jan. 12 - 1 pm. Drinking Powerade and Boost. Nausea under control. Took Kytril before bed.

Jan. 13 - No medication today. Eating small amounts of solid food. Continue drinking Powerade and Boost.

Jan. 14 - 12:30pm Arrived for Paracentesis - Removed 8 liters

Jan. 14 - Asked for medication that would create an appetit. Marinol Dronabinol

Jan. 15 - Went out to eat dinner. Only taken Marinol

Jan. 16 - 2 medications of Marinol. Eating small eggs, drinking Powerade, boost.

Jan. 18 - CBC Differential and Platelet Count

Jan. 19 - Not eating many solid foods. Still drinking Powerade, boost and eating peanuts.

Jan. 20 - No change

Jan. 21 - 10:30am Arrived for paracentesis - Removed 4 liters.
Good sign that the chemo might be working.
Starting to take Imodium to stop diarrheal since Karen has not eaten a lot of solid foods
Need to start eating solid foods. Bananas, Avocados, crackers.
Trying a new food drink. 16oz of milk, 2 scoops of vanilla ice cream, 8oz Insure, 2 scoops of UltraInflamX PLUS 360, 1 banana, 1/2 avocado. - Taste is good. I might have one myself. :) t4

Jan. 22 - Created more drinks containing a banana, apple, pear, avocado, ensure, milk, 2 scoops of UltraInflamX PLUS 360. Made about 1/2 gallon

Jan. 23 - Morning Karen finished 1/2 gallon. Eat hotdog

Jan. 24 - Eat three eggs, toast, banana, PowerAde and "Tyge" power Drink
Dinner - Eat 1/2 white fish and lazona, potato, chicken noodle soup

Jan. 25 and rest of the week. Eat at least one banana and one avocado per day

Jan. 27 - CBC Differential and Platelet Count, CMP, Magnesium, LDH, CA 125
low sodium and low protein

February 2010

Feb. 2 - Chemo. First time use of Aloxi to control nausea

Before starting chemo, had Karen drink one 8oz 30g protein drink. During chemo, continue drinking "tyge's big bang" drink". This drink contained 63g of protein. If the chemo does not kill, than these drinks will. :)

Unbelievable - After chemo and after Karen got home, she at a 3 egg omletette with cheese and avocado. At night, she took one pill of kytril.

Feb. 3 - Paracentesis. Removed 5.5 liters.

Feb. 3 - Before the paracentesis, karen drank 50g of protein. Came home, eat a bowl of cereal and walked about 1/4 mile. Rested, continue drinking lots of powerade and "tyge" protein drinks. Dinner ate a salmon burger. So far everything is good. Nausea is under control. Next steps, eat, get fat, exercise and continue being happy.

Started lifting 10 pound weights while setting down

Weight - 142 lbs. - reason for recording weight is to see how fast, if any, fluids come back.

Feb. 5-6 - Looks like fluids are coming back. Weight 150 lbs. About 2 pounds per 1 liter of fluid.

Feb. 10 - Weight is 159 pounds.

Feb. 11 - 8am Paracentesis. Removed 8 liters.

Feb. 10 - Walked for 45 minutes. lifting 3 pound weights with arms. Tired scale t3. Still eating 100+ grams of protein.

Feb. 11-14 Karen eating very well. Still tired t3

Feb. 15 - CBC Differential and Platelet Count

Feb. 15-17 Fluids starting to come back. Karen continues to eat well; However, still tired t3

Feb. 18 - 9:30am Arrived for paracentesis - Removed 6.3 liters.

Feb. 23 - CBC Differential and Platelet Count, CMP, Magnesium, LDH, CA 125

March 2010

Mar. 2 - Appointment with Dr. Hicks
News good/bad
Good, ca125 count is below 35
Bad, still creating fluids. Usually, fluids disappear before ca125 count goes down
Therefore 1/2 the cancer seems to be under control. As such, we agreed to keep the same chemo for the 3rd time.
Tyge's theory - Drain the fluids before the chemo (less cancer for the chemo do have to fight with), monitor fluids after chemo. If the chemo is working, by Karen's next paracentesis (Mar. 11), she should have 3-4 liters or less of fluids
Mar. 16th paracentesis, 2-3 liters or less
Mar. 23rd paracentesis, 1-2 liters or less
Mar. 30th paracentesis, 0 liter
If there are still fluids by Mar. 31st., then the chemo will need to be changed. To what? is the big question.

Mar. 2 - Paracentesis removed 7.0 liters

Mar. 3 - Chemo, Ate very little during chemo
medication Kytril (11pm)

Mar. 4 - Very tired - medication Kytril(10am/11pm) -

Mar. 5 - Very tired - medication Kytril(10am/11pm) -

Mar. 6 - Very tired - medication Kytril(11pm), Switch medication compazine(4pm/10pm)
morning ensure (threw up), rough day. Only able to drink 2 8oz ensures and one milk shake (2 scoops ice cream, ensure, whole milk)

Mar. 7 - Extremely tried level t1 - Fluids are startingto build up

Mar. 8 - Extremely tired level t1 - Has not been able to eat solid foods since Thursda/Friday March 4,5 Drinking protein drinks and electrolytes

Mar. 9 - CBC-D blood - Very low

Reports

Cancer Antigen (CA125) Normal Range 0-35

More information about ca125

28 October 2009 - 37.3

02 December 2009 - 70.0

30 December 2009 - 37.3

27 January 2009 - 47.9

23 February 2010 - 20.4 This is good

Paracentesis (Body fluids with cancer)

07 October 2009 - 9.0 liters

08 December 2009 - 6.0 liters

22 December 2009 - 5.0 liters

31 December 2009 - 7.2 liters

07 January 2010 - 10.0 liters

14 January 2010 - 8.0 liters

21 January 2010 - 4.0 liters

03 Feburary 2010 - 5.5 liters

11 Feburary 2010 - 8.0 liters

18 Feburary 2010 - 6.3 liters

25 Feburary 2010 - 6.3 liters

03 March 2010 - 7.0 liters

11 March 2010 - 8.0 liters

Blood Transfusion

08 October 2010 - 2 units

11 March 2010 - 2 units

Hemoglobin Normal Range 11.9-15.9 g/dL

09 March 2010 - 7.4

Foods and Drinks

Foods eating with high protein

Good resource

banana - good source of potassium

avocado - good source of magnesium

eggs

chesse

peanuts

dried cranberries

raisins

tangreines

apricot

almond

Boost

Instant Breakfest Essentials

Ensure

glutathione

Electrolyte drinks

Powerade

Vitaminwater

Dietray Suppliemnets

Metagenisc Adrenogen

1 tablet three (3) times a day

more information

Metagenisc Andrographics Plus - Herbal Immune Support

2 tablets every 2 hours for 12 hours w/unchilled water. Then take one (1) tablet three (3) times a day between meals for five (5) days

more information

Metagenics Vessel Care

One (1) tablet daily or as directed

more information

Metagenics Multigenics

Six (6) tablets daily with meals or as directed

more information

Metagenics Multigenics Intensive Care

2-3 tablets twice a day

more information

Metagenics D3 5000

One (1) tablet daily

more information

Metagenics Celapro

One (1) tablet daily

more information

Metagenics Kaprex AI

One (1) tablet three (3) daily with food

more information

Metagenics NanoCell-Q

One (1) teaspoon (5.1 ml) alone or added to a cup of beverage

more information

Ovarian Cancer Chemo Types

Tables source below are from oncologychannel

Other Excellent Resources

Resources

Ovarian Cancer Research Fund

Links - Thanks to Ralph Nozzi (Friend)

Immunocal

Articles Regarding Immunocal

McGill, Dec. 14, 2009 - New protein key for cell proliferation

Comments may be directed to Tyge at btc@chipchat.com