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endometrial cancer - 5th cycle chemo

PJL
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My wife has stage 3 endometrial cancer. She is in her 5th (of 6) cycle of chemo - paclitaxel and Carboplatin 4 hours of cocktails. Before chemo her tumour was too big for surgery and CA125 1699.  After 3 cycles and CT scan her CA125 was down to 101 and the CT scan showed tumour had shrunk 'considerably'. She has just finished her 5th cycle and CA125 is down to 32.  We had feedback from nurse yesterday that based on results of CT scan (which was after 3 cycles of chemo) they will still not operate and have asked for another CT scan and MRI with the suggestion of radiotherapy.  What would the MRI be for? And I wonder if after the full 6 cycles is the tumour  likely to shrink more or does the impact of the chemo cocktail slow down after three cycles? 

  • Hello PJL and thank you for posting,

    I am sorry to learn of your wife's situation, this must be a difficult time for you all.

    Often scans are done after a few cycles of treatment to see how well a person is responding. This helps the doctors decide whether to continue with the current treatment or if not try a different treatment depending on the situation. The scans may include CT scan and MRI scan, both scans will give the doctors different views, which helps them to plan treatment.

    It sounds like your wife had a good response to treatment, therefore she will continue to have a further 3 cycles of the same treatment.

    Without being involved in her care it is difficult to say what will happen once treatment has finished. It is hoped that if your wife has had a good response with the first few chemotherapy cycles then she will continue to respond, however, each person's response is individual and in some situations this may not be the case. I can appreciate this uncertainty is difficult.

    Your wife's team at the hospital are best to discuss this with as they know her situation, they will also be able to clarify why an MRI is needed as well as a CT scan.

    I hope this helps a little. Please feel free to get back to us if you need any more information or support.  You may find it helpful to talk things through with one of the nurses on our helpline.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    Take care,

    Jemma

  • Offline in reply to CRUK Nurse Jemma

    Thank you, Jemma.  I am trying to understand a number of situations better before speaking further with the team - although speaking with Team (MDT) isnt really an option. At very best a conversation with a consultant.  

    After 3 cycles the CT scan shows my wife has responded very well to the chemo  treatment and the tumour has shrunk 'significantly'. My question is does cycle 4 and cycle 5 and cycle 6 have equal impact or does the power of the chemo reduce?  Is it usual the the last three cycles see less impact, less shrinkage? 

    Clearly what we want is tumour shrunk to the point of being able to have surgery / hysterectomy. Is there a specific size required for a hysterectomy? 

    Also interested very much in immunotherapy - but I understand NICE / NHS only allow this very effective therapy for patients with dMMR rather than pMMR, because the former responds better....although some evidence that pMMR also responds positively but not as positively. Perhaps it is about cost effectiveness.

  • in reply to PJL

    Hello and thanks for your further post,

    Your question about the further cycles. The specialist will be hoping for continued activity (shrinkage) over the next few cycles. However this is not possible to predict with any certainty, as every patient will respond to treatment a bit differently. 

    I'm afraid we can't answer your question about the size of tumour and a possible hysterectomy. That is something that an oncologist or a gynaecological surgeon are better placed to provide a comment on. You would have to talk through immunotherapy treatment options with the specialist, as there will be protocols and rationale guidelines for use of these. They may be able to expand it a bit on this in relation to your wife's situation. 

    I hope this helps,

    Please get back to us if you need any more information or support.  You may find it helpful to talk things through with one of the nurses on our helpline.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    Yours sincerely,

    Vanda

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