I'm writing to seek your advice for my dear Aunt (58 y/o Indian) who in February 2018 has been diagnosed with Ovarian Cancer.
- CA-125 was measured at 54.4 U/ml
- CECT of the Abdomen notes: "Large poorly enhancing and dense soft tissue mass in the left Adnexa and Ileac Fossa with surrounding diffuse fat stranding. Similar density multiple omental soft tissue nodules seen in the abdomen in the right sub-hepatic space. Diffuse omental caking, edema in the abdomen. Moderate Ascites. Multiple enlarged Retroperitoneal (RP) nodes. No pleural effusion. Findings suggestive of primary malignant left Ovarian neoplasm with diffuse omentoperitoneal spread of disease, metastatic omental deposits and metastatic abdominal nodes with malignant ascites.
- Cytology report notes: "Cytosmears are haemorrhagic and clumped reveal many scattered pleomorphic cells with high N:C ratio and hyperchromatic nuclei. Cell in cell phenomena seen. Occasional bizzare tumor giant cells".
- PET CECT scan report notes: "Metabolically active left adnexal soft tissue mass legion with omental thickening & deposits, left paraaortic and anterior diaphragmatic lymph nodes, mesentic deposits and ascites. Metabolically active few predominantly marrow lesions in pelvic bones - most likely due to benign etiology. Right lung sub-cm sized sub pleural nodule without significant metabolic activity."
Her current treatment plan: As advised by a oncologist, she will soon be taking her 3rd dosage of chemo/Carboplatin chemo (Feb 10, March 2, March 23 is the calendar). Doctors recommend a subsequent scan and surgical removal, followed by more rounds of chemo as necessary.
I would be grateful if this community could please help answer any of our following Qs:
Q1. if any of you were in a similar state we'd love to hear your treatment story from you! And any best practices you'd recommend.
Q2. Simply based on the above test results, what stage and type of Ovarian Cancer does this appear to be? Just looking for an empirical opinion.
Q3. Treatment in the United States - Assuming she is not covered by insurance (all "out of pocket"), what total $ costs should one estimate for surgery and follow-up chemo etc.? Just looking for a rough range.
Q4. Treatment in the United States - most gyn oncologists here in New York are unwilling to talk to me unless my aunt is in attendance as well. This is unhelpful as my aunt lives in India and is not in a state to travel just for a consultation with them. Any workarounds or alternate resources you'd suggest? Looking more for a free/inexpensive clinical second opinion.
Q5. Treatment in India - who are the top 3 doctors in India you'd recommend under whose care we should have the surgery done?
Q6. If you've considered or received treatment in India: For this cancer at the stage my aunt is at, would surgery in the US be advisable over surgery in India?
THANK YOU for your time, support and valued opinions!
Palash
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