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Unusual Tumors in the Ovary

Posted Aug 24 2008 1:49pm
ANNOUNCER: Friends used to tease Irene Wall, for quick reaction to alcohol at parties.

IRENE WALL: I was having flushing, which of course is one of the signs for carcinoid. I thought it was just when I was anxious, or if I had a drink my face would get red, my arms. I thought that was a normal thing, but obviously it's not.

ANNOUNCER: Carcinoid cancer was the cause, but it wasn't diagnosed until irregular menstrual periods sent Mrs. Wall to a gynecologist, who discovered a large mass.

RICHARD R.P. WARNER, MD: She was first diagnosed in 1994 and was found to have a large pelvic mass, which at surgery was an 8x10 cm carcinoid arising in the left ovary. There was no evidence of spread at that time.

ANNOUNCER: Carcinoid cancers are usually slow-growing tumors that release high levels of serotonin and other chemical messengers into the bloodstream.

When those chemical messengers cause flushing, or other symptoms, like diarrhea, a person is said to have carcinoid syndrome.

Usually, carcinoid syndrome indicates cancer has spread into the liver. Mrs. Wall's case was different, for she had no spread of the disease.

RICHARD R.P. WARNER, MD: The unusual feature is that she didn't have any spread of the tumor, but there's a good reason for that: because the carcinoid rising in the ovary gives hormonal products — serotonin and the other products that it makes — directly into the systemic venous blood flow.

ANNOUNCER: When carcinoid cancer originates in the intestines, which is more common, serotonin and the other chemical messengers tend to be inactivated by the liver. In those cases, the messengers wreak havoc only when the cancer has spread to the liver itself.

For several years after her surgery, Mrs. Wall thought her cancer had been cured. Then flushing returned. And startling news came from a five-year checkup.

IRENE WALL: I always thought that when you go for your fifth-year checkup, if you make it to five years, you've got it made. You know, everything's fine, hunky-dory.

Well, lo and behold, no. I went for a CAT scan, and they found that the cancer had metastasized to my liver.

ANNOUNCER: This time, the cancer was inoperable.

Research on the internet led Mrs. Wall to Dr. Richard Warner. He put Mrs. Wall on a series of nutritional supplements, and a combination of medications.

RICHARD R.P. WARNER, MD: Well, she was started on octreotide, Sandostatin, with complete improvement in her flushing. And improvement in the chemical markers, which is the term we apply to the products of the tumor in the blood and in the urine. In addition, a new CT scan even showed some shrinkage in the size of the tumors.

Now, besides the Sandostatin, she was started on a low-dose schedule of alpha-interferon. There is some evidence that the combination of that and Sandostatin acts synergistically.

ANNOUNCER: Today, Mrs. Wall's carcinoid disease remains under good control.

IRENE WALL: My tumors have actually stopped growing. Dr. Warner thought that they had actually shrunk a little bit in January, and when I saw him this month they've stayed the same size. And that's one of the things that we're hoping for, is that the tumors stay the same.

RICHARD R.P. WARNER, MD: She remains free of symptoms except for trivial little episodes of flushing. Her weight remains constant. She has no pain or other symptoms. She has her normal weight, full energy, and conducts her normal life without any difficulties.

IRENE WALL: I think I'm doing very well. I guess that just puts it in a nutshell. I feel wonderful.

I mean, I had pretty much given up on a lot, on my life.

And now I make plans. I make plans ahead. You know, next year, maybe going on a trip. My life has changed a lot. It really has.

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