12-4-2008 Pam's cancer treatment has hit a bump in the road. She expected a chemo treatment, but her doctor noticed the excessive bloating of her abdomen and immediately concluded that the topotecan drug was not working. Then bloating really became apparent over the past two weeks and caused Pam extreme discomfort. Fluid accumulated in her abdomen because cancer cells prevented efficient distribution.This condition convinced the doctor that the cancer may not actually be ovarian and may be classified as a cancer of unknown origin. If the topotecan were working as predicted, the cancer cells would most likely be destroyed since that drug is targeted to ovarian cancer. This situation will need further evaluation because the last cancer marker test obtained after 4 of the planned 8 treatments indicated a reduction in cancer cells.

Pam will undergo a CT scan on 12/5 and meet with her doctor again next week. The current plan involves using a drug that has been effective against general abdominal cancer and has been effective for lung and pancreas cancer. The bottom line is that the ovary may not be the primary source of cancer and that is the next step-isolate the source of the cancer cells.

Radiation is currently ruled out because it would encompass the entire abdominal area. Referrals to other cancer centers at this time would most likely not be accepted because the primary cancer source has not been located and no clinical trials are known to be available.

Pam will work on eliminating the fluid with diuretics and that will certainly make her feel more comfortable.

We thank you for your prayers and best wishes as we continue to control this disease.