Q: My 62 years old mother underwent primary cyto-reduction for ovarian cancer eight months back and completed 6 chemotherapy cycles consisting carboplatin and paclitaxel. The doctor discontinued paclitaxel after 4 chemotherapy sessions because my mother suffered from peripheral neuropathy and the doctor felt that paclitaxel will worsen the problem. Her CBC done after last chemotherapy session showed presence of immature granulocytes and blast cells. Her platelet count is also showing decreasing trend as compared to last CBC. Can peripheral neuropathy lead to stroke? Does the presence of immature and blast cells along with lowering platelet and haemoglobin count indicates the possibility of leukaemia? My mother is also showing symptoms like joint pain, headache, night sweat etc. Does the high grade serous adenocarcinoma of ovary recur? Why is she suffering from back pain and giddiness? What is palliative care?

A:The treatment and prognosis of ovarian cancer depends upon the stage and type of ovarian cancer. It is reasonable to discontinue the paclitaxel due to severe neuropathy.
Can peripheral neuropathy lead to stroke? Peripheral neuropathy will not lead to stroke. It predominantly affects the peripheral nerves of hand and foot. It will usually get better (it is reversible) in about 4-6 months.
Does the presence of immature and blast cells along with lowering platelet and hemoglobin count indicates the possibility of leukemia? Your concern is very valid. If she has persistent blast cells in the blood, that has to be investigated further with further studies (which may include a peripheral smear examination and a bone marrow biopsy). Hope she is not on G-CSF or any other growth factors. Sometimes, the growth factors can falsely elevate the number of immature cells in the peripheral blood (not very common). If she has persistent low blood counts with blasts and systemic symptoms (as you mentioned), please see your oncologist as soon as possible for further evaluation as soon as possible. I understand that she continued to receive carboplatin. Carbo is a very effective agent for ovarian cancer.

Does the high grade serous adenocarcinoma of ovary recur? As I mentioned above, the prognosis of ovarian cancer depends upon its stage. If your mother had an advanced stage, it can spread to other parts of the body and recur. But it will not manifest itself in the blood by itself as blasts.

Why she has back pain and giddiness? Giddiness could be secondary to anemia or generalized weakness. I am not sure about the back pain. Back pain could be due to any number of reasons, including the ovarian cancer or surgery etc. Please talk to your doctor (he or she has to examine your mother to come up with a diagnosis).

What is palliative care? Palliative care means, management of symptoms. Shift the focus of care from curative to symptom management and supportive care.