We've been blessed to have another baby. Thank you Allah swt, for the gift from heaven..

More story at www.NeezaNeedleS.com

I've recoved.. Alhamdulillah. Hopefully ia tidak kembali semula..

I would like to thanks all my followers, people who read this blog and to those who pray for my wellness. Terima kasih yang tak terhingga.

I'm closing this blog officially (i hope not to open it back).. so, dear gentle reader, please tune to LUVTALE for other story of me.. :-)

Till now, byebye then...

Chemo cycle six : Start 8th April 2009, schedule to be end on 17th April 2009.

The whole thing mengujakan. Can't hardly wait. :-)

Start 23 March.. most probably will be end on 1 April 2009.

Alhamdullillah..
Beta HCG level - wk 16: less than 2 (normal)

This thing really work.. yeay!

I'm done with chemo chapter 4.

My beta HCG update:
Levels were at start: 779 539 (21 Nov 2008)
wk 1: 573108
wk 2: 5401
wk 3: 2793
wk 4: 7697
wk 5: 14 428
wk 6: 13470 ---- Start with Mtx
wk 7: 15322 … cycle 1
wk 8: 291 … cycle 1
wk 9: 231 … cycle 2
wk 10: 90 … cycle 2
wk 11: 246 … cycle 3
wk 12: 351 … cycle 3
wk 13: 4 … cycle 4
wk 14: less than 2 … cycle 4
wk 15: less than 2… cycle 4


Alhamdullillah, my beta-HCG has drop to normal level - that is below 2 for non-pregnant lady.

But, yang tak best nye, even beta-HCG dah drop to normal, I still have to complete my chemo course that would up til 6 cycle. I just finished 4, another 2 to go : bile dah baik ni (sort of dah baik la), macam malas je nak buat chemo.. argh... 2 cycle = 20 days = 10 days to be pricked.
Sigh.. sigh...

.. since I last updating this blog.
Bukan tak de cerita, banyak sangat cerita but each time I log on to this site – I’ll be feeling very sad. Rasa nak marah jer. So, I opt not to look at this blog and concentrate with the other blog (yang banyak cerita-cerita happy).. heheheh..

First, I’m still on my chemo treatment – now dah masuk cycle 4.
Banyak cerita berlaku on cycle 3 – which sometimes make me feel to giving-up with this chemo course.

Lets start with the beta HCG results:
Levels were at start: 779 539 (21 Nov 2008)
wk 1: 573108
wk 2: 5401
wk 3: 2793
wk 4: 7697
wk 5: 14 428
wk 6: 13470 ---- Start with Mtx
wk 7: 15322 … cycle 1
wk 8: 291 … cycle 1
wk 9: 231 … cycle 2
wk 10: 90 … cycle 2
wk 11: 246 ---- Increased … cycle 3
wk 12: 351 ---- Increased … cycle 3

As u can see, my level increased during my third chemo cycle. Dr assumed that my body might develop resistance to MTX+FA drug regime. And they suggested to change my chemo regiment to higher dose : MTX + ActinoD + FA for the next chemo course.

My responds – of course, I was mad and a bit confused. To clear my thought, I started to dig lot of journals regarding the chemotherapy regiment for GTD and the GTD itself. Found out that 5% of patients that undergo the MTX-FA will start to develop resistant towards the drugs. Argh… (again I considered myself as lucky-one to be in the statistical data)

As for the MTX+Actino-D+FA chemo regime, what will I face is that I’m going do chemo for the straight 10 days:
Day 1,3,5,7,9 – MTX
Day 2,4,6,8,10 – Actino-D + FA
Meaning I’ll have to go to the hospital everyday (fuel and time consuming) and I’ll be pricked everyday as well (sakit duhhh…).

So, since I’ve been reading lot of journals, I noticed that there is other method for those who develop resistant to MTX+FA that been practiced in the Europe country and even in Singapore.
The regime is EMA: Etoposide+MTX+Actino-D for only 2 consecutive days:
Day 1: Actino-D + Etoposide + MTX (for 12 hr)
Day 2: Actino-D + Etoposide + FA
The different is EMA is really high dose of drugs (12 hr of MTX), which I might losing my hair fast enuff.

After talking to the Dr, giving A-Z reasons, I opt for EMA – I don’t want to be pricked everyday, I don’t fell like going to the hospital everyday, and I don’t care being bald (I’m wearing tudung, who will notice it anyway).

Before starting the 4 cycle (EMA-regiment), they took my blood for reading the beta-HCG level. To my surprise (the Dr as well) my result shows 4 - Not 400, not 40 but 4. And the parameter for normal people should be below 2. Alhamdullillah, I can help but to cry. Alhamdullillah, terima kasih Allah swt.

So, here I’m, still on my 4th-cycle of chemo treatment but with the same regiment: MTX+FA.

Dr said that if by end of the cycle, if my beta-HCG show less that 2, I might only need another one cycle to complete my chemo course, and then they’ll just monitor my Beta-HCG weekly or monthly.

I can’t say more: I’m not in charge of anything. Allah swt yang berkuasa.
But I’ll pray for the best. Amin…

Dear gentle reader,

I’m sorry for being grumpier on the last two entries. It was not me who wrote it – it’s the ‘tumor’.. heheheh.. And I was like sorry to myself – more on shame actually – for writing such craps.

I know, somewhere, somehow, out there, there would be a cmp/pmp patient reading my blog and she’ll be like – What happen to her? Does the chemo hurt so bad she suddenly change to a cranky mama?

Yes, the chemo and the whole process do hurt – physically and mentally. I’ve been crying for the last two weeks – merintih dan meratap – in the toilet, while talking to DH, while talking to friends on phone, with the nurse in PPUM, and to God especially.

However, I am feeling a lot better now. Health wise, I definitely have more energy. Emotionally, I think I'm doing better, too. I finally have been feeling less angry and more sad – even admitting that I experienced a loss (the loss of hope for a baby). That was something I never thought would happen. I’ve admit that I am hurt, maybe the hurt can have a chance to heal.

This whole thing has taught me that I am definitely not in control. Setting plans is not always the wisest and making finite decisions is a bit ridiculous. Let God sort this mess out for me. If God wants another little one running around our house, who am I to stop Him? I'm ignoring my "plans" list. I don't plan on doing anything. I can't plan anything until the year ends. I am going to change it to a wish list instead:

I hope my numbers hit 0... and fast.
I hope that somehow, this will end up okay.
I don't want anymore sadness.
I don't want to have another tumor.
I want another baby.

I've been putting off asking about my numbers because I didn't want to know. My HCG levels are something that can tell me if I am on the road to recovery or heading into another dark time, and I was not feeling up for more disappointment.
I thought I might as well face the numbers.
So here we go.

Levels were at start: 779 539 (21 Nov 2008)
wk 1: 573108
wk 2: 5401
wk 3: 2793
wk 4: 7697
wk 5: 14 428
wk 6: 13470 ---- start with Mtx
wk 7: 15322
wk 8: 291
wk 9: 231
I just got a test today, but won't get the results until later.

Wow, 9 weeks already past.
It’s like walking in a very long dark tunnel – searching for the end of light.
Will there be any?
Insya Allah.

Aku lari ke hutan, kemudian menyanyiku
Aku lari ke pantai, kemudian teriakku
Sepi... Sepi dan sendiri aku benci.
Aku ingin bingar. Aku mau di pasar.

Bosan aku dengan penat,
dan enyah saja kau, pekat!

Seperti berjelaga jika aku sendiri
Pecahkan saja gelasnya biar ramai
Biar mengaduh sampai gaduh

Ahh.. ada malaikat menyulam jaring laba-laba belang
di tembok keraton putih
Kenapa tak goyangkan saja loncengnya?
Biar terderah,
atau... aku harus lari ke hutan belok ke pantai?

Bosan aku dengan penat,
dan enyah saja kau, pekat.. seperti berjelaga jika ku sendiri..

----

Hari ini adalah hari terakhir sesi kedua chemo..
Aku penat.. aku ingin semua ini over.. aku menjadi tidak sabar..
Aduhhh, Tuhan... besar- sangat besar dugaan ini...

Third session will be start in a week..
Aku bosan + mual + jelak + benci + jemu..
Tapi aku ingin sembuh..

*bertahan.. bertahan.. dan kekal bertahan*
-boleh kah.............????

Allah swt, aku perlukan kekuatan itu.. amin....

Exhausted. Angry. Mad.
As written previously, I’m on my second cycle of my chemo treatment. Everything’s ok – just like the first chemo – what I felt and what I’m going tru.

However, yesterday was the worst day of my chemo process. 5 times being needle – just because the Dr cannot (or can be said as not good enuff) to find my vein. Sakit, memang sakit – He pricked me 4 times which later on I requested for a different Dr.

While waiting for other Dr, i cried - like a baby. Saat tu rasa nak lari je balik rumah and never turn up to that hospital again. I really felt like berputus asa. ;(

And Alhamdullillah, a female Muslim Dr came. Not being religious racist but I preferred Muslim as he/she will recite ‘Dengan nama Allah yang Maha Pemurah lagi Maha Mengasihani’ before perforate tru my vein.

Moan. Moan. Moan. I can't imagine going through this 2, 3, 4 or 5 more times. I can't think about that right now.
Sad, sad post. Will feel better tomorrow I'm sure.

---

Oh! I'm almost forgot to write. My levels have dropped! 297.
Alhamdullilah. That’s 15025 down.
Great news! Despite of all, I'm so grateful that this is working.

Will be starting tomorrow onwards..
And will be end by 20th January (insya Allah)..

Esok jugak another beta-hcg monitoring..
Hopefully levelnya turun.

1st chemo session: started on 26th December, ended on 3rd January

What did I feel:
During chemo: Nothing, just feeling cool because the drug is cool.
After chemo: Dry mouth, dry eyes, hungry but yet bloated, constipated with hard stool.

And I gained weight – 2kg. aiseh..

On the first day of my chemo treatment, I had an immense period pain and I bleed lump of bloods (both red and brown). Then on the last day of chemo, I also encounter the same condition, immense period pain with black blood bled.

Bleeding made me worried because it indicated two possible condition:
1. it signaled that you would have a big drop in beta-hcg hormone levels because the mole tissue was dying (good sign), or
2. the mole tissue was continuing to grow and proliferate (bad sign).

My second treatment will start on 12 January. So, for the time being, just lepak-lepak kat umah..

kerana esok adalah:

- hari terakhir bagi sesi chemo yang pertama - then rehat seminggu - proceed second session

- lepas chemo, plan nak balik Ipoh - and meeting Zahra

Yeehaaa... *suka sambil melompat-lompat*

This is my graph.
Still on going chemo (part One) - level still high. dugh..

My last day for chemo (part One) will be tomorrow - 3 Jan 2008.

If the graft shows constant level / no drop meaning another round heading on the way.

Looking forward actually.
Chai yok.. Chai yok..

I went to the office this morning - to settle the LNPT, MC, and to claim the Ellaroo..

Everybody in the office was so concern on what had happen to me. They wondered why I have to face all the hassle and gone for the chemo treatment. I just replied – it’s the medical procedures.

When I was diagnosed with this illness, I was so sad – to lose the baby and to know its an abnormal pregnancy, however there’s people came and approached me that by having molar pregnancy is not the end of your fertility. Some shares stories about their relative – having molar and continue to get pregnant 6 months later, and also this lady said to me she used to have molar pregnancy and continue to have normal baby 8 months later. Then, when I asked them about the blood monitoring and beta-HCG, they seems to be unaware.

So, what if I just run from my chemo treatment?
Not turning up for my blood routine check-up?
Ignore all the medical reports and just get pregnant?
What will happen then?

I found this answer:
Molar pregnancies and their management is the easy part. The problem is when they are ignored, not followed adequately, or inadequately treated, because then major problems occur. If a previous pregnancy ended in a miscarriage and there was no pathologic specimen it may have been an unknown molar pregnancy. If the last pregnancy was a normal term pregnancy and delivery, then nobody would be expecting choriocarcinoma to develop. But it can and it is usually not diagnosed promptly. It can be anywhere in the body and is a very aggressive cancer. It metastasizes widely and early. It is very invasive and destroys the tissue. It bleeds profusely. If it is in the brain then signs of a stroke or seizure may occur; if in the lung then the patient may cough up blood; if in the uterus then irregular bleeding.

Hidup dan Mati itu di tangan Tuhan. Tapi dalam keadaan ini, kita diberi pilihan – memilih untuk hidup atau sebaliknya..

Since my chemo course is like a day on and a day off, I was given a choice whether to keep the IV for next chemo or set up a new IV for each chemo session. I chose to keep it – sebab each time nak pasang adalah sakit sangat kena cucuk and now I have like more than 5 tusukan IV di tangan – 1 during giving birth to Zahra, 1 during my first DnC, 2 during my second DnC (nurse tak jumpa vein so kena cucuk 2 kali), 1 during my first chemo session, and now another one for the third chemo session = Total 6 IV shots (arghhh…)

Tu tak kira ngan tangan lebam-lebam sebab kena amik darah for beta-HCG monitoring. Even though, I’m not phobia having needles here and there in my body, but somehow, kalo dah banyak kali macam ni jadi boring jugak – mual.. bila la nak sudah ni..

But satu je cons nyer: Nak amik wuduq tu jenuh la skit.. But apapun, Solat Itu Wajib :-)

Sapaan seorang teman – Wah, bersemangat sungguh.. Siap buat blog lagi..

Hehehehe..

The idea of making a blog specifically for my excursion with molar pregnancy came out when I was browsing any information related to molar and chemo in the net. I came across molar pregnancy support group – www.molarpregnancy.co.uk. But I was actually hoping to get real life experiences from people suffered with this illness - however I managed to find none from local but one from Canada; and I was so inspired by her – http://chantelle-blog.blogspot.com.

Her writing has lead me to all information regarding molar pregnancy and the chemo processes – how was the chemo procedure, the side effects, bleeding matter, beta-HCG patterns and such and I hope by writing my own experience I can help those mother out there who undergo the same condition as me.

And I also wish that my story will be end like hers. Aminn…

Sejujurnya, aku menulis bukan untuk menunjuk-nunjuk apatah lagi menagih simpati. :-)

Today was my 3rd day chemo session. I arrived at PPUM at 8.30am, and reaching Ward 10U, mostly everybody (who know me – the Dr, Nurses, other patients, cleaner) greeted me. The ward community was so warm.

----

Staying in the hospital for few days give me a new perspective. I used to work in a hospital but working and staying as a patient is vast different.

I met a few patients which their cases are much more serious than me – one having an ovarian cancer as young as 14 years old, my roommate having cervical cancer few years back and now its seems to coming back, and this one untie who’s been staying in there for three months due to vaginal cancer.

Drs and nurses are also quite helpful. This one Dr, a HO to be exact, pity her sebab asik kena marah je ngan senior Dr. And this very young nurse, baru je masuk keja was so paranoid, wearing double of gloves and mask and what so ever protection she can wear to protect herself from the chemical used for chemo – muda lagi saya ni kak, tak kawin lagi.. hehheheh.. And a Medical student who came to interview me told me that she regretted chosing the path – long working hour and high commitment.. heheheh – macam-macam kan..

Apa pun, having to stay in Ward 10U PPUM for 3 days was an experienced for a life times. Thanks all for being very helpful and generous.

Kalo kita rasa kita ni sakit, ada orang lagi sakit dari kita – Muhasabah diri part III.

KEHAMILAN MOLAR

PENDAHULUAN

Kanser anggur ataupun di dalam istilah perubatan dinamakan Koriokarsinoma (”Choriocarcinoma”) adalah sejenis kanser yang jarang berlaku tetapi ianya boleh dirawat dengan rawatan kemoterapi. Kanser anggur adalah salah satu spektrum di dalam penyakit yang dikategorikan sebagai ”Gestational Trophoblastic Diseases (GTD)”. ”Gestational” adalah istilah perubatan yang bermaksud kehamilan manakala ”Trophoblast” adalah merujuk kepada uri ataupun plasenta. Dengan perkataan lain, penyakit GTD ini adalah penyakit yang mempunyai kaitan yang rapat dengan ketumbuhan yang terhasil dari proses kehamilan yang tidak normal melibatkan uri ataupun plasenta.


GTD boleh dibahagikan kepada beberapa jenis dan 4 kategori yang utama adalah :

1. Kehamilan Molar/Anggur

2. Invasif mol (”invasive mole”)

3. ”Placenta site throphoblastic tumour”

4. Koriokarsinoma (Choriocarcinoma)



Jenis pertama iaitu kehamilan Molar/Anggur adalah yang paling kerap berlaku tetapi ianya bukan kanser dan hampir semua pesakit akan dapat dipulihkan sepenuhnya dengan rawatan. Manakala jenis 2 hingga ke 4 merupakan kanser yang memerlukan rawatan seperti mana rawatan-rawatan kanser yang lain.


KEHAMILAN MOLAR/ANGGUR


Perkataan anggur digunakan kerana rupa bentuk ketumbuhan yang dihasilkan oleh persenyawaan yang tidak normal ini menyerupai buah anggur.

Istilah yang lebih tepat untuk jenis kehamilan ini adalah kehamilan molar (”molar pregnancy”) jadi untuk keterangan selanjutnya istilah kehamilan molar akan digunakan sebagai ganti kehamilan anggur.

Kehamilan molar tidak dikategorikan sebagai kanser dan punca kejadian kehamilan molar ini adalah disebabkan oleh kelainan yang berlaku semasa proses persenyawaan di antara sperma (benih lelaki) dan ovum (benih wanita). Akibat dari persenyawaan yang tidak normal ini maka terbentuklah kehamilan molar.


Kita tahu bahawa persenyawaan benih lelaki dan wanita akan menghasilkan embrio dan embrio ini akan dibawa melalui tiub falopian dan bergerak ke arah dinding rahim. Seterusnya embrio akan melekat pada selaput dinding rahim dan akan membesar menjadi bayi atau janin di dalam kandungan. Walau bagaimanapun di dalam kes kehamilan molar, tidak terjadi janin tetapi digantikan oleh ketumbuhan yang berbentuk seperti gugusan anggur ataupun kelihatan seperti buih ataupun sista-sista kecil.

------


KANSER ANGGUR ATAU KORIOKARSINOMA (”CHORIOCARCINOMA”)

Istilah koriokarsinoma adalah istilah yang lebih tepat digunakan untuk kanser jenis ini, ”korio” adalah istilah yang diambil dari vili korionik (”chorionic villi”) iaitu salah satu komponen uri manusia. Istilah karsinoma pula merujuk kepada kanser yang berasal dal sel-sel epitelial. Disebabkan kanser ini mempunyai atau berasal dari salah satu komponen uri atau plasenta maka salah satu ciri khusus kanser ini adalah ia boleh menghasilkan hormon HCG (”Human Chorionic Gonadotrophin”) yang sangat tinggi malah lebih tinggi daripada wanita-wanita yang hamil. Penyakit koriokarsinoma boleh berlaku kepada sesiapa yang pernah hamil termasuk kepada wanita-wanita yang pernah mengalami kehamilan molar. Tidak seperti kehamilan molar, koriokarsinoma boleh berlaku di mana-mana organ badan seperti hati, limpa, paru-paru, tulang belakang dan otak. Koriokarsinoma boleh juga terjadi di dinding rahim. Koriokarsinoma adalah sejenis kanser yang agresif tetapi sangat sensitif kepada ubat kemoterapi menjadikannya salah satu kanser yang boleh sembuh sepenuhnya. Koriokarsinoma boleh merupakan salah satu komplikasi jangkapanjang kehamilan molar. Walau bagaimanapun kemungkinan berlakunya komplikasi ini adalah sangat kecil di mana cuma 2-3 peratus sahaja kes koriokarsinoma berlaku selepas kehamilan molar.


Koriokarsinoma boleh berlaku bila-bila masa dari beberapa bulan sehingga beberapa tahun selepas sebarang kehamilan samada kehamilan normal, keguguran ataupun kehamilan luar rahim. Koriokarsinoma yang berlaku beberapa tahun selepas kehamilan normal dikatakan jenis yang paling agresif.


TANDA-TANDA DAN GEJALA-GEJALA KORIOKARSINOMA


Memandangkan koriokarsinoma boleh berlaku di mana-mana sahaja organ badan maka pesakit yang menghidap kanser jenis ini boleh mengalami berbagai-bagai tanda dan gejala.

Berikut adalah di antara gejala-gejala dan tanda-tanda yang mungkin dialami oleh pesakit koriokarsinoma:

a. Batuk berdarah dan sesak nafas

b. Sakit kepala dan lumpuh sebelah badan

c. Sakit tulang belakang

d. Ketumbuhan dan perdarahan di bahagian faraj.

e. Bengkak perut dan kuning mata

f. Hilang selera makan dan turun berat badan


Faktor yang paling penting yang memastikan pesakit ini menghidap koriokarsinoma adalah kandungan hormon HCG (”Human Chorionic Gonadotrophin”) di dalam badan mereka. Jadi ujian darah bagi mengukur hormon HCG ini adalah satu kemestian jika sekiranya doktor mengesyaki koriokarsinoma.

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RAWATAN KEMOTERAPI


MEMAHAMI KEMOTERAPI


Salah satu kaedah rawatan kanser yang sering diberikan kepada pengidap kanser adalah ubat kemoterapi. Kemoterapi tidak dapat tidak akan mengubah kehidupan anda. Disamping mengalami perubahan dari segi penampilan fizikal dan emosi, anda mungkin juga akan merasa sukar untuk bercakap mengenai apa yang anda rasa kepada orang lain. Dengan memahami bagaimana kemoterapi bertindak ke atas sel-sel yang normal dan tidak normal dalam diri anda, diharap anda akan lebih tabah dalam menghadapi sebarang kesan sampingan yang dialami sepanjang dalam rawatan ini. Apa yang penting adalah anda perlu sentiasa berfikiran positif di dalam menjalani rawatan kemoterapi ini.


APAKAH ITU KEMOTERAPI


Kemoterapi ialah rawatan yang menggunakan ubat-ubatan yang khusus untuk merawat sesuatu penyakit kanser. Di sini, kemoterapi merujuk kepada penggunaan ubat-ubatan khusus untuk melawan dan memusnahkan sel-sel kanser yang sedang merebak dengan cepat dalam badan anda. Ubat ini akan memasuki sistem pengaliran darah anda dan pergi ke seluruh badan untuk membunuh sel-sel kanser yang tidak dapat di buang melalui pembedahan atau di musnahkan oleh rawatan radioterapi. Bila lebih dari satu jenis ubat digunakan, ia dipanggil kemoterapi kombinasi.


BAGAIMANA KEMOTERAPI BERTINDAK


Terdapat banyak jenis ubat kemoterapi yang digunakan untuk merawat kanser. Ubat kemoterapi sebenarnya banyak yang dihasilkan dari tumbuh-tumbuhan seperti contohnya ubat Paclitaxel yang digunakan untuk merawat banyak jenis kanser. Ubat kemoterapi ini dihasilkan dari kulit pokok yew. Terdapat beberapa kategori ubat kemoterapi yang mempunyai perbezaan dari segi bagaimana ubat-ubat ini mematikan sel-sel kanser. Secara amnya semua ubat-ubat kemoterapi mematikan sel-sel kanser dengan cara bertindak mengganggu atau merencat proses pembiakan sel-sel kanser. Ini dilakukan dengan cara merosakkan DNA ataupun baka sel-sel kanser melalui berbagai-bagai kaedah seperti mengikat (“cross-linking”) ataupun memotong DNA tersebut. Akibat kerosakan DNA ini maka sel-sel kanser ini akan mati. Ubat kemoterapi lebih berkesan terhadap sel-sel kanser yang cepat membiak. Kadangkala ubat ini tidak dapat membezakan di antara sel-sel kanser dan sel-sel normal yang juga cepat membiak seperti sel-sel dinding usus, mulut, organ reproduktif terutamanya ovari, sel-sel rambut dan juga sel-sel sum-sum tulang. Sel-sel ini mungkin terdedah kepada kesan ubat kemoterapi walau bagaimanapun dengan kaedah rawatan yang terancang dan teliti oleh Pakar Kanser, kesan-kesan ini dapat diminimakan malah jika sekiranya berlaku ianya adalah lebih bersifat sementara.


APAKAH FUNGSI RAWATAN KEMOTERAPI

Rawatan kemoterapi mempunyai beberapa tujuan, diantara tujuan rawatan kemoterapi adalah seperti berikut :

A. RAWATAN UTAMA. Sebagai kaedah rawatan utama kanser. Contoh rawatan kemoterapi sebagai rawatan utama adalah di dalam kes kanser anggur ataupun koriokarsinoma.

B. KEMOTERAPI ADJUVAN. Untuk mengurangkan kadar kejadian semula kanser kepada pesakit-pesakit yang telah menjalani rawatan utama contohnya rawatan pembedahan. Rawatan kemoterapi ini dikenali sebagai rawatan adjuvan ( “Adjuvant chemotherapy”). Contoh rawatan ini adalah rawatan kemoterapi ke atas pesakit kanser ovari yang telah menjalani rawatan pembedahan.

C. KEMOTERAPI NEOADJUVAN. Sebagai rawatan permulaan sebelum pesakit menerima rawatan utama. Tujuan rawatan neoadjuvan kemoterapi ini adalah untuk mengecilkan saiz kanser dan dengan itu rawatan pembedahan yang akan dijalankan akan menjadi lebih mudah. Contoh rawatan neoadjuvan ini adalah rawatan ke atas sebahagian kes kanser pangkal rahim dan kanser ovari.

D. KEMOTERAPI PALIATIF. Peranan terakhir rawatan kemoterapi adalah sebagai kaedah rawatan untuk mengurangkan penderitaan pesakit kanser yang sudah tidak dapat disembuhkan lagi. Ini dinamakan Kemoterapi Paliatif ( “Palliative Chemotherapy”). Contoh rawatan ini adalah kepada pesakit kanser pangkal rahim ataupun kanser-kanser lain yang merebak biji kelenjar Para-aortik dan menyebabkan penyumbatan saluran buah pinggang dan menyebabkan salur buah pinggang dan buah pinggang menjadi bengkak (“hydroureter, hydronephrosis”). Pesakit akan menghadapi masalah sakit pinggang dan jangkitan buah pinggang. Biji kelenjar yang besar ini juga boleh menekan urat saraf dari tulang belakang dan menyebabkan kesakitan bahagian belakang. Tujuan rawatan adalah untuk mengurangkan kesakitan dan mengurangkan kesan penyempitan. Rawatan kemoterapi paliatif ini tidak bertujuan untuk menyembuhkan penyakit kanser pesakit tetapi untuk mengurangkan penderitaan akibat kesakitan.

Soalan yang ramai sangat bertanya..
So di sini ku amik je dari net - info related with Molar Pregnancy.
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What is a molar pregnancy?

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Trophoblastic disease is an uncommon complication of pregnancy. To understand it we must first look at a normal pregnancy. This consists of two 'parts' developing in the womb.

The foetus or developing baby, the placenta (or after-birth), which has many functions including the feeding of the baby and the removal of its waste products. The placenta is made of millions of cells called trophoblasts.

These two parts normally develop together, in parallel, the end result being a healthy baby and a placenta which is no longer needed, so the latter is expelled just after the baby is born (afterbirth).

In trophoblastic disease there is an abnormal overgrowth of all or part of the placenta, causing what is called a molar pregnancy or hydatidiform mole. The term seems strange but is similar to that used for a harmless growth on the skin, which is also called a mole.

As with skin moles, a hydatidiform mole is often harmless. However, it can keep growing and, if left untreated, can bury itself into the organs around it, including the uterus (womb) and even spread via the blood to other distant organs including the lungs, liver or brain. It is once it has reached this stage that it can have serious effects.

Although a hydatidiform mole is not cancer and rarely even becomes cancerous, it can behave in similar ways. Most of the treatment is aimed at stopping the disease process long before any of these things happen.

Different types/stages of moles:

• Hydatidiform mole
• Partial Mole
• Complete Mole
• Persistent Gestational Trophoblastic Disease
• Choriocarcinoma

HYDATIDIFORM MOLE

The commonest kind of trophoblastic disease, where the overgrowth is benign but may spread to other parts of the body if not treated. This is further subdivided into:

PARTIAL MOLE

Where part of an apparently normal placenta overgrows (proliferates) and part develops normally. There may be a developing foetus present, but this is genetically abnormal and cannot survive outside the womb. This is where two sperm enter the egg and instead of forming twins forms an abnormal foetus.

Partial Mole

COMPLETE MOLE

Where the whole placenta is abnormal and usually grows very rapidly. There is no developing foetus in these pregnancies. This is where one sperm enters the egg but only half of one set of chromosomes are present and do not develop into a foetus.

PERSISTENT GESTATIONAL TROPHOBLASTIC DISEASE

Where part of the mole remains in any part of the body despite initial treatment by the gynaecologist. Even a tiny amount of mole anywhere in the body can grow quickly and cause problems, so active treatment of this condition is very important.

CHORIOCARCINOMA

A very rare but curable form of cancer where the placenta becomes malignant. This can arise from a molar pregnancy or an otherwise normal pregnancy or miscarriage. Choriocarcinoma can also spread throughout the body, usually to organs like the lungs, liver and brain.

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What causes it?

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Molar pregnancy is thought to be caused by a problem with the genetic information of an egg or sperm. Factors that may increase your risk of having a molar pregnancy include:

• Age. Risk for complete molar pregnancy steadily increases after the age of 35
• History of molar pregnancy, particularly if you've had two or more
• Possible ovulatory disorders
• History of miscarriage
• A diet low in carotene (a form of vitamin A). Women with low carotene or vitamin A intake have a higher rate of complete molar pregnancy
• Living in certain geographic locales (especially Southeast Asia and Mexico)

It is however, worthwhile noting, that the number of times a women has been pregnant doesn't influence her risk.

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Treatment Regimens

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Up to 10% of diagnoses require additional treatment other than the D and C and urine testing follow up. This is in the form of chemotherapy.

Each individual’s case is different but the vast majority of patients begin on Methotrexate. This is also used for arthritis and skin conditions. It is administered by intra-muscular injections (buttock) followed by a Folinic Acid (NOT folic acid) tablet exactly 24 hours later. The usual regimen is to have four injections on alternate days with Folinic Acid in between but regimens differ at different treatment centres. You will stay as an in-patient for the first part of the course of treatment as the chemotherapy could cause heavy bleeding and other side effects. You will then continue as an outpatient either at your treatment centre or it may be possible to arrange it at your local hospital to avoid commuting long distances.

As mentioned previously measurements of BhCG are used to monitor treatment response. It is essential with all chemotherapy regimens that BhCG is measured regularly. In general an adequate treatment response is defined by a 50% reduction after each course of chemotherapy.

The level of BhCG may reach normal (different regions aim for different levels between 2-5) or become undetectable when there is still a residual tumour burden of cells. Therefore with all regimens, treatment is continued for at least six weeks.

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