Case Conference April, 4th 2012

05-Apr-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

APRIL 4^TH 2012

1 OUTPATIENT

 

Mrs. L, 57 yo

Residive Ovarian Carcinoma Stage IIIc Post suboptimal debulking + Chemotherapy CP 6 series

3434281

 

 

HISTORY

 

October  4^th, 2010

 

•         Referred by RSUD Gunung Jati for chemotherapy with Endometrioid ovarian ca IIIC (Performed HTSOB + Omentectomy partial  18/9/2010 in RSUD Gunung Jati, Cirebon)

•         PA-RSUD Gn. Jati (20/09/10):

1. Endometriosis interna

2.Endometrioid ovarian carcinoma desktra

3.Metastasis endometrioid carcinoma on peritoneum

•         à Ovarian cancer  st. IIIC  post sub optimal debulking ?

•         Ca -125 : 163.8 (Pre Op)

•         Ca-125: 101.8 (post op)

 

 

Previous history: DM(-), HT (-), cor/pulmo disease (-),history of tumor/cancer(-)

Previous history in family: Appendictomy in 1989

 

 

Menstruation history:

Regular menstruation, 28-30 day, long of menstruation 6 day,  dismenorrhea (-), change pad 2-3x

Marital history:

She was married when she was 24^th years old. First marriage for both patient.

 

 

Obstetrical history : P2:

                1. 30 yo, spontaneuos

                2. 26 yo, spontaneuos

              

Family Planning history : IUD

Social history:  Patients : PNS
                          Husband : retireman

 

PHYSICAL EXAMINATION on admission

 

General status, Compos mentis

Height : 147 cm        Bw: 55 kg

BP 120/80 mmHg Pulse 84x/min RR 18x/min T 36⁰ C

Conjunctiva    : not anemic

Heart/lung     : wnl

Abdomen       : scar (+)

Extremities     : edema -/-

Lymph node     :no enlargement in supraclavicular, inguinal lymph node

 

Gynecological status

•      Inspection            : wnl

•      Inspeculo : smooth vaginal stump, vaginal wall smooth, fluor (-)

•      Gyn RVT   : intact vaginal wall, uterus not palpable, adnexal mass not palpable

 

Oncology USG : (October, 4^th 2010)

Minimal ascites at right pelvic

No metastasis at liver , lien & renal

Enlargement lymph node left iliac

 

Post op ca 125 : 101.8 (post op)

 

Slide review (October, 6^th 2010)

Corresponds to previous PA : Adenoca type: endometrioid ovary, moderate diffrentiated.

Metastasis adenoca type endometrioid at omentum

 

Discussion with Consultant :

è Performed Chemotherapy with : Carboplatin 600 mg + Paxus 270 mg, 6 series

 

Adjuvant Chemotherapy:

1.CP 1 :15/10/2010

2.CP 2:18/11/2010

3.CP 3: 9/12/2010

4.CP 4: 29/12/2010

5.CP 5: 25/1/2011    à  31/1/2011 : 5.47 u/ml

6.CP 6: 16/2/2011  

 

USG (March,16^th 2011) : No abnormal mass & metastase nodul in pelvic cavity &

                                               abdomen

Ca-125 (15/3/2011) : 15.1 u/ml    

Discuss with Consultant (16/3/2011)

Will be controlled for 3 months (USG & Ca-125)

 

Follow Up ( Ca-125)

14/6/2011: 12.2 u/ml

12/9/2011: 11.98 u/ml

14/12/2011: 28.7 u/ml

 

USG (October, 4^th 2010): Minimal ascites at right pelvic, No metastasis at liver,

                                                lien & renal. Enlargement lymph node left iliac

 

USG (June, 15^th 2011) : No abnormal mass in pelvic & abdominal cavity.

USG (Sept, 15^th 2011) : No abnormal metastatic mass in pelvic & abdominal

                                             Cavity

USG (Dec, 16^th 2011) : No abnormal metastatic mass in pelvic & abdominal

                                            Cavity

 

17/3/2012: 98.9 u/ml

 

Oncology USG  (March, 20^th 2012)

Lymphadenophaty in para aorta and right inguinal

Mass in pelvic cavity susp recurrent

 

CT Scan (March, 28^th 2012) : There was lobulated mass in lower abdominal cavity untill pelvic cavity with size 16.1 x 9.6 x 9.0 cm à Ovarian tumor (malignant). The mass at right paracardial, enlargement paraaortic lymph node, multiple nodul at segmen II,IVA & VII

 

ASSESMENT

Residive Ovarian Carcinoma III C

History chemotherapy (Carbo-Paxus 6 series)

    à 13 month ago

    à Platinum sensitive

 

April, 3^rd 2012

Discussion with Prof. Dr.dr. Andrijono,SpOG(K):

è Will be discuss in CC

 

PLAN

Residive mass à Consider to give chemotherapy (Platinum sensitive)

Laparoscopy exploration