Case conference April 25th 2012

25-Apr-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

APRIL 25^TH 2012

2 OUTPATIENT

 

Mrs. A, 51 yo

Ovarian Cancer Advanced Stage Post NAC (CP 3 series) & Suboptimal Debulking

3581498,JAMKESMAS

 

 

HISTORY

 

September  30^th, 2011

 

•         CC : abdominal enlargement since 1 month ago

•         Consult by internal dept à Ovarian tumor (Ca 125 : 26.230)

•         Decreased of body weight (+)

•         Micturition & defecation wnl

 

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

Previous history in family: -

 

Menstruation history:

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

Marital history:

She had been married 2x ( 19 yo & 43 yo)

Obstetrical history : P5A0, Youngest : 20 yo                

Family Planning history : Tubectomy

Social history:  housewife

 

PHYSICAL EXAMINATION on admission

 

General status, Compos mentis

Height : 137 cm        Bw: 34 kg

BP 130/80 mmHg Pulse 92 x/min RR 20x/min T 36,6⁰ C

Conjunctiva    : not anemic

Heart/lung     : wnl

Abdomen       : Enlarged untill 2 fingers below proc. Xiphoideus. Median scar (+), There was palpable mass sized 10 x 8 x 8 cm at right hipochondria.

Extremities     : edema -/-

Lymph node     :no enlargement in supraclavicular, inguinal lymph node

 

Gynecological status

•      Inspection: wnl

•      Inspeculo : smooth portio, closed ostium, fluor (-), fluxus (-).

•      Gyn RVT   : Solid mass sized 10x8x8 cm at right adnexa, mobile (+), parametrium smooth. 

 

USG FM : (September, 14^th 2011)

Conclusion: Massive ascites, Malignancy mass in both ovaries (small) & malignancy mass in omentum (big). It’s not clear with primary tumor

 

CT Scan  (September, 15^th 2011)

-          Massive ascites

-          Intra abdomen organ wnl

-          No mass in rectum

-          No enlargement lymph node

 

Thorax Foto ( Agustus, 21^st 2011)

No abnormality

 

Laboratory : September,8^th 2011

CBC : 11.2/25.9/12.650/497.000/78.6/24.5/31.2

BT/CT : 2.30’/13.00’

SGOT/SGPT : 23/7

Ur/Cr : 15/0.6

RBG : 79 mg/dl

Na/K/Cl :140/4.11/106.1

Ca-125 : 26.320 U/ml

 

October, 25^th 2011 :

è Puncture Ascites : Serous fluid 10 cc

è Cytology Result : Adenocarcinoma

 

November,9^th 2011

Discuss with consultant (Dr.dr. Laila N, SpOG(K))

Considered cytology result adenoca & waiting list for operation procedures full & Ca-125 ↑à Performed NAC (CP) continued laparotomy debulking & Chemoth/ 3 series

 

November,15^th 2011 untill January,4^th 2012 à NAC 3 series

 

Before NAC :                          After NAC :

-          CA -125 :              26.320                                                194.5

-          Right ovary          10x5x8 cm                             5.5x1.2 cm

-          Left ovary                        4.3x2.3 cm                              wnl

-          Ascites                  Massive                                  Decreased

 

January, 13th 2012 (US FM)

Ascites & malignancy mass in omentum (susp. Metastatic)

Ascites & the mass progressive decreased compared to US before.

 

February, 6^th 2012 :

Suboptimal debulking, with residu mass size Φ 2cm on posterior right liver lobe  adherent to transverse colon (hepatic flexure).

PA Result :

è Adenocarcinoma, poor differentiated at both ovaries, right pelvic lymph node, para aortic, omentum & periapendiks

è Uterus with adenomiosis

è Maybe metastatic tumor, how about with the breast?

 

February, 16^th 2012:

Control after sub optimal debulking

è Plan to give Adjuvant Chemotherapy CP 6 series

 

March, 9^th 2012 à Adjuvant Chemoth/ I

March, 28^th 2012 à Adjuvant chemoth/ II

 

April,17^th 2012

CC : Abdominal enlargement untill 2 finger below umbilicus

 

April,19^th 2012 (Oncology US)

-       No mass

-       Massive ascites

-       Hidronefrosis sinistra gr.I

è Puncture ascites :3.000 cc, yellowish clear fluid

CA-125 : 721

 

ASSESMENT

Progressive Ovarian Cancer, Platinum Resistance, post NAC 3 series & Suboptimal debulking

 

PLAN

April, 17^th 2012

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

Patient with progressive ovarian cancer & platinum resistance à Considered to choice 2 modalities :

1.      Second line

2.      Paliative