Case Conference August 15th 2012

15-Aug-2012, Divisi Ginekologi Onkologi RSCM

 

Progressif  Ovarian Cancer, Post Laparatomy Optimal De Bulking(March 2012), Post Chemotherapy  4 Series

 

Identity

Mrs W, 36 yo 3584041,GAKIN

 

RESUME

December 2011

Refered by Sari Asih hospital with inta abdomen tumor

Abdominal enlarged, history of TAH 2008  at Pasar Rebo Hospital due to uterus cancer, no radiation .

Menarche 15 yo. Regular.

Married 23 yo, 1X

P1

No contraception

 

Physical Exam :

Io : smooth vaginal wall,stump vagina(+)

RVT : there was cystic mass with solid part until 2 finger above navel, limited mobility.

 

US exam (5/12/2011)

Unvisualized uterus

Left adnexa: cystic mass with echoic dot ,moved slowly with position changing, papilary growth+,  filled  cav abdominal ,solid part+ , no neovascularization, size 135x121x153 cm vol 1323 cc

 

 

Conclucion :

Left ovarian neoplasm -borderline type

Ca 125  (6/12/2011)

133.3

Assessment : Cystic and solid ovarian tumor susp malignancy, history of TAH

 

March 9 ^th  2012

Laparotomy  BSO, omentectomy,appendectomy, de bulking pelvic and paraaortic LNDs

(optimal debulking ) ,

Pre op diagnosis : Cystic and solid ovarian tumor susp malignancy, history of TAH

Post op diagnosis : ovarian cancer III C

Operation findings :severe adhesion of the omentum, vesiko uterin plica and bowel, colon covered cystic solid mass of the ovarian tumor 16 cm (left and right side). There were enlargement of left pelvic LND 2,5 cm, right pelvic LND 3 cm. Performed BSO , FS result : cystadenocarcinoma serosum et mucinosum papiliferum ovarii. Residual tumor : ex adhesion in the area 5x3 cm at colon descenden, not nodular(optimal de bulking)

 

PA (10/4/2012 no1202044)

Cystadenocarcinoma mucinous papiliverum ovarii ,moderate-severe differentiated

Metastase right and left pelvic lymph nodes

 

Chemotherapy (Cisplatin,Carboplatin)

Ca 125

US finding

 

6/12/11  : 133,3

 

18/4 /12 : 173,1

 

24/4/12 : chemo I

 

	16/5 /12 : 110,7
26/5/12 : chemo II

 

	15/6/12 :  106,6
20/6/12 : chemo III

 

	12/7/12:   101,1
18/7/12 : chemo IV
		27/7/2012 Posterior right found cystic lesion with solid part 5.6x3.3x4.5 cm, no metastases in hepar and lien Paraaorta LN-hidronefrosis- pleural effusion- ascites-
	30/7/2012 : 82.3

 

Discussion with dr.Andi D.P obgyn(C)

Planed to continue chemotherapy.

Discussion in CC