Case Conference October 17th 2012

17-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

Mrs.S, 53 yo. 526819,JAMKESDA

Ovarian carcinoma advance stage post NAC 3 series  (CP)continued with optimal de bulking  (march 2012) and adjuvant chemo 1 series, platinum resistent

Post chemotherapy second line (1 serie s)  , not respons

 

 

November 11^th 2011

Patient came to policlinic with complained of abdominal enlargement since 3 months before admission.  Patient had been have menopause since 2 years. Lost of appettite (+). Decreasing body weight 6 kg ( during 3 months).

 

US 11/11/11

Massive ascites and solid mas in right adnexa, adhered to right adnexa susp malignancy ovarium dd/ tube malignancy  dd/adnexal specific inflamation

 

16/11/11

Ca 125 2891  AFP :3,3  Ca 15-3 : 370.8

 

 

Assessment :

 pelvic tumor dd/ cystic ovarian neoplasma susp maligna with RMI 8673

 

Cytology result :

Mesothelioma dd/adenocarcinoma

 

CT scan : (20/11/11)

Bilateral pleural efusion

Ascites massive ec sirosis ?

Intra abdominal organ  within normal limit

 

9/12/11,  10/1/12 , 1/2/12 

Patient got NAC  3 series with cyclophospamide and platosin

 

US post NAC 16/2/12

No ascites, no progressive 34.5mass

 Ca 125 post NAC : 34.5

 

	Pre NAC	Post NAC
Complain	Abdominal enlagement dyspneu	No complain
US	Cystic mass 10x10 cm Ascites(+)	Mass (-) Ascites(-)
Ca 125	2891	34.5

 

 

Marc 29^th 2012

Pre op diagnostic : advance stage ovarian cancer post NAC

Post op diagnisc : advance stage ovarian cancer

 

Performed optimal de bulking ( total abdominal hysterectomy, bilateral salphyngooophorectomy, tumor resection, total omentectomy, appendectomy and lymphadenectomy)

 

Surgery report :

·        After peritoneum was opened , on exploration no ascites, uterus both tube and ovaries within normal limit in shape and size. There was residual tumor mass 2x1x1 cm at the douglas pouch. The omentum was smooth  and no tumor nodules nor implants was found on the omentum.

·        Decided performed total hysterectomy and BSO

·        On palpation , there was no enlargement of both pelvic  lymph nodes. The paraaortic LNds were found enlarged sized 2x1 and 1x1 cm

·        The aorta was skeletonized from the bifurcation aortae cranially until the level of renal vein. There were enlargement LNds : above the left ovarian artery 2x1 cm and under the left renalis vein 1x1 cm. sampling of bulky LNds were performed:

·        On further exploration : liver,spleen,intestines, colon and peritoneal wall were normal, no residual tumor mass.

 

 

PA result  ( no PA 1202631)

 

·        Cystadenocarcinoma serosum pappiliferum ovarium, poor differentiation

·        Tumor metastatic to LNds , omentum and paraaorta

·        Adenomyosis uterus

 

Ca 125 ( 2/5/2012) : 136.8

 

May 9 ^th  2012

 Got Chemotherapy-IV

 

September 13 ^th  2012

 

Patient came to policlinic after last chemo at May 2012., with complained abdominal discomfort.

Clinical examination:

Abdomen enlarged  with  residif mass until 3 finger below navel , ascites (+)

 

US ( 18/9/  2012 )

Complex types of ascites

 

Ca 125 (18/9/12) : 2.494

 

Discussion with dr.Sigit OBGYN (C):

·        Patien was  lost follow up, although pre and post NAC : complete response ( decreasing Ca 125 and tumor mass ), after  fourth chemotherapy with increasing ca 125 à platinum resistens, offer the patient  second line chemotherapy (oxaliplatin and gemcitabine) ,the prognosis is still poor.

 

 

October 16 ^th 2012

Patient   controled to policlinic, has got first series of oxaliplatin and gemcitabine (october 10^th 2012), nausea(+), abdomen is getting bigger.

Clinical exam :

Ascites massive (+)

 

Assessment :

Ovarian carcinoma advance stage post NAC 3 series  (CP)continued with optimal de bulking  (march 2012) and adjuvant chemo 1 series, platinum resistent

Post chemotherapy second line (1 serie s)  , not respons

 

·        Patient with history of follow up,

·        No respons with chemotherapy

·        Mass/ ascites(+)

 

Discussion with prof Andrijono :

·        Not respons with chemo

·        Discussion in CC à planning for paliative or continue chemo

·        Release ascites with cystovix

à discussion in CC