Case Conference April, 4th 2012

05-Apr-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

APRIL 4^th 2012

1 OUTPATIENT

 

Mrs S, 54 yo, 3307023, Jamkesmas

Ovarian cancer residive, post hystrectomy, salpingoooforectomy, omentectomy and appendectomy outside, post chemo CP 6 series 2 times, post chemo carboplatin – paclitaxel 6 cycles

 

April 8th, 2009:  

Patient was referred to RSCM from Jambi with ovarian cancer IIIB.

March 2009 patient was performed laparotomy hystrectomy, salpingoooforectomy, omentectomy and appendectomy in Asia medica Hospital Jambi, with PA result : Cystadenocarcinoma musinosum papiliferum ovarium infiltrated to uterus, appendix and omentum.

Review slide PA (0902584):

•      Adenocarcinoma papiliferum ovarii tipe endometrioid well differentiated with spreading at omentum and periappendix. Whether there is lesion in uterus can not be sure

 

St gen :

•      No enlargement of supraclavicular or inguinal lymph node

•      Abdomen : palpated mass until 2 finger under navel, limited mobile, smooth surface

St gyn:

•      I: vulva /urethra wnl

•      Io: Smooth portio, vagina wnl

•      RVT:palpated mass until 2 finger under navel.

 

Ca 125 : 1151 U/ml

USG oncology april 8th 2009:

•      Cystic mass size 6,3x6,2 x 5,1 cm at posterior vagina stam, no vascularitation intra mass. No ascites. No metastatic in Hepar, Lien and no lymphnode enlargement. Ren dx wnl, Ren sinistra with 7 mm dilated pevis renis.

•      Assesment: Ovarian cancer advanced stage (III B) suboptimal debulking

 

Discussion with consultant : chemotherapy with CP 6 series

•      Chemotherapy was done on 13/5/2009 – 28/09/09

 

Supportive examination after chemotherapy

Lab finding: Ca 125 : 55,3 U/ml

USG Oncology oct 7th 2009:

•      No mass visible. Compare with usg result April 4th 2009 à complete remission.

 

Assesment : complete remission à she went back to Jambi and did regularly controls in Jambi  at Obgyn

 

 

August 23th 2010 : 

Control after 1 year with chief complain : abdominal enlargement since 1 months before admission.

 

St gen : abdomen :massive acites with cystic mass with solid part size 6x5x5 cm, limited mobile.

St gyn :

•      I: V/U wnl

•      Io : vagina stamp smooth

•      RVT : palpated cystic mass with solid part in pelvic cavity and acites

 

USG gynecology August 23th 2010:

•      Posterior V. Urinaria there was hipoekoik mass, clear border size 3,03x1,37,3,37 cm (vol 7,32 cm 3). And also acites. No metastasis in hepar, lien or lymph node.

Lab finding : ca 125 : 2599 U/ml

 

Assesment:

Ovarian cancer residive (platinum sensitive).

Discussion with consultant : plan to give again chemotherapy with CP

Chemotherapy CP II was done on 4/9/2010 – 21/12/2010

 

Supportive examinations after chemotherapy

USG February 22th 2011 :

No mass were seen, no acites à complete remission.

Lab ca 125 : 32,9 U/ml

 

Discussion with consultant (Prof Dr Andrijono SpOG (k)) :

Assesment as complete remission,  she could go to Obgyn in Jambi to do the post therapy controls every 3 months  and in 1 year control in Jakarta.

 

 

September 21st 2011:

•      Control after 1 year with chief complain :  abdominal enlargement.

•      No difficulty in defecation and micturition.

 

St gen:

No lymphnode enlargement in supraclavicula, axilla and inguinal.

Abdomen: no palpable mass, shifting dullness (+)

St gyn:     I: V/U wnl

•                  Io: vagina stam  smooth

              RVT : no palpable mass in pelvic cavity.

•      USG FM sept 22th 2011 : ascites with suspected secretion process from the tiny implantations. Pseudocyst intraabdomen.

•      Lab finding : Ca 125 : 4781 U/ml

 

Assesment: Ovarian cancer  residive

                       (platinum sensitive)

 

Discussion with consultant (Dr dr Laila SpOG (k)):

•      Considering that acites serohemoragic (+), and ca 125 raised with history 2 times CP à alternative palliative or chemotherapy other regimen.

Discussion with Prof Dr dr Andrijono SpOG(k):

•       whether giving second line or CP again

Decided to give carboplatin paclitaxel.

 

Carbo Pacli I: October 4th 2011

                    II : October 25th 2011

      III: November 15th 2011

After 3 cycles chemotherapy, clinically she feel better, the abdomen is getting smaller.

•       Lab ca 125 : 1213 U/ml

•      USG FM : Vagina stam wnl. Around posterior peritoneum there is hipoekoik mass with form and border irreguler, size 16 x 12 x 13 mm  with acites. There are Fibrin – fibrin adhesion  suspected spesific process.  How is pulmo?

•      Foto thorax 13/12/2011 : Pneumonia, no sign TB or metastasis.

 

Case conference Des 14th 2011

Considering :

•      Ultrasound : new mass

•      Ca 125 :  4781 U/ml à1213 U/ml

•      Clinic :  better feeling

Conclution :

Partial response  after 3 cycles in recurrent  ovarian ca

Decission:

continue the chemotherapy carboplatin – paclitaxel based on good respons after 3 cycles.

à Chemotherapy 4th – 6th :19/12/2011 – 14/02/2012

 

Examinations after chemotherapy 21/2/12

 

St gen:

No lymphnode enlargement in supraclavicula, axilla and inguinal.

Abdomen: no palpable mass

St gyn:     I: V/U wnl

                Io: vagina stam  smooth

              RVT : no palpable mass in pelvic cavity.

CA 125: 759.3

USG:

Non visible mass (compare to dec 6th,2011) minimal ascites

Plan: CA 125 and US exam 1 month

 

Examinations after chemotherapy 30/3/12

St gen:

No lymphnode enlargement in supraclavicula, axilla and inguinal.

Abdomen: no palpable mass

St gyn:     I: V/U wnl

                 Io: vagina stam  smooth

                RVT : no palpable mass in pelvic cavity.

CA 125: 2104

USG:

Non visible mass, minimal ascites

Assesment:

Ovarian cancer residive, post chemo carboplatin – paclitaxel.

Ca-125 level not achieve normal level, no evidence of disease.

Considering :

•      Clinic : no complain

•      Ultrasound : no mass

•      Ca 125 : 4781 U/ml à2104 U/ml

 

Plan:

Whether palliative treatment or second line chemotherapy