Case Conference December 5th 2012

05-Dec-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                           

 

Mrs.M, P6, 59 yo. JAMKESDA,3549969

Advance stage ovarian carcinoma  (pleural metastasis) post 3  series NAC, no respons

 

13/9/12

 

Patient came to policinic onco-gyn, refered from RS.Pasa Rebo  with ovarian carcinoma. At the beginning, the lump was as big as tenis ball, then increasing fastly as big as aterm pregnancy. Decreasing body weight (+) with abdominal pain. Normal mixturution and defecation.

 

Married : 18 y.o

P6,

No history of contraception

 

Gen state :

Abdomen : massive ascites, with cystic mass was palpated at umbilical navel.

 

Gyn state :

I : v/u normal

Io: smoothnportio, pushed to anterior

RVT: cystic mass was palpated reach to umbilical level, mobile

 

Ca 125 : 1797

BNO-IVP : secretion and finction both kidneys were normal

Chest x-ray : aorta dilatation, left  pleural efusion

Ascites citology: malignan cell (-)

Pleural cytology :adenocarcinoma

 

US (onco-gyn ) 23/8/12 :

Cystic ovarian neoplasma, multilocular,

Massive ascites

Cystic mass withsolid part 19x12x19 cm, septum (+)

 

Lab : ur: 28, cr: 1,30

CCT : 37,46

 

Assessment:

Advance stage ovarian carcinoma (pleural metastasis), low CCT

 

Discussion with prof.Andrijono :

Planning to have chemo (carbo  AUC 5)and paclitaxel

 

 

29/9/12-21/11/12

Patient had 3 series chemotrerapy with carboplatin(AUC5) and paclitaxel,

 

Ca 125  after firs chemo :1940

 

US (29/11/12):

Massive ascites with solid mass multi-locular susp maligna, stqa pre chemotherapy.

 

Assessment and discussion with dr.Hariyono, OBGYN(C):

 Tumor were   in pelvis and upper abdomen  à resectable

Options :surgery,  even this  could be  a high risk procedure , and possibility of stoma anßd sub optimal de bulking.

Ovarian carcinoma, with massive ascites à omental cake could be found, involving digestivus tract,

Discussion in CC

 

	Ca 125	USG	Chemo (carbo AUC5+paclitaxcel)	ascites
		Mass :19x12x19 cm
4/9/12	1797			>>
29/9/12			Chemo I
16/10/12	1940			>>
31/1`0/12			Chemo 2
21/11/12			Chemo 3
29/11/12		Mass:18x12x18