Case Conference February 6th 2013

06-Feb-2013, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

6^th February 2013

 

 

Mrs. SM, 55 yo

 

6/1/2012

Patient first came to policlinic referred by Depok Hospital due to abdominal mass

US result was ovarian tumor, paient didn’t check for lab yet. Patient already menopause, P5A0.

 

9/1/2012

Ca 125: 3415 CEA 2,94

 

11/1/2012

Puncture of ascites

 

12/1/2012

FM Ultrasound (Azen Salim) Inhomogen solid mass scattered in anterior wall specially anterior and left anterior wall and posterior wall of abdomen. Irreguler shape and edge. Neovascularization intra tumor (RI=0,5)

Massive ascites

At right liver lobe: hipoechoic mass 3 x2,7 cm susp metastasis

Assesment: Advance ovarian malignancy

 

16/1/2012

Cytology: positive adenocarcinoma

 

18/1/2012

Multiple slice CT-scan:

Ovarian tumor size 12x11x14 cm with massive ascites, already infiltrating uterus: malignancy

Bilateral pleural effusion

Non specific hepatomegaly

No lymph node enlargement

 

19/1/2012

Confirmation dr Arman: Comparing liver ultrasoundà no suspicious lesion correspond with liver metastasis

 

18/1/2012

US guided thoracosintesis on left pleural effusionà yellow serous fluid 500 ccà cytology, gram, BTA, MDR. Massive  pleural effusion left, minimal at right.

 

26/1/2012

Chemotherapy (Acc dr.Sigit SpOG) with platinum and taxan (Carboplatin 450 Paclitaxel 252)

 

27/1/2012

First Chemotherapy

20/3/2012

Ca 125: 1530

 

22/3/2012

Second chemotherapy

 

11/4/2012

Ca 125: 442

 

16/4/2012

Third chemotherapy

 

24/4/2012

Ca 125: 144

 

24/4/2012

Oncology ultrasound:

Uterus size and shape normal size 5 x 2 x 2,3 cm, anteflexed, echostructure of parenchyma was homogen, endometrium 1 mm, no fluid intra uterine cavity.

Adnexa: multicystic mass 5 x 4 x 4,5 cm, RI negative, implant near rectum and some attached with rectum

Minimal free fluid at pouch of douglas

No liver nodule, echostructure normal

Abdominal aorta: lumen size normal, no paraaortic or parailiaca lymph node enlargement

Both kidney normal

No free fluid at pleural cavity

Minimal free fluid at subhepatic cavity

 

3/5/2012

Chest x-ray:

Suggestive thickening of left pleura, no sign of significant pleural effusion. Minimal fibrosis at lower lung lobe. Heart wnl

 

General status : wnl, no nodes enlarged

Abdomen: No abdominal mass palpable

Gyn status : I v/u wnl

Io : smooth portio, ost closed, no fluor nor fluxus

RVT : CUT wnl, there was solid mass at left adnexa 5x3x3 cm, suggestive attached with rectal serous, not attached to surrounding tissue, smooth rectal mucosa.

 

	Before NAC	After NAC
Size	12 x 11 x 14 mm	55 x 19 x 23 mm
Ca 125	3415	144
Ascites	Positive	negative

 

Assesment: Ovarian cancer advanced stage (ascites + adenocarcinoma), post chemotherapy 3x partial response

 

21/5/2012

Performed laparotomy optimal debulking (TAH BSO, total omentectomy, parametrial nodule extirpation) PA 1204222: Clear cell carcinoma, serous adenocarcinoma with seeding in peritoneum and omentum.

5/6/2012

Chemotherapy IV (Carboplatin-paclitaxel)

 

27/6/2012

Ca 125 24,4

 

3/7/2012

Chemotherapy V

 

23/7/2012

Ca 125 13,1

 

27/7/2012

Chemotherapy VI

 

15/8/2012

Ca 125 14,7

 

3/8/2012

Oncology US: No new mass, both kidney wnl

 

15/8/2012

Discussion with Prof.dr.Andrijono SpOG: Ovarian cancer st III C post NAC continued with Carbopaclitaxel 3 seriesà complete response à follow up 1 month, no need chemotherapy

 

14/9/2012

Ca 125 12,1

 

25/11/2012

Ca 125 11,2

 

22/1/2012

Control, Ca 125 149,4, US: ascites (+)

 

31/1/2012

CT scan abdomen: Heterogenous mass at left side pelvic, posterosuperior to the bladder size 4,3x4,8x4,3 cm, infiltrating perirectal fat suggestive of ovarian recurrent mass , hepatomegaly, ascites, liver multiple nodule (posterior, inferior, superior) with perihepatic fluid collection suggestive metastasis

 

4/2/2012

Assesment by dr.Unedo SpOG: ovarian cancer advanced stage post optimal debulking, post complete (6 times) chemotherapy, with recurrent mass

 

Discussion with Dr.dr.Laila N SpOG(K):

Discuss at CC, treatment option :

1.     Chemotherapy with epirubicine-platosin or gemcitabine-oxaloplatin

2.     Palliative (quality of life)