Ovarian Cancer with Metastases
Short Summary

61-year-old female underwent resection of the uterus, adenexae, onsectonomy and appendectomy for papillary serous carcinoma of the ovary . After 6 chemotherapy cycles tumor recurrence was diagnosed. Patient is being treated with chemotherapy that is believed to be the cause of some tumor regression.

Patient's Questions

1. Can you confirm the diagnosis?
2. Can you confirm the current therapy?
3. Are there any specialist centres for the diagnosis that was given?

 

Medical Background

Diagnosis: hepatic and lymph node relapse of ovarian cancer
 
Case history:
Diagnosis of ovarian carcinoma approx. 5 years before this report.
Therefore, a surgical procedure was carried out on (shortly after diagnosis): ITAB + Omentectomy + appendectomy.
The results of the histology test were as follows:
Papillary serous ovarian carcinoma G1, p53 neg., E receptors + 70%, Rec. Prog. 90% +.
This was followed by adjuvant chemotherapy with carboplatin x 6 cycles from , the last being on (5 month period, also approx. 5 years earlier).
At the onset of the relapse just under 2 years prior to this report (very slight ascites attributable to carcinosis -> CAT scan: Numerous hepatic lesions, the largest being 4 cm; hepatic hilar lymph nodes, Spleen + paraaortic lymph nodes). The patient had Tax-JM 8 x 6 cycles with a relapse in the hepatic region. This was followed by Taxol maintenance, which was stopped after the 7th cycle due to a marker increase.
In (approx. 1 year prior to this report), the CAT scan was negative.The patient then took Nomafen 20 mg, 1 tablet a day, from (about 10 months earlier) for 8 weeks.
Due to left axillary lymph node and right supraclavicular dissemination, from approx. 2-3 months prior to this report, the patient had 8 cycles of polychemotherapy with Caelyx-Oxaliplatin, achieving clinical and biochemical remission of more than 50% at the follow-up visit on:“reduced (<50%) mediastinal, paraaortic, hepatic hilus and celiac lymph nodes and a decrease in the marker (CA 125:56.8 prior to last cycle).During the follow-up on (same time), it was confirmed that the patient should continue with the chemotherapy started on (6 cycles of Cae-Oxali) as scheduled, although reducing the dose due to toxicity.
 

 

Expert's Opinion

  1. Results of pathology should be confirmed by a pathologist that will review slides of pathology. Given the pathology is as mentioned above, there is no need of further pathology. For sure, we are dealing with the same tumor that recurred or progressed.
  2. Since there is some degree of remission, I recommend that the patient continue with the same chemotherapy treatment (i.e. Oxilaplatin and Caelyx) until tumor progression. Should patient performance status stabilize, I would then consider a new line of chemotherapy.
  3. There are several centers dealing with Gynecological Cancer in different areas. However what I think is the most relevant for this patient is to see Dr… a medical oncologist that specializes in this field.

 

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