Microsoft word - ovarian adenocarcinoma 20081205 - hp case study
Case study tumour type: 44 year old female with serous papillary ovarian adenocarcinoma Case study tumour type: Serous papillary ovarian adenocarcinoma Medical history prior to first course of radiowave therapy (RWT) prior to 31.05.2010 Presenting symptoms Patient is a 44 year old female who presented to her GP and gynaecologist in November 2008 with lower abdominal pain, prompting further investigation. Initial diagnosis – 5.12.2008 – Serous papillary adenocarcinoma of the right ovary Method of diagnosis – Surgical pathology (5.12.2008) Morphology – Serous papillary adenocarcinoma Stage– T3 N0 M0 (at diagnosis) Grade – Silverberg Grade 1 Past medical history Reflux Weight gain/obesity Anxiety/depression Back pain Migraines Skin cancers Investigations and treatments (prior to RWT) – treatments, imaging and blood tests
November 2008 – CT scan and Ultrasound – Showed mass in pelvis measuring 8 x 6 x 6cm (report unavailable, taken from specialist letter). November 2008 – Tumour marker CA125 = 246 (N<35) (report unavailable, taken from specialist letter) November/December 2008 – Tumour marker CA125 = 346 (N<35) (report unavailable, taken from surgical notes) 4.12.2008 – CT Pulmonary Angiogram – Soft tissue mass within the medial portion of the inferior segment of the lingual. Main consideration is a metastasis. Other considerations are an area of round atelectasis or round consolidation. 5.12.2008 – Surgery – Division of sigmoid adhesions from previous surgery, removal of uterus, fallopian tubes, ovaries, omentum and left pelvic side wall tumour. 5.12.2008 – Biopsy (from surgery) – Showed invasive serous papillary adenocarcinoma originating from the right ovary, Silverberg Grade 1. Adenocarcinoma also seen in sigmoid
colon adhesions and serosa, colonic mesenteric node (no lymph node present), omentum, uterus, left ovary and left fallopian tube. 18.12.2008 – Tumour marker CA125 = 272 (N<35) 8.01.2009 – Tumour marker CA125 = 84 (N<35) 13.01.2009 - 5.05.2009 – Chemotherapy – Taxol and Cisplatin (6 cycles). 30.03.2010 – PET Scan – Metabolically active focus in the right pelvis between two loops of bowel, suspicious of peritoneal recurrence. Two further nodules described: peritoneal deposit at hepatic flexure measuring 0.4cm and superficial nodule at lateral aspect of right rectus muscle measuring 1.2 x 0.7cm. These are suspicious of recurrent metabolically active disease. Soft tissue thickening superior to the bladder may represent post therapy changes or small volume recurrent disease. April 2010 (ongoing) – Hormone Therapy – Femara 2.5mg daily. 23.04.2010 – Tumour marker CA125 = 44 (N<35) 14.05.2010 – MRI Pelvis and Lower Abdomen – Only soft tissue nodule lateral to right rectus abdominis muscle seen, measuring 1.0 x 0.8cm (previous PET scan stated 1.2 x 0.7cm). Other described lesions within right pelvis not obvious on MR with lesion at hepatic flexure not covered in the MRI. No impression of bony metastases.
Radiowave Therapy – first course
From 31.05.2010 to 18.06.2010 Interruptions to first RWT None Investigations during first RWT
Medical history following first course of RWT – post 18.06.2010 6 weeks post first RWT
29.07.2010 – Tumour marker CA125 = 36 (N<35) 9 weeks post first RWT 16.08.2010 – MRI Abdomen and Pelvis – Persistent focus of enhancement within medial fibres of left rectus abdominus muscle measuring 0.4cm which was seen previously and is unchanged. No evidence of a mass or pelvic lymphadenopathy. 19.08.2010 – MRI Abdomen and Pelvis (addendum) – Focus of enhancement demonstrated just lateral to right lateral rectus muscle measuring 1.0 x 0.8cm. This is not significantly altered since previous MRI (14.05.2010) and would concur with the PET avid focus.
14 weeks post first RWT 23.09.2010 – Tumour marker CA125 = 49 (N<35) 16 weeks post first RWT 6.10.2010 – PET Scan – In comparison to previous PET (30.03.2010), there is residual stable metabolically active disease in the abdominal wall, pelvis and perivesical region. The previously reported pericolic mass is not identified on the current study. Other treatments post first RWT Ongoing (from April 2010) – Hormone Therapy – Femara 2.5mg daily. Radiowave Therapy – second course
From 18.10.2010 to 5.11.2010 Interruptions to second RWT None Investigations during second RWT
18.10.2010 – Tumour marker CA125 = 46 (N<35) 3.11.2010 – Tumour marker CA125 = 41 (N<35) Medical history following second course of RWT – post 5.11.2010 6 weeks post second RWT
17.12.2010 – Tumour marker CA125 = 47 (N<35) 9 weeks post second RWT 6.01.2011 – MRI Abdomen and Pelvis – There is irregular high signal and enhancement in much of the inferior portion of the left inferior rectus abdominus, much of this is less prominent than was previously the case. There is a small focal area of enhancement at medial border of left rectus sheath, which is stable when compared to images from May and August 2010. Other treatments post second RWT
Ongoing (from April 2010) – Hormone Therapy – Femara 2.5mg daily. Current status Disease statusas at 6.01.2011 – Latest imaging showed stable disease and tumour markers had reduced following each course of RWT. Patient status as at 18.02.2011 – Patient started feeling sick with sharp, radiating pain in her abdomen on Sunday evening (13.02.2011). Patient was admitted to hospital on 17.02.2011
with bowel obstruction. Patient deceased 18.02.2011 due to complications associated with bowel obstruction. Just prior to this, patient had been feeling well.
Disclaimer Any particular case study outcome does not mean that in every case the treatment of cancer using radiowave therapy will achieve the same result
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Case study tumour type: 44 year old female with serous papillary ovarian adenocarcinoma 