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)
– Serous papillary adenocarcinoma

– T3 N0 M0 (at diagnosis)
Grade – Silverberg Grade 1

Past medical history
Weight gain/obesity
Back pain
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

Investigations during first RWT

31.05.2010 – Tumour marker CA125 = 33 (N<35)
16.06.2010 – Tumour marker CA125 = 32 (N<35)

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

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
Other treatments post second RWT

Ongoing (from April 2010) – Hormone Therapy – Femara 2.5mg daily.

Current status

Disease status
as 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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