Ovarian Cancer Community
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Aged Ovarian Cancer Patient

A 77 yrs  old frail lady is having low grade fever for a month, loss of  appetite,and general run down condition. Following diogonstic tests done Hammogram: Hb 8.8 g/dl, Packed Cell Vol 27.90 %,  RBC Count3.38, MCV 82.30,MCH26.00,MCHC 31.5RDW 18.90, Platelet  count 150.0 thou/mm3, segmented Neutrophils 8.10,Lymphocyte 0.33, E.S.R 62 mm(1 hr), LFT shows normal results,Mantoux test is negative,Urine Routine Examination: Specific Gravity:1.015, Albumin Trace, Epithelial Cells 2-3/HPF, Pus cells 6-8/HPF, RBCs 4-6/HPF, Casts, Crystals, Others NIL,

Ultra Sound of upper abdomen shows Free fluid in the pertoneal cavity, Increased omental echogenicity with apparent thickening (Bladder empty) lower abdoment shows heterogenous mass lesion in pelvis.Ultrasound revels 1. Ascites 2.Increased omental echogencity( ?Omental deposits)3.Hetterogenous lesion in pelvis.
Ultrasound Pelvis(TAS) shows large rounded thick walled cystic SOL in the pelvis measuring 8.4x7.7.6.2 cm in size, it reveals hypoechic with a peripheral echogenic mural nodule.US of pelvis reveals a rounded heteroechoic SOL in the pelvis with ascites likely mitotic in origin.Bilateral mamomogram reveals smooth rounded sol's both breasts. On correlative USG appear soilid hypochoic and transversely placed likely fibroadenomas.CA-125: 240.72 U/ml.

QUESTIONS/CLARIFICATIONS: Please advice, 1) if its a case of ovarian cancer 2) Is CA test definative for malgancy, if not, what are other tests? 3) Should she go for open surgery or laprarscopy for removal of the growth? Will she able to stand follow up treatment like radiation etc?4) weather the present fever is due to some infection other than growth? Thanks!
3 Responses
Avatar universal
With a mass this size I can't imagine anything but a laparotomy being performed.  It is simply not posssible to say for certain whether a tumor is malignant or not before surgery and a pathology report.  The CA125 is not 100% but is a good indicator in postmenopausal women.  I didn't run a fever before being diagnosed but there are women here who did say it was one of their symptoms.  Whether or not she will be strong enough for treatment after her surgery depends on a lot of things.  One thing I will say...SHE HAS ONLY ONE CHANCE TO GET IT RIGHT THE FIRST TIME....make certain she has a gyn/oncologist performing her surgery.....the quality of her future just might depend on it.  I certainly hope all goes well for her.....she is lucky to have someone in her corner who is trying to figure things out ahead of time.  There are many women here who will be able to chime in ......please do stay in touch.
158061 tn?1202678326
You have identified her as frail, saying that she will need to have her nuritonal state improved before surgery. She has a low hemoglobin count and probably low protein.  Unless it is an emergency I am not sure they will operate immediately.  They will probably biopsy the fluid in the abdomen and see if there are cancer cells in it.  For your other questions they really need to be answered by her doctor.  Is she being seen by a Gyn/Onc, if not you should ask for one.  They may, when they increase her hemoglobin give some chemo and shrink the tumor cells and then operate at a later time when she is stonger.  If they did surgery it probably would be a laparotomy, because of the size of the tumor and the other areas with prossible tumor.  Each case is very individual and needs to be considered looking at what is the best they can do for the person.  Make sure she is involved in the decisions and is aware of what is going on.  See Susan's post above.  All my best to you, this is a very difficult time, with lots of decisions to be made and not enough information yet.
Avatar universal
Thanks Dian and Marrie for your interest shown and valuable comment.

Some further investigations have been made on the above patient. The Cytopathology Report says:
1) There is no evidence of cancer in this specimen.
2) The specimen was Ultrasound guided aspiration of fluid (? site)
3)  Microscopic Examination: Smears from centrifuge deposit show lymphocytes and reactive mesothelial cells in a hemorrhagic background.
Further Hematology reveals:
1. Hb 8.7 gm/dl
2.Total Leukocyte Count (TLC) 7,900 cells/cumm
3.Neutrophils/Polymorphs 80%
4.Lymphocytes 18%
5.Eosinophils 02%
Tumour markers/Hormones Assay
1.CA 125  241.6 U/ml
2.CEA(Carcino Embryogenic Antigen) 1.43 mg/ml
Gastro-Duodenoscopy reports findings:
Cricopharynx is normal Esophagus shows A LARGE HITUS HERNIA
Fundus, body, and antrum stomach are normal
Duodenal bulb is normal
Dll is normal
Video colonoscopy Report
Colonoscopy passed till cecum
Rectum shows normal mucosa
Recto-sigmoid is normal
Descending colon is normal
Transverse colon is normal
Right sided preparation was suboptimal there was considerable fecal matter no obvious pathology seen
Conclusion: Normal colonoscopy

The patient is now having no fever. May be due to administration of Antibiotic the fever has gone. She continues to feel weak, no appetite, heavy breathing sometime in the night and general run down condition prevails. May I please invite guidance/advice on the following that comes to my mind?
1) Is it malignant?
2) If not what are the sure test for proving malignancy?
3) Can tuberculosis is ruled out by montex test, already negative in this case?
4) If it is malignant, and if we don’t go for any treatment (chemo/surgery) what complications she would face?
5) The patient is 77 yrs old weak and frail, can she stand chemo and surgery at this stage.
6) It is generally believed   that if cancer is touched/operated, it spreads very rapidly, to some other part.

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