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 8.4x126.96.36.199 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!