Case 7
CASE DESCRIPTION
A 40-year-old lady diagnosed with locally advanced cancer of the ovary. The challenge was her CA 125 was 9,600 (which is extremely high) with gross ascites.
Very rarely we see such high CA 125
Consultation and diagnosis
Prompt and accurate diagnosis made in-house
Tumour board
A multi-disciplinary team deliberated on action
Individualized care
Patient’s mental makeup taken into consideration
Modular care
A suite of therapies that contribute to holistic healing
WHAT WE DID
She required high motivation and was started on neoadjuvant chemotherapy. After 3 cycles her CA 125 level remained the same. After discussion, we added Bevacizumab and after 2 doses, her CA 125 level started decreasing. She developed dengue after the 2nd dose of bevacizumab and therefore, a low platelet count. Since she had taken chemotherapy, she took one month to recover from dengue and we could not continue the chemotherapy. Her relatives were very apprehensive. We counseled them and after 2 months we prepared her for surgery (Cytoreductive surgery with HIPEC). Her CA 125 levels were on a reducing trend but still high.
She underwent Cytoreductive surgery. She had extensive small bowel mesenteric disease which we could remove entirely and a 90-minute chemotherapy was given during surgery which she tolerated. The surgery took 10-12 hours.
- Chemotherapy administered
- Dengue managed
- Counseled patient and family
- Underwent planned surgery with HIPEC
- Advanced disease cured
FINAL RESULTS
We could discharge the patient on day 6. She completed adjuvant chemotherapy. We did BRCA testing and she came positive and now she is on maintenance Olaparib. Now, it has been over one year, her CA 125 is normal and she is doing well.
Learning: Challenges will be there but a personalised approach with continuous joint clinic discussion and persistent patient counseling and motivation can change the tide in your favour.
