Cancer Support Group

Friday, Sep 22nd

Last update:06:42:40 AM GMT

Case Discussion

Case Discussion
Case 1
  • A 68-year-old woman presents with a three week history of abdominal pain and nausea. A Computerized tomography (CT) scan of the abdomen and pelvis shows ascites, a large omental mass, and an enlarged right ovary. During an exploratory laparotomy performed by a general surgeon, the patient is found to have a poorly differentiated adenocarcinoma of the ovary. After completion of surgery, the largest residual tumor is less than one centimeter in maximum diameter.
  • Which of the following would you recommend as the next course of action ?
Objectives
  1. Repeat exploratory Laparotomy by a gynecologic oncologist.
  2. Six cycles of Cisplatin plus three-hour infusion Paclitaxel.
  3. Six cycles of single-agent Carboplain (AUC 12 .)
  4. Six cycles of Carboplatin (AUC,6) plus three-hour infusion Paclitaxel
  5. Six cycles of Carboplatin (AUC,6) plus Cyclophosphamide
Correct Answer
  1. Repeat exploratory Laparotomy by a gynecologic oncologist.
  2. Six cycles of Cisplatin plus three-hour infusion Paclitaxel.
  3. Six cycles of single-agent Carboplain (AUC 12 .)
  4. Six cycles of Carboplatin (AUC,6) plus three-hour infusion Paclitaxel.
  5. Six cycles of Carboplatin (AUC,6) plus Cyclophosphamide.
Explanatory Answer
Randomized trials with advanced ovarian cancer have shown that cisplatin and paclitaxel is better than cisplatin and Cyclophosphamide in terms of RR,DFS, and OS.

Trials have confirmed that cisplatin and paclitaxel and carboplatin and paclitaxel are equivalent, but the carboplatin-based regimen has a more favorable toxicity profile.

Currently no evidence to suggest that high-dose platinum-based chemotherapy results in a superior outcome. The patient appeared to have optimal surgical Cytoreduction, so there is no indication for repeat exploration.

Case 2
  • A 62- year old woman who has had pelvic discomfort for several months is found to have an enlarged left` ovary.The CA-125 antigen level is 97 U/mL. The patient is referred to a gynecologic oncologist who performs a laparotomy with a definitive resection of the mass. Pathologic review indicates a stage I (grade 3) epithelial ovarian cancer.
  • Which of the following is the most appropriate next step in the treatment of this patient ?
Objectives
  1. Computerized tomography (CT) of the abdomen and pelvis every eight weeks for three years.
  2. Six courses of a Platinum (Cisplatin or Carboplatin)-based Chemotherapy.
  3. Physical examination and measurement of the CA-125 antigen level every three months for two years, then every six months for three years then yearly.
  4. Repeat exploration by laparotomy or Laparoscopy in once year.
  5. Whole abdomen radiotherapy followed by four cycles of Platinum-based chemotherapy
Correct Answer
  1. Computerized tomography (CT) of the abdomen and pelvis every eight weeks for three years.
  2. Six courses of a Platinum (Cisplatin or Carboplatin)-based Chemotherapy.
  3. Physical examination and measurement of the CA-125 antigen level every three months for two years, then every six months for three years then yearly.
  4. Repeat exploration by laparotomy or Laparoscopy in once year.
  5. Whole abdomen radiotherapy followed by four cycles of Platinum-based chemotherapy
Explanatory Answer
Phase III clinical trials have demonstrated 8% improvement at five years, associated with the adjuvant delivery of platinum-based chemotherapy for high-risk, early stage ovarian cancer, compared with observation.

Chemotherapy should be given to patients with stage II disease or stage I, grade 3, cancer.

Chemotherapy is not necessary for patients with appropriately staged disease who have stage, I grade 1, ovarian cancers. It is uncertain whether adjuvant treatment should be given to patients with stage I, grade 2, cancers.

Case 3
  • A 35-years old woman presents with a primary symptom of abnormal vaginal bleeding.. Pelvic examination and the findings on analysis of a biopsy specimen indicate a squamous cell malignant lesion, which on further evaluation, is found to be a stage IIB cervical cancer.
  • Which of the following is the most appropriate next step in the treatment of this patient ?
Objectives
  1. External beam radiation therapy.
  2. Six cycles of cisplatin and paclitaxel.
  3. Three cycles of cisplatin and fluorouracil followed by radiation therapy to the pelvis.
  4. External beam radiation therapy followed by five cycles of cisplatin and ifosfamide.
  5. External beam radiation therapy plus with weekly cisplatin.
Correct Answer
  1. External beam radiation therapy.
  2. Six cycles of cisplatin and paclitaxel.
  3. Three cycles of cisplatin and fluorouracil followed by radiation therapy to the pelvis.
  4. External beam radiation therapy followed by five cycles of cisplatin and ifosfamide.
  5. External beam radiation therapy plus with weekly cisplatin.
Explanatory Answer
Several phase III randomized trials have demonstrated better DFS and OS associated with the concurrent administration of cisplatin-based chemotherapy and external beam radiotherapy for advance, localized cervical cancer.

Neither the adjuvant (following definitive local treatment) nor the neoadjuvant (prior to definitive local treatment) delivery of Cisplatin-based chemotherapy has been shown in randomized trials to have a favorable influence on survival.

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