Cancer Support Group

Saturday, Jul 11th

Last update:06:42:40 AM GMT

Case Discussion

Case 7
  • A 20 year old woman with a one week history of fairly intense pelvic pressure is seen by a physician. On palpation, the physician feels a mass, and a CT scan abd. & pelvis showed a large rt. ovarian cyst. Exploratory surgery, performed by a general gynecologist, benign cyst is found, but a small portion (less than 10 %) of the mass is found to be an endodermal sinus tumor. There is no evidence of disease outside of the ovary. Postoperatively, the beta-human chorionic gonadotropin (HCG) and alpha-fetoprotien levels are within normal limits.
  • Which of the following is the most appropriate next step in the treatment of this patient ?
Objectives
  1. Observation, with monthly monitoring of tumor markers (beta-HCG< alpha-fetoprotein).
  2. Repeat exploratory surgery performed by a gynecologic oncologist.
  3. Chemotherapy with blemomycin, etoposide, and cisplatin (BEP).
  4. Chemotherapy with carboplatin and paclitaxel.
  5. Chemotherapy with carboplatin and paclitaxel followed by high-dose.
Correct Answer
  1. Observation, with monthly monitoring of tumor markers (beta-HCG< alpha-fetoprotein).
  2. Repeat exploratory surgery performed by a gynecologic oncologist.
  3. Chemotherapy with blemomycin, etoposide, and cisplatin (BEP).
  4. Chemotherapy with carboplatin and paclitaxel.
  5. Chemotherapy with carboplatin and paclitaxel followed by high-dose.
Explanatory Answer
Endodermal sinus tumors are uncommon but extremely aggressive ovarian neoplasms. Even if apparently localized at the time of surgical exploration, most of these cancers will have micrometastatic spread beyond the confines of the ovary at the time of initial diagnosis.

Adjuvant standard-dose chemotherapy Endodermal sinus tumors are uncommon but extremely aggressive ovarian neoplasms.

Case 8
  • A 45 year old woman is found to have a locally adv. Ca Cx that is treated with RT + Cisplatin (40 mg/m2 ). At the completion of RT, the patients condition appears to be improved but she has persistent disease. Which is confirmed by CT. Two months after the completion of CTRT, the patient reports having back pain that prevents her from sleeping. She also notes a major decrease in appetite and a loss of 15 pounds over the past month. A repeat CT scan demonstrated a number of newly enlarged retroperitoneal lymph nodes 3-4cms, a growing pelvic mass 4-5cms, and several pulmonary nodules 1-3cms, which were not present on the previous Ct scan.
  • Which of the following would your recommend ?
Objectives
  1. Surgery to remove the pelvic mass and enlarged nodes, followed by chemotherapy with cisplatin and paclitaxel.
  2. Chemotherapy with cisplatin and ifosfamide.
  3. Pelvic exenteration followed by surgical removal of the pulmonary nodules.
  4. Palliative measures to treat symptoms and provide comfort.
  5. Whole abdomen radiation therapy followed by cisplatin based chemotherapy.
Correct Answer
  1. Surgery to remove the pelvic mass and enlarged nodes, followed by chemotherapy with cisplatin and paclitaxel.
  2. Chemotherapy with cisplatin and ifosfamide.
  3. Pelvic exenteration followed by surgical removal of the pulmonary nodules.
  4. Palliative measures to treat symptoms and provide comfort.
  5. Whole abdomen radiation therapy followed by cisplatin based chemotherapy.
Explanatory Answer
Must focus on comfort measures, pain management.

There is less than 5% to 10% chance that second line chemotherapy will relieve symptoms . In addition , any objective or subjective benefits of therapy are likely to be brief (less than 2-3 months).

Patients with good KPS should be consider for phase I and II trials. Surgical resection or radiation therapy to the whole abdominal cavity has no role in the treatment of wide spread metastatic Cervical cancer.

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