Tariq Parvez.
Role of induction chemotherapy in inoperable ovarian cancer.
J Coll Physicians Surg Pak Jan ;9(1):49-52.

Induction chemotherapy can be effective in debulking inoperable ovarian cancer resulting in successful resection, followed by elimination of minimal residual disease and prolonged disease free survival by consolidation chemotherapy.

CASE REPORT: A female patient named T.K. aged 48 admitted in medical ward from 24-7-95 to 12- 8-95 with general complaints of abdominal distention, low grade fever, generalized weakness and constipation on and off of one month duration. From there she was shifted to gynae ward as a case of tubo-ovarian mass based on ultrasound o abdomenopelvic region and tumor marker, CA-125 of 886 u/ml (Normal: <35u/ml). This patient was married but marriage lasted only for 3 months. She was Po+o. Menarch was at 13 years of age, Menopause 4 years back. Nothing relevant in menstrual, past or family history. On physical examination abdomen was protuberant, tense and slightly tender. Shifting dullness and fluid thrill was present and due to ascites mass could not be properly assessed. She had left leg edema probably due to pelvic nodal comparession. On per vaginal examination cervix was nulliparous, an ill defined mass was noted in the anterior fornix but size could not be assessed and uterine body could not be felt separately. There was fullness in both fornices due to ascites. On ultrasound a large complex mass predominantly solid with cystic changes, irregular in outline was seen in the pelvis. Mass measured 12.3cm x 7.3cm x 10cm. The solid component also showed calcification. Uterus could not be separated from the mass, measured 6.2 x 2.5 x 3.5cm. Ascites was present with septation extending from pelvis to the epigastrium. Intestinal loops showed adhesions with the mass and lymph nodes could not be seen. Left sided pleural effusion was also observed. X-rays of abdomen with erect and supine film showed multiple air fluid levels but no abnormal dilatation of loops or free gas under the diaphragm, which showed partial intestinal obstruction. On x-ray chest there was a patch in the left lower zone. On IVP and plain abdominal film, a soft tissue dense mass was seen occupying the pelvis with extension over the sacrum. IVP revealed slight prominence of pelvicalyceal system and upper urinary passages on both sides due to the pressure of pelvic mass. Urinary bladder also showed smooth cresenteric pressure effect superiorly due to the mass. Urinary bladder film showed retention of the contrast; rather it was delayed emptying of pelvicalyceal system and urinary bladder due to compression of the mass. Ascitic fluid taping revealed bloodstained, yellowish fluid with some clots. Microscopy revealed clusters of adenocarcinoma cells with glandular appearance as well as some signet ring formation, papillary groups were also seen. Cellular appearance was consistent with moderately differentiated adenocarcinoma and ovarian tumour was most likely primary. Pleural tapping revealed blood stained, sterile tap without malignant cells so it was diagnosed as `Ca ovary stage IIIc.` According to the condition of the patient it was decided to proceed with induction chemotherapy. Continued..

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