Remission of adenocarcinoma

History A 69 y/o female had h/o ovarian adenocarcinoma IC2 15 years back. She had underwent chemotherapy and surgery at that time. Her reports were fine after chemotherapy. Chief Complaint Yesterday she came with abdominal pain, fever & bloating. Investigations Her serum CA-125 level raised to 94 U/ml. CT shows enlarged (2.2 cm) right internal mammary lymph node. Treatment What should be done now?



Serum raised level of CA 125 to 94u / ml and CT report shows enlarged( 2.2 ) right internal mammary LN. Needs radical resection of LN . Chemotherapy is the best treatment at this age . Oncologist evaluation and opinion required.

Thanks Dr Pushkar Bhomia

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You need to rule out if it is another primary carcinoma, or recurrence or metastasis of previous carcinoma Get PET scan done first, if mets seen, chemo is only option However is carcinoma seems to b confined then biopsy for type or lesion, decision for chemo/radiation accordingly

Recurrence of adenocarcinoma with metastasis She will need chemoradiotherapy Sos may need surgical intervention Take an opinion of oncologist

Thanx dr Pushkar ji Bhomia

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Tnx Dr Ashok Leel sir

In view of she being of 69 , Chemotherapy is the best alternate. Still opinion of Oncogist is the final one.

Raised CA 125 can be normal, but when CT shows enlarged Right IMLN, it is more suggestive of a recrrence with metastasis . As involvement of lymph nodes in pry disease is very very rare. So she needs chemotherapy and follow up also monitoring of CA 125 levels.

Do you know what the histology was , serous or clear cell? what is the cause of the fever? I would repeat the CT and CA-125 in 6 weeks and if still increasing in size would consider a biopsy. 15 years is a long time to relapse, and one should want to make sure it is not something else. (second malignancy, lymphoma). CA-125 is a good marker to follow a patient, not to diagnosed.

Remission allows for the possibility that some microscopic, undetectable cancer remains in the body, while cancer-free indicates exactly what it sounds like: the patient is entirely free of cancer.

Radical Surgery of lymphnodes & chemotherapy & Radiotherapy consult Onchologist


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