Introduction:
This is a case study of a 54-year-old lady who was diagnosed with Stage 4 Ovarian cancer and was told by her surgeon that she had little hope of survival and was likely to die within six months. The patient sought additional treatment options and was treated with chemotherapy and cytoreductive surgery resulting in complete disease control and a five-year remission period free of the disease.
Family Concerns:
The patient and her family were scared and anxious about the diagnosis and the prospect of chemotherapy. They were reassured that the disease could be controlled with treatment and that the patient would be able to lead a normal life.
Investigations:
The patient had a CT Scan of the abdomen & pelvis which showed extensive disease. A biopsy of one of the lesions showed a High Grade Serous Adenocarcinoma of the Ovary with a CA-125 of 3500. I asked for a full body PET-CT Scan to assess the extent of metastases. It showed involvement of both ovaries & fallopian tubes with the cancer, with spread into the uterus, pelvic and abdominal lymph nodes, there were deposits on the liver surface, omental, peritoneal and serosal deposits. Multiple lesions could be seen over the intestinal surfaces. The lungs however were still free of disease. Her routine blood tests & cardiac evaluation were normal.
A molecular work up that I performed showed a BRCA1 mutation, which explained why the disease had presented so early, when the patient was in her 50s.
Treatment Offered:
The patient was started on first-line chemotherapy with Paclitaxel and Carboplatin. She responded well to the treatment and an interim PET-CT scan performed after three cycles of chemotherapy showed an 80% reduction in disease load. At the completion of six cycles, the scan showed complete disease control with no active disease. A cytoreductive surgery was then performed to remove all areas of initial disease involvement.
Results:
The patient remained in remission for the next five years, undergoing regular scans and a close follow-up under the supervision of Dr. Sujata. A molecular profiling showed that the patient’s daughter was a BRCA1 mutation carrier and was at a high risk of future development of breast and ovarian cancer. The daughter was counseled to consider a risk-reducing surgery at a later age. This case illustrates the effectiveness of a combination of chemotherapy and surgery in treating advanced Ovarian cancer