I HAVE NO CONFLICT OF INTREST METASTATIC ENDOMETRIAL CARCINOMA - - PowerPoint PPT Presentation

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Jun 08, 2023 113 likes •304 views

I HAVE NO CONFLICT OF INTREST METASTATIC ENDOMETRIAL CARCINOMA AN ILLUSTRATIVE CASE STUDY DR OKUMU JOEL OMONDI UNIVERSITY OF ZIMBABWE PART II MMED RADIOTHERAPY & ONCOLOGY CONSULTANT- DR NYAKABAU .A. DEMOGRAPHIC DATA J.C 61

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I HAVE NO CONFLICT OF INTREST

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METASTATIC ENDOMETRIAL CARCINOMA

DR OKUMU JOEL OMONDI UNIVERSITY OF ZIMBABWE PART II MMED RADIOTHERAPY & ONCOLOGY CONSULTANT- DR NYAKABAU .A.

AN ILLUSTRATIVE CASE STUDY

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DEMOGRAPHIC DATA

J.C
61 years old
Unemployed widow
Lives with her daughter outside Harare

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PRESENTATION

Presentation
lower abdominal pain x 1/12
Post menopausal intermittent PV bleeding x 2years

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HISTORY OF PRESENTING ILLNESS

Gynecologists did a cervical punch biopsy which

showed widely invasive poorly differentiated

adenocarcinoma. Endometrial origin could not be ruled
ut
CT scan pelvis - Enlarged uterus with thickened

endometrial cavity, obstruction of the cervix and evidence of periuterine infiltration with bilateral inguinal lymphadenopathy

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Imaging

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FAMILY AND SOCIAL HISTORY

No history of smoking or alcohol intake
No history of malignancy in the family.
No history of TB contact

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PAST MEDICAL HISTORY

Hypertensive on HCT 25 mg
Gynecological history

– Menarche at 14 years – Menopause at 58 years – P8+0 – No history of contraceptive use

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EXAMINATION

On presentation to the oncologist
Good general condition, obese, pink, no lymphadenopathy , ECOG 1
Abdominal exam
mass arising from the pelvis measuring ~22/40
VE
Huge fungating cervical mass extending to the lower 1/3 vaginal wall anteriorly
DRE
Anteriorly rectal wall feels smooth and freely mobile

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INVESTIGATIONS

CXR – normal
Abdominal USS –
No liver metastasis
No abdominal lymphadenopathy
No hydronephosis
FBC, U/E/Cr, LFTs – normal
HIV negative

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MANAGEMENT

MDT held – metastatic endometrial carcinoma
MDT consensus was to give palliative chemotherapy
Chemotherapy IV carboplatin AUC 6 and Paclitaxel at

175mg/m2 was given for 3 cycles Q3W then reviewed.

After the third cycle the tumor had minimally shrunk to ~

8cm (previously ~10cm)

Chemo increased up to 6 cycles

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RE-EVALUATION

After the 6th cycle patient was re-evaluated
Good general condition, ECOG 1
On

VE there was minimal disease regression with a palpable tumor extending to the lower 1/3 vagina + contact bleeding.

DRE- rectal mucosa free of tumor.

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RE-STAGING INVESTIGATIONS

Could not afford CT scan chest abdomen and

pelvis.

Had an abdominal pelvic USS
no liver metastases
No lymphadenopathy. No hydronephrosis
There was an irregular shaped solid mass seen on

the borderline of the left lumbar and left iliac region attached to the fundus of the uterus (7.4x6)cm in diameter. Endometrium thickened measuring 2.3cm.

Cervix is bulky and irregular shaped measuring 5.6

cm in AP diameter. No fluid in the POD

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MDT HELD

2nd line chemo initiated
Doxorubicin 60mg/m2 + cisplatin 50mg/m2 Q3W
Last cycle Oct 2017

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QUESTION???

Is there anything else that could have been done

surgically?

Would the sequencing of chemotherapy be

different ?

Is there a role of targeted treatment ?

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