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

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 years old • Unemployed widow • Lives with her daughter outside Harare

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

HISTORY OF PRESENTING ILLNESS • Gynecologists did a cervical punch biopsy which showed widely invasive poorly differentiated adenocarcinoma. Endometrial origin could not be ruled out • CT scan pelvis - Enlarged uterus with thickened endometrial cavity, obstruction of the cervix and evidence of periuterine infiltration with bilateral inguinal lymphadenopathy

Imaging

FAMILY AND SOCIAL HISTORY • No history of smoking or alcohol intake • No history of malignancy in the family. • No history of TB contact

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

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

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

MANAGEMENT • MDT held – metastatic endometrial carcinoma • MDT consensus was to give palliative chemotherapy • Chemotherapy IV carboplatin AUC 6 and Paclitaxel at 175mg/m 2 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

RE-EVALUATION • After the 6 th 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.

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

MDT HELD • 2 nd line chemo initiated • Doxorubicin 60mg/m 2 + cisplatin 50mg/m 2 Q3W • Last cycle Oct 2017

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 ?

THANK YOU ASANTE SANA TINOTENDA SIYABONGA MERCI EROKAMANO DANKIE GRACIAS