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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize the signs and symptoms of ovarian cancer.

  • Describe the genetic factors associated with ovarian cancer.

  • Recommend a pharmacotherapeutic plan for the chemotherapy of newly diagnosed and relapsed ovarian cancer.

  • Describe the uses and potential pharmacologic advantages of pegylated liposomal doxorubicin.

  • Recognize the dose-limiting and most common toxicities associated with the chemotherapeutic agents used in the treatment of ovarian cancer.

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PATIENT PRESENTATION

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Chief Complaint

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“I’m very anxious about getting chemotherapy. My uncles have gone through chemotherapy for colorectal cancer and they became very sick. One of them was even admitted to the hospital due to the side effects. I don’t want that to happen to me.”

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HPI

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Edith Hillebrand is a 56-year-old woman who presents to the Gynecology Oncology clinic 1 week after surgery for stage IIIB (T2c N1 M0) serous epithelial ovarian adenocarcinoma. She originally presented to her PCP’s office 1 month ago with complaints of a 3-day progressive worsening of LLE pain, swelling, and redness. The physician ordered a Doppler ultrasound of the LLE. Results indicated that she had a DVT in the popliteal vein extending to the iliac vein. Her last physical exam was performed more than 15 months prior. The physician performed a complete history and physical exam and identified a left adnexal mass, abdominal pain, bloating, and weight gain. CT scans of the abdomen and pelvis showed a large, soft tissue pelvic mass. Laboratory examination revealed a CA-125 level of 490 IU/mL.

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Mrs Hillebrand underwent an exploratory laparotomy, TAH-BSO, omentectomy, and bilateral pelvic and periaortic lymph node dissection with comprehensive staging by a gynecologic oncologist. On entering the abdomen, there was a relatively small amount of ascitic fluid. A large left adnexal mass measuring 15 cm × 5 cm × 10 cm was discovered and removed. Multiple small tumor nodules (2 cm or less) outside the pelvis were also removed. Numerous adhesions were seen throughout the omentum and surrounding organs. At completion of the surgery, the surgeon noted that the patient was optimally debulked. Ascitic fluid, peritoneal washings, left adnexal mass, left and right ovaries, multiple pelvic and periaortic lymph nodes, and omentum were sent to pathology for further examination.

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Gross examination of left and right ovaries revealed multiple adhesions extending from each ovary with interspersed broad regions of necrosis. Each ovary was serially sectioned for microscopic examination, which revealed numerous papillations of tumor cells destructively permeating the stroma (grade 2). Based on this information, Mrs Hillebrand was diagnosed with stage IIIB (T2c N1 M0) serous epithelial ovarian adenocarcinoma.

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PMH

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  • Hypothyroidism × 30 years

  • HTN × 22 years

  • Type 2 DM × 17 years

  • Dyslipidemia × 15 years

  • GERD × 10 years

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FH

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Married × 37 ...

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