A 30 year old lady, presented to MIOT with recurrent stage IV carcinoma ovary in May 2015.

Patient history:

She is a known patient of cancer of both ovaries first diagnosed in 2011 in Seychelles.  She underwent complete removal of both ovaries and uterus at her place, following which she received 6 cycles of chemotherapy. She was disease free for alomst 4 years.

Relapse with inoperable stage 4 recurrent ovarian cancer:

During follow up, in March 2015, the blood tests and scans suggested that the cancer had come back. Scans done at her place, showed recurrent disease through out her entire abdomen. It was involving the whole of inner lining of abdomen(peritoneum), spleen,liver, large intestine and rectum. She was declared inoperable stage 4 recurrent ovarian cancer and sent for palliative chemotherapy.  But this young lady was determined to fight.

Approach to MIOT:

She presented to MIOT in the month of May 2015. She was completely re-evaluated and the above scan findings were confirmed.  The Doctors explained her that certain cancers like ovary, colorectal even in stage 4, when appropriate chemotherapy and surgery done, there is a possibility of 5 year survival upto 30- 40%.

Ray of hope :

She readily started with second line of chemotherapy to fight her last stages of cancer. She completed six cycles of chemotherapy between 28.05.15 and 08.02.16. The scans showed good response and reduction in disease status due to chemotherapy. She was advised surgery to completely remove all the disease inside the abdomen.

Her surgery was planned in  March 2016, but due to personal reasons, she did not take it up. She came back in August 2016 for surgery. PET CT scan showed increase in disease extent as the patient was off therapy for last 6 months. Also she developed a cancer nodule in umbilicus. Without wasting further time, we immediately took her for surgery.

Treatment given:

She underwent a supra major surgery which lasted for 16 hours. A complete removal of entire peritoneum, part of rectum, part of large intestine, part of stomach, part of liver, part of pancreas, spleen and umbilicus was completely removed. All visible disease inside the abdomen was removed and HIPEC treatment given in the same setting. A stoma was made to divert the fecal matter, so as to enable the healing within intestines.

Advantage MIOT:

A special procedure called HIPEC (Hyperthermic intraperitoneal chemotherapy) was offerred.  HIPEC involves infusion of heated chemotherapy inside abdomen, after completion of surgery. It  will help in eradication of microscopic disease, prevent disease recurrence and improve survival of the patient. These advanced facilities are available only in very few centres.

Relapse to Recovery:

Patient was in ICU for two days and had a phenomenal recovery. She had minor problems like wound hematoma, minor blood clot in veins, but had an uneventful recovery. She was fit for chemotherapy within a month. She completed all six cycles of chemotherapy. Patient is on routine follow up. Her latest blood tests(ca 125) and scans suggests that she is free of cancer.

Patient is happy and very active. She resumed her normal work after four months post surgery.  This patient was told that, she will live only for few more months in May 2015 at Seychelles, but she has already lived with stage 4 cancer for 2 and half years.

Thanks to the excellent chemotherapy, the heroic marathon surgery, HIPEC and all state of art facilities at MIOT which helped in saving the life of this patient. As of now, she is under close follow up. Hence, this brave lady is an example for similar patients with stage 4 cancer, because at MIOT we still have a ray of hope for you.

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