instruction: hello doctor I would like to know about weekly chemotherapy for peritoneal cancer of 76 year old lady instead of full dose chemotherapy at 21 days interval weekly chemotherapy is done at a lower dose to have a less side effects first chemo charged on her caused severe side effects like dysentery diarrhea please confirm this whether this is really fruitful for elderly patients whether the weekly scheme is as effective and less toxic please help with your answer I am writing for my writing for my 76 year old sister suffering primary peritoneal carcinoma before four years one my medicine while treating her for asthma problem detected by clinical examination a huge lump in abdomen he ordered for us of lower abdomen and pelvis the report says kidneys both kidneys are normal in size but maintains shape outline and position cortical echogenicity is increased with maintained corticomedullary differiention no evidence of any hydronephrosis renal calculus or mass lesion is seen right kidney 4 am left kidney 5 am ureter both ureters are not visualized hence not dilated urinary bladder urinary bladder is seen normal in size shape and wall thickness no intraluminal lesion is seen uterus and ovary it is not visualized removed in 1996 suprapubic region mesentery is grossly thickened and appears as sol 10 4x5 am with displaced bowel loop around it impression mesenteric mass suggest it scan bilateral small size kidneys with grade I renal parenchymal changes next seen by an oncosurgeon he ordered for noncontrast it of upper abdomen noncontast because as her creatinine level was 9 compared to a maximum of 0 for females it scan of upper abdomen done and report shows the liver is of normal in size and is of normal contour and attenuation no ihr dilation gallbladder is well distended with normal wall thickness pancreas is normal in size and attenuation peripancreatic fat planes normal mad not dilated spleen is of normal size contour and attenuation no focal lesions sections through the lower abdomen show mental fat stranding and nodularity the bilateral kidneys are mildly contracted the pelvicalyceal system are normal adrenals are seen no evidence of any focal lesions no evidence of ascites no retroperitoneal lymphadenopathy is noted visualized bowel loops reveal normal in position caliber and wall thickness scoliosis noted with convexity towards left side impression mental stranding and nodularity the surgeon also asked for contrast enhance mri of pelvis the report shows mri report patient postoperative case of ovarian malignancy no documents available study reveals mental thickening and nodularity caking there is a focal protrusion of the momentum through a defect in the umbilicus postoperative post contrast study shows enhancement of the momentum dwi images show restricted diffusion within the momentum no abnormal lymphadenopathy seen bones under review are within normal limits uterus and ovaries are not visualized postoperative there are minimal pelvic ascites on post contrast study thin smooth peritoneal enhancement is seen with few nodules at places enhancement is also noted along the sigmoid and descending colon impression modular cake like mental thickening smooth peritoneal enhancement with nodularity at places in a patient with previous malignancy features suggest possibility of peritoneal carcinomatosis advise mental biopsy next core needle biopsy from mental mass was ordered the report shows us guided core biopsy from mental mass microscopic examination section shows deposition of malignant gland formed by cuboidal cells within fibre collagenous tissue with desmoplastic stromal reaction impression adenocarcinoma deposit I have forwarded to you four reports in respect of her for us it scan mri biopsy probably she is suffering from extra ovarian primary peritoneal cancer eopcc which happens to candidates whose ovary uterus already removed for her hysterectomy was done some 20 years back when biopsy report was normal please also note that her ca 125 is 2948 almost 80 times the normal value please intimate me in short whether any first dose of chemotherapy given caused heavy side effects like acute dysentery diarrhea for her whether at this age of 76 chemo with one single drug is advisable as per discussion with doctors here this peritoneal cancer resembles almost like ovarian cancer treatment mode also same although ovary removed some 20 years back
output: hi I have read through your query in detail please find my observations below the investigations conclude the presence of peritoneal cancer which has characteristics like that of ovary cancer most patients are diagnosed at stage I or iv and chemotherapy is the preferred treatment I confirm that the treatment is same as ovary cancer chemotherapy protocols are being updated every day but what your doctors have suggested is in the right direction treatment is usually with medicine like carboplatin and paclitaxel with some patients being given cisplatin dysentery and diarrhea are known adverse effects of chemotherapy and occur in some patients weekly treatment is good as full dose chemotherapy with comparable rates of response talking about single drug and multi drug options every cancer is different and the treatment course is closely monitored and changes made appropriately every cancer patient is different and changes should be made after carefully studying the patient condition in conclusion as a patient relative you can help maintain a good general condition of the patient and give adequate fluids and nutrition side effects are uncertain and cannot be predicted I hope this helps