Successful Treatment of Advanced Ovarian Cancer in a 78 Year Old Patient

The management of ovarian malignancy at an advanced stage in older patients is a unique task because of changes in physiology due to the aging process, other health problems in addition to the problem of complicated oncological surgery. The success of treatment depends on proper patient selection, careful planning for surgery, teamwork, and post-surgery care. In the case of an old female patient with ovarian malignancy at an advanced stage who was operated on in Kailash Hospital, Noida, it can be said that the new field of geriatric oncology is playing a vital part.

Presentation of Symptoms (if any)

The patient presented with:

• Progressive abdominal distension
• Recurrent episodes of vomiting
• Gradual decline in appetite and general well-being

These symptoms were present 6 months back for which she underwent detailed evaluation and major surgery of Cytoreductive surgery.

Diagnosis

Comprehensive clinical examination and radiological investigations confirmed the diagnosis of advanced ovarian malignancy.

Considering the extent of disease and the patient’s overall clinical condition, a multidisciplinary tumor board recommended aggressive cytoreductive surgery followed by systemic chemotherapy with curative intent.

Condition Overview

Ovarian cancer is usually detected at the advanced stages since the signs are subtle and non-specific. The treatment of cancer in older people becomes more complicated since they have low physiological reserves, multiple heart and other systemic diseases and high probability of postoperative complications.

This case is remarkable as the woman was 78 years old and needed to undergo one of the most invasive operations done in surgical oncology. At that, she had an excellent result of multimodality therapy for cancer followed by another operation with significantly impaired heart function with ejection fraction being 20%.

This case shows that age should not limit treatment options since under proper preparation and involvement of multidisciplinary team, good results can be obtained in cancer therapy even in elderly patients.

Treatment Plan

After comprehensive preoperative optimization, Dr. Manish Sahni, Consultant Surgical Oncologist, along with Dr. Vinod Tiku, Oncosurgeon, performed extensive cytoreductive surgery.

The procedure included:

• Exploratory laparotomy
• Total Abdominal Hysterectomy (TAH)
• Bilateral Salpingo-Oophorectomy (BSO)
• Bilateral pelvic lymph node dissection
• Omentectomy
• Peritonectomy
• Small bowel resection
• Creation of a stoma for intestinal diversion

Following successful recovery from surgery, the patient completed the planned course of chemotherapy under close oncological supervision.

Subsequent staging investigations demonstrated complete response with no evidence of residual disease.

After the cancer treatment had been successful, she was scheduled to have her stoma reversed. During the pre-operative evaluation, two-dimensional echocardiography showed a LVEF of 20% which placed her at a very high anesthetic risk.

However, despite the difficulties posed, she was well-prepared by the multidisciplinary team and successfully had stoma reversal surgery while under high-risk general anesthesia.

Outcome and Follow-Up

The patient’s postoperative recovery remained smooth despite the complexity of surgery and her severe cardiac dysfunction.

Key recovery milestones included:

• Oral liquid diet initiated on Postoperative Day 2
• Soft oral diet started on Postoperative Day 4
• Gradual recovery of bowel function
• Stable postoperative course without major complications

She was discharged in a stable condition on Postoperative Day 7.

Follow-up evaluation confirmed:

• No residual ovarian cancer
• Successful restoration of bowel continuity
• Excellent functional recovery
• Continued disease-free status on surveillance

Conclusion

This remarkable case highlights the evolving role of specialized geriatric oncology in managing advanced cancers among elderly patients. It demonstrates that advanced age and associated medical comorbidities should not automatically exclude patients from receiving potentially curative treatment.

The successful performance of major surgeries, including cytoreductive surgery and high-risk stoma reversal in spite of the dramatically impaired heart function shows that careful patient evaluation before operations is essential for optimal patient outcomes.

With the help of the highly skilled Dr. Manish Sahni and Dr. Vinod Tiku, this case shows a good example of the ability to restore good health in elderly patients suffering from advanced malignancies with the help of comprehensive oncological care.

Clinical Significance

This particular case of special geriatric oncology proves that properly chosen elderly patients with advanced ovarian cancer have all chances to get excellent results after proper treatment.