A 56-year-old woman with no relevant personal history presented in June 1995 with progressive abdominal pain and distension of 3 months duration.
Physical examination revealed a distended abdomen with semiology of ascites, not tension.
There are no signs of liver disease or heart failure.
Complementary examinations showed basic biochemistry and complete blood count without alterations, tumor markers with Ca 125: 35 Ul/ml, Ca 19.9: 37 Ul/ml and CEA: 8 Ul/ml.
Diagnostic paracentesis is tried, but it is unsuccessful in several attempts.
Imaging tests revealed ascites, adenopathy and several peritoneal nodules; normal and normal gynecological ultrasound.
Finally the patient underwent exploratory laparotomy finding a moderate amount of ascites with abundant mucus, multiple adhesions to the intestine and gynecologic adnexa, numerous implants in the omentum, abdominal wall and peritoneal cavity.
Hysterectomy was performed with double adnexectomy, pelvic lymphadenectomy, cystectomy and right hemicolectomy.
Surgery is not radical, with residual disease greater than 2 cm.
Anatomopathological analysis of the specimens reported peritoneal carcinomatosis due to adenocarcinoma of the appendix; colon and ovary without alterations.
Postsurgical CT showed tumoral nodules in the omentum and peritoneum.
Tumor markers had decreased to normal levels (CEA: 1.7 Ul/ml; Ca 19.9:27 Ul/ml).
It was decided to administer chemotherapy with the Mayo Clinic scheme (5FU-FA).
The patient was treated for one year with a total of 12 cycles, with disappearance of CT images and normalization of markers.
Since February 1997 the medical profession has been under control.
During follow-up, slow growing peritoneal nodules were observed, with a progressive increase in tumor markers.
Therapeutic abstention is chosen because the patient remains asymptomatic.
When nodules grew, a biopsy was requested in June 2001, which confirmed peritoneal relapse of adenocarcinoma to the colon.
At that time, it was decided to portray the case with a Mayo Clinic scheme for a total of 8 cycles, reaching stable disease criteria.
It was decided to continue third-line chemotherapy with Tomudex-Oxaliplatin (6 cycles).
The response was again stabilisation in August 2002.
Since then the patient remains oligoasymptomatic with active life, and with the presence of multiple peritoneal nodules that form a crust in the abdominal wall.
In December 2003, the disease progresses with compression of the horsetail secondary to a presacral mass.
She received radiotherapy, relieving pain and without neurological deficit.
The disease situation in October 2004 is the slow deterioration of the general state due to disease progression, anemia and malnutrition due to difficulty in ingestion due to underestimates.
