Devita, Hellman, and Rosenberg's Cancer

LWBK1006-37 LWW-Govindan-Review November 24, 2011 11:29

Chapter 37•Peritoneal Carcinomatosis 491

Question 37.18. A 45-year-old woman presented with lower abdominal pain, and imag-

ing study revealed a moderate amount of ascites with large peritoneal

implants and one suspicious 3×5-cm heterogeneous mass in the right

ovary. The patient also has high CA-125. FNA of the ovarian mass showed

a malignant serous type cells. No other lesions were seen. What would be

the next step of diagnosis or treatment?

A. Exploratory laparotomy with optimal surgical debulking

B. Systemic chemotherapy with platinum and paclitaxel

C. Surgical debulking and intraperitoneal chemotherapy

D. Surgical debulking and intraperitoneal chemotherapy followed by

systemic chemotherapy

Question 37.19. A 50-year-old man with a history of gastric cancer with diffuse peri-

toneal involvements progressed after two lines of chemotherapy, now

with persistent nausea, vomiting, and constipation. An abdominal CT

scan showed multiple air fluid levels but no clear obstruction transition

points. The patient also has poor performance status. What would you

consider to relieve his obstruction?

A. Diverting colostomy

B. Gastrostomy tube placement

C. Surgical exploration to locate the site of obstruction

D. Gastrointestinal (GI) evaluation for possible stent placement

Question 37.20. A 65-year-old man with progressive and refractory pancreatic cancer who

presented with a large amount of ascites resulted in shortness of breath

at rest. The patient underwent a large-volume paracentesis but returned

1 week later with reaccumulated fluid. What would be the next step to

manage his ascites?

A. Repeat paracentesis

B. Initiation of antidiuretics, such as spironolactone

C. Placement of a peritoneovenous shunt

D. Placement of a Denver catheter

Question 37.21. A 23-year-old woman presents with worsening abdominal pain and dis-

tention. CT scan of the chest and abdomen reveals multiple rounded

masses in the peritoneum and liver. Biopsy of the tumor nodule reveals

small round cells that were positive for both epithelial and mesenchy-

mal markers. Cytogenetic testing revealed t(11;12) (p13;q12). What is

the diagnosis in this patient?

A. Ewings sarcoma

B. Desmoplastic small round cell tumor

C. Gastrointestinal stromal tumor

D. Clear cell sarcoma