Advanced ovarian cancer that resulted in death from intestinal perforation following tumor lysis syndrome: A case report. (September 2022)

• Record Type: Journal Article
• Authors: Kunimoto, Saki; Tashima, Lena; Ito, Kimihiko; Hori, Kensuke
• Is Part Of: International journal of surgery case reports. Volume 98(2022)
• Publication Date: 2022-09
• Subjects: Tumor lysis syndrome -- Ovarian cancer -- Chemotherapy -- Intestinal perforation; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107518
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Tumor lysis syndrome (TLS) is an oncologic emergency, with 20 % cases occurring in solid tumors. Preventive measures are necessary depending on TLS risk. We report a case of TLS development after chemotherapy for advanced ovarian cancer which resulted in death by intestinal perforation. Case presentation: A 76-year-old woman with multiple metastases had multi-cystic mass in the pelvic cavity. We diagnosed stage IVB ovarian cancer after exploratory laparoscopy and imaging test. Paclitaxel and carboplatin were started as neoadjuvant chemotherapy. Since day 4 of chemotherapy, vomiting, appetite loss, and diarrhea manifested; blood tests on day 9 showed electrolyte abnormality and decreased renal function. We diagnosed TLS and ileus. Her symptoms disappeared and blood chemistry improved after electrolyte correction in intensive care unit. However, vomiting and arrhythmia worsened on day 11, consciousness level lowered, and computed tomography showed intestinal perforation. She died on day 13. Clinical discussion: Advanced ovarian cancer is at high TLS risk due to large tumors, multiple metastases, and impaired renal function caused by urinary tract stenosis. TLS reported in ovarian cancer had large tumor volume; disease onset was often within 1 week after chemotherapy. After TLS improves, follow-up is necessary to detect serious complications. In ovarian cancer with intestinal adhesions, intestinal perforation risk should be considered, and intestinal wall invasion may be evaluated before treatment. Conclusion: TLS can be followed by fatal complications; many advanced ovarian cancers are at high TLS risk. Therefore, prophylactic measures and adequate information to patients and families before chemotherapy are necessary. Highlights: Tumor lysis syndrome (TLS) in solid tumors is rare, but predictable to an extent. TLS risk should be evaluated and precautions taken. Chemotherapy-related intestinal perforation is still a risk even after recovering from TLS.