Medanta

Patient ID : MM01738680 Patient Name : Mrs. Reeta Sood

Gender : Female Age : 70Y

Encounter ID : 194711040001 Encounter Type : Outpatient

Visit Date : 21/11/2022 12:14 Location : Medical Oncology & Hematology

Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Ashok Vaid & Team

Note Type : Medical Oncology OPD Note Med/Anc Service : Med Onco& Hemat
Date/Time : 21/11/2022 12:58 Performed By : Dr Devender Sharma

Medical Oncology OPD Note

Known DM
No h/o Joint disorder /Autoimmune disease /skin disease
Investigated for Urinary Retention, catheterization done
CT KUB - Multiple liver Sols, cervix wall thickening infiltrating UB and ant. Wall of rectum, moderate HDN, B/L
External iliac LAP

5.12.20
CECT -PET scan -Hypermetabolic heterogeneously enhancing infiltrative mass involving the cervix with
extensions and relations as described with pelvic lymphadenopathy and multiple hypermetabolic lesions in
liver and lung, suggestive of metastatic spread

Family counselled about need of biopsy

Biopsy- Sq .cell carcinoma
Family expalined about stage IV nature of diseaae and non curative intent of treatment
Plan:- Weekly Nab. Paclitaxel/Carboplatin
15.3..21
Due for 11 th weekly dose
Pt. reprots improvment in general condition
CECT -PET scan - Interval reduction in the primary heterogeneously enhancing infiltrative mass involving the
cervix with significant metabolic regression in the pelvic lymphadenopathy as well as liver metastases. The
metastatic lung nodules also show interval reduction in size and number, suggesting response to therapy

Response statue explaned to the family , and further plan to contniue with same paln , intent of treatment will
contniue to be pallaitve /non curative
14.04.21 -received last dose (14th)
11.5.21
Video consult
Pt. had COVID 19 -0n 7.5.21

29.5.21
Video consult
CECT -PET Scan- Interval progression in the primary infiltrating cervical mass as well as mesorectal lymph
nodes while other pelvic nodes are stable. Interval increase is also seen in the liver and lung metastases
(although a single lesion in right upper lobe does show interval reduction). Hypermetabolic sclerotic lesions
in sacrum and left ischium also noted; suggesting overall disease progression

Family expalned about progression of disease

4.1.220 - CECT -PET SCan- Cervix appears bulky with FDG vid irregular heterogeneously enhancing
circumferential lesion involvingboth anterior and posterior walls, with infiltration into the posterior wall of
urinary bladder. Fat planes with the rectum and sigmoid colon posteriorly also appear ill defined. Inferiorly the
lesion is infiltrating the vagina. Superiorly, it is involving the lower uterine segment with gross distention of
the endometrial cavity with large collection/fluid within. There is suggestion of parametrial extension with

Authorized by Dr Devender Sharma on 21 Nov 2022 13:02 This is a computer generated report. Signature is not required.

Regd. Of f ice: Global Health Limited, E-18 Def ence colony , New Delhi, 110024 , India T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 help-line: +91(124 )4 14 14 14 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U85110DL2004 PLC128319
 Medanta

Patient ID : MM01738680 Patient Name : Mrs. Reeta Sood

Gender : Female Age : 70Y

Encounter ID : 194711040001 Encounter Type : Outpatient

Visit Date : 21/11/2022 12:14 Location : Medical Oncology & Hematology

Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Ashok Vaid & Team

diffuse paracervical fat stranding bilaterally,Multiple FDG avid heterogeneously enhancing enlarged lymph
nodes are noted in the bilateral external iliac and obturator locations; largest measuring approx. 2cm in SAD.
Few FDG avid mesorectal lymph nodes are also seen, larger measuring 10mm in SAD
25.3.21 - PET scan- Volume of local disease 57 cu/cm
28.5.21 - 109 cu/cm
Plan is to contniue with same drug with addition of bevacizumab ( after discussion with family)
Opiinon form RT for palliation of local disease
02. 06.21:
I have counselled the family regading the potential side effects of bevacizumab icliuding hypertension,
internal bleeding, perforation etc
8.6.21
2D ECOH - 55% EF
10.6.21
Video consult
Complete Blood Count (CBC) with Differential, Renal Function Test (RFT), Liver Function Test (LFT) &
Random Blood Sugars (RBS) - acceptable
18.6.21
Due for next dose of Nab. Paclitaxel/Carboplatin and Bevacizum ab
Had 1 episode of bleeding PR
CBC/biochem- acceptable
25.6.21
MSI - low
PDL 1 - 50 -60%
Family explained about ,further mangment , to contniue with chemo and bev or to add IO to chemo ,
Imn view of clinical response planned t ocontinue with Nab Paclitaxel/Carboplatin and Bevacizumab and do
early assessment
27/8/21
Proxy;-
CECT -PET scan -Interval increase in size and number of bilateral multiple FDG avid lung nodules.
Few moderately defined hypodense liver lesions with no significant FDG uptake presently.
Heterogeneously enhancing FDG avid ill-defined mass lesion involving the cervix and lower uterine segment
as before.FDG avid sclerotic lesions are seen in lower sacrum, left ischium and upper cervical vertebrae, as
before
I have explained t othe family about disease progression .
And further options in treatment include immunotherapy or best supportve care
Intent of treatment shall remians non curative
Family will decide and come back
4.9.21
S.Cortisole level -10.3
2D ECHO - 55% EF
Recieved Pembrolizumab on 8.9.21

4.10.21 - 2nd dose of Pembrolizumab

11.11.21
Overdue for 3rd cycle
Patient had SKin Rashes ? Pembrolizumab induced
Has recieved 2 weeks of Wysolone with inadequate response
Residula Rashes still persists (Grade 2/3 ) '

Authorized by Dr Devender Sharma on 21 Nov 2022 13:02 This is a computer generated report. Signature is not required.

Regd. Of f ice: Global Health Limited, E-18 Def ence colony , New Delhi, 110024 , India T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 help-line: +91(124 )4 14 14 14 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U85110DL2004 PLC128319
 Medanta

Patient ID : MM01738680 Patient Name : Mrs. Reeta Sood

Gender : Female Age : 70Y

Encounter ID : 194711040001 Encounter Type : Outpatient

Visit Date : 21/11/2022 12:14 Location : Medical Oncology & Hematology

Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Ashok Vaid & Team

22.11.21
Afebrile
CBC/biochem -acceptable
Skin rashes are Resolving
Pt and family counselled , about holding further treatment till resolution of skin rashes

7.12.21
Skin rashes are Resolving
Afebrile
CBC/biochem -acceptable
4.1.22
Proxy;-
CECT -PET SCan -Interval decrease in primary mass and lung metastasis. Please see above detailed
description.Interval appearance of FDG uptake with increase in size of right external iliac node.
Expalned to the family about need and intent of pallaitve chemotherapy
Plan - Gemcitabine /Avastin weekly

24.3.22
Due for next cycle ( delayed)
Not on Regular treatment ( having multpile delays due to UTI /Hypoerkalcemia_)

26.5.22
Due for 9th dose Gemcitabine /Avastin weekly
tolerating well
general condition better
fully ambulatory
Afebrile
CBC/biochem- acceptable
Urine R/M- Pus cells -2096

31.5.22
Symptmoaitcally beeter
Afebrile
Blood accepeptable

Advised;
admit day care
CECT -PET SCan after 10 days

20/06/2022
Proxy visit.
CECT-PET scan (16/06/2022)-
Significant regression in the metastatic lung nodules while the primary mass as well as right external lilac lymph node
are largely stable . A right inguinal lymph node shows interval increase in size with appearance of metabolic
activity, needs sampling to exclude metastases
Patient counselled regarding PET scan findings and need for FNAC.

12.7.22
Proxy

Authorized by Dr Devender Sharma on 21 Nov 2022 13:02 This is a computer generated report. Signature is not required.

Regd. Of f ice: Global Health Limited, E-18 Def ence colony , New Delhi, 110024 , India T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 help-line: +91(124 )4 14 14 14 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U85110DL2004 PLC128319
 Medanta

Patient ID : MM01738680 Patient Name : Mrs. Reeta Sood

Gender : Female Age : 70Y

Encounter ID : 194711040001 Encounter Type : Outpatient

Visit Date : 21/11/2022 12:14 Location : Medical Oncology & Hematology

Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Ashok Vaid & Team

Due for next Gem /Bevacizumab

No new symptmos
Afebrile
CBC/biochem- acceptable
Right Inguinal node- Compatible with metastatic carcinoma
In vie LN psotive , further paln is to add Cisplaitn ( Platinam last received in Aug 21) , intent wil lremanis no curaitve
Plan; Inj. Gemcitabine IV day 1,8 Q 3 weekly
In.j Cispaltin 25 mg/m2 IV vday 1,8 Q 3 weekly
Inj. Bevacizumab 7.5 mg /kg Q 3 weekly
Advised;-
Urine Microalbumin

17.08.22
PROXY visit
Was due for D8 on 03.08.22 - delayed in view of UTI , received a course of antibiotics
presently better, no history of fever
post 3 weeks after cycle 1 day 1 - day 8 not taken
CBC, Biochem, PT/INR - acceptable
Adv :
- Urine microalbulin
- Review with patient tomorrow with above report for admission for cycle 2 day 1

31/08/2022
Over due for cycle 2 day 8
Proxy visit
No fresh complaint
CBC/LFT/RFT : ACCEPTABLE : TLC 14000 Na 130 , Urine Microalbumin : 45
To review with patient coming morning for cycle 2 day8 after clinically assessing the patient
To repeat urine microalbumin before next dose of bevacizumab

7.10.22
overdue for nexct cylce
C/o Back ache , short lived post chemo
due for cycle 3 day 1
urine microalbumin 15.6
CBC, BIochem - acceptable

7/11/22
On Gemcitabine /Bevacizumab since Jan 22

Reprots Reivewed;-
CECT -PET SCan- Essentially stable primary mass involving cervix with interval appearance of a hypermetabolic left
common iliac lymph node . Rest of the previously seen nodes in right external iliac and inguinal regions are
unchanged
No metabolically active lesion identified elsewhere in the survey, with stable appearances on CT of the healed lesions
in lung and bone .

PFE done about contnuation of pallaitve treatment with Gemcitabne /Bevacizumab

Authorized by Dr Devender Sharma on 21 Nov 2022 13:02 This is a computer generated report. Signature is not required.

Regd. Of f ice: Global Health Limited, E-18 Def ence colony , New Delhi, 110024 , India T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 help-line: +91(124 )4 14 14 14 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U85110DL2004 PLC128319
 Medanta

Patient ID : MM01738680 Patient Name : Mrs. Reeta Sood

Gender : Female Age : 70Y

Encounter ID : 194711040001 Encounter Type : Outpatient

Visit Date : 21/11/2022 12:14 Location : Medical Oncology & Hematology

Speciality : Medical & Haemato Oncology Attending Practitioner : Dr Ashok Vaid & Team

21.11.22
cycle1 daY 8 (gemcitabine only)
PS 2
afebrile
No new symptoms
CBC?biochem- acceptable

Adv :
admit day care for Gemcitabine only
Syp Neogadine 15 ml twice a d ay to contniue

Authorized by Dr Devender Sharma on 21 Nov 2022 13:02 This is a computer generated report. Signature is not required.

Regd. Of f ice: Global Health Limited, E-18 Def ence colony , New Delhi, 110024 , India T el: +91 11 4 4 11 4 4 11 Fax: +91 11 24 33 14 33
24 X7 help-line: +91(124 )4 14 14 14 Emergency: 1068 Email: inf o@medanta.org www.medanta.org CIN: U85110DL2004 PLC128319