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Course of treatment for ADENOCARCINOMA infiltrated VAGINAL VAULT.

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My wife, 57 years, underwent a successful surgery for adenocarcinoma of the colon in August 2013, followed by chemotherapy and regular check up every three months with no symptoms of reappearance of the problem. However, in mid December 2014, a cyst was detected in the pelvis region in the course of regular check up. On the doctor's advice PET CT scan was done from vertex to mid-thigh (Oral and IV contrast). The impressions of the PETCT are:
1. 2.8x1.1 cm mild wall thickening of the distal sigmoid colon
2. 5.8x66.6x4.9 cm heterogeneously enhancing solid cystic metabolically active mass in the midline pelvis, infiltrating the vaginal vault, bladder base, pelvic small bowel loops and anterior wall of sigmoid colon-pelvic deposit
3. Left external iliac, metabolically active para-iortic and iortocaval lymphadenopathy –likely metastatic
4. No evidence of hepatic, pulmonary and skeletal metastases
Following PET scan colonoscopy was done which show normal colon; biopsy of vaginal vault shows “tumour tissues made up of irregular complex glandular structures lined by columnar and pleomorphic cells having pleomorphic nuclei; most of the glands show epithelial stratification. Tumour is seen infiltrating into the underlying connective tissue. Features are of well differentiated adenocarcinoma”.
Please suggest the course of treatment to be followed

Category: Pulmonologist

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Category: Allergy and Immunologist
 31 Doctors Online

Thank you for your query at

I would like to be frank and outspoken.
To make a long story short, I would like to say that your patient condition is very critical .The prognosis of such a condition is usually determined by

1) duration of hypoglycemia
2) time elapsed between loss of pulse to return of spontaneous circulation in emergency department
3) degree of hypoxic injury suffered

At present I do understand that she is in severe sepsis and her kidney function is deteriorating. Anticipated duration of mechanical ventilation cannot be predicted with any degree of certainty via online. I suggest you to discuss with treating physician regarding signs of brain death and futility of treatment after 72 hours of ICU admission , Till then it is advisable you to continue full support and withdraw it after 72 hours if there is any signs of brain death. Hope I cleared your doubt.
Feel free to revert any time,

Dr. Jacob George

Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
Dr. Jacob George Pulinilkunnathil and 4 other Medical Specialists are ready to help you

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