Case Study: Catalina

Clinical timeline

Events will be populated from reviewed records.

25 events

1. Between 2000-01-01 and 2000-12-31 (in 2000 (year only, as the medical summary states it)) Interval

   TestDocumented

   Diagnosis of non-Hodgkin lymphoma

   Non-Hodgkin lymphoma diagnosed in 2000, according to the 2022 medical summary, which gives the year only.

   Evidence type: Medical recordDocument date: 2022-05-18

2. Between 2000-01-01 and 2000-12-31 (completed in 2000 (year only, as the summary states it)) Interval

   Confirmed administrationDocumented

   Radiotherapy for the lymphoma, 30 fractions, completed in 2000

   Radiotherapy for the lymphoma, 30 fractions, completed in 2000 according to the medical summary.

   Evidence type: Medical recordDocument date: 2022-05-18

3. Around 2001-01-01 (from 2001 (year only, as the summary states it)) Approximate date

   Clinical outcomeDocumented

   Lymphoma surveillance from 2001

   Under surveillance for the lymphoma from 2001, according to the medical summary.

   Evidence type: Medical recordDocument date: 2022-05-18

4. 2020-10-02 Exact date

   TestDocumented

   Laboratory studies requested, including tumor markers

   On 2 October 2020 a general and digestive surgeon in private practice requested laboratory studies, among them the tumor markers CA-125, carcinoembryonic antigen, CA 19-9, alpha-fetoprotein and human chorionic gonadotropin.

   Evidence type: Other documentDocument date: 2020-10-02

5. 2020-10-02 Exact date

   TestDocumented

   Lower-abdominal and transvaginal ultrasound requested

   The same request of 2 October 2020 asked for a lower-abdominal and a transvaginal ultrasound, with emphasis on the ovaries, uterus and tubes.

   Evidence type: Other documentDocument date: 2020-10-02

6. 2020-10-02 Exact date

   TestDocumented

   CT of the abdomen with contrast and plain chest CT requested

   The same request of 2 October 2020 asked for a CT of the abdomen, plain and with oral and intravenous contrast, and a plain chest CT.

   Evidence type: Other documentDocument date: 2020-10-02

7. 2020-10-04 Exact date

   TestDocumented

   Tumor markers: CA-125 at 531.4 U/mL, flagged outside the reference interval; CEA, CA 19-9, alpha-fetoprotein and beta-hCG within reference

   Blood drawn on 4 October 2020 at a private hospital laboratory (preliminary report printed 5 October) gave a CA-125 of 531.4 U/mL against a reference interval of 0 to 35, flagged by the laboratory as outside the interval; carcinoembryonic antigen, CA 19-9, alpha-fetoprotein and beta-hCG were within their reference intervals.

   Evidence type: Laboratory reportDocument date: 2020-10-05

8. 2020-10-04 Exact date

   TestDocumented

   General laboratory panel: blood count, coagulation, febrile agglutinins, chemistry, lipids, electrolytes and hormonal profile

   The same preliminary report of 4 October 2020 covered a complete blood count, coagulation times, febrile agglutinins, a 24-element blood chemistry with lipids and electrolytes, and a gynecologic hormonal profile. The laboratory flagged as outside its reference intervals: erythrocytes 5.65 x10^6/uL, mean corpuscular volume 79.3 fL, globulins 3.7 g/dL, lactate dehydrogenase 238 U/L, cholesterol 260 mg/dL, triglycerides 199 mg/dL, total lipids 827 mg/dL and LDL 190 mg/dL. Hemoglobin, platelets, leukocytes, coagulation, kidney and liver values and electrolytes were within reference; febrile agglutinins were negative; the hormonal values were reported next to post-menopausal reference ranges.

   Evidence type: Laboratory reportDocument date: 2020-10-05

9. 2020-10-05 Exact date

   TestDocumented

   Pelvic ultrasound: ascites; uterus and ovaries without alterations

   A pelvic ultrasound on 5 October 2020 at a private laboratory found abundant free fluid in the pelvis and both iliac fossae (ascites), a uterus of normal sonographic appearance and ovaries without alterations.

   Evidence type: Imaging reportDocument date: 2020-10-05

10. 2020-10-05 Exact date

    TestDocumented

    Transvaginal ultrasound: ascites and endometrial thickening (16 mm); left ovary not evaluable

    A transvaginal ultrasound the same day found abundant diffuse free fluid and a thickened endometrium of 16 mm, to be correlated clinically; the right ovary showed small diffuse follicles and the left ovary could not be evaluated by this method.

    Evidence type: Imaging reportDocument date: 2020-10-05

11. 2020-10-05 Exact date

    TestDocumented

    Abdominal CT with contrast: ascites of undetermined cause and bilateral pleural effusion; no masses or adenopathies reported

    A CT of the abdomen with oral and intravenous contrast, performed on 5 October 2020 for ascites and abdominal pain and reported on 6 October, found an important amount of free fluid in the abdomen and pelvis and a bilateral pleural effusion with left predominance. Liver, spleen, pancreas, adrenals, kidneys, bowel and the uterus were reported normal, with no retroperitoneal, iliac or inguinal adenopathies.

    Evidence type: Imaging reportDocument date: 2020-10-06

12. 2020-10-06 Exact date

    TestDocumented

    Chest CT: bilateral pleural effusion with passive atelectasis, moderate ascites, no suspicious lung lesions

    A chest CT without contrast on 6 October 2020 at a private imaging center found a bilateral pleural effusion, mild on the right and moderate on the left, with passive atelectasis; moderate ascites in the upper abdomen; a 6 mm calcified granuloma in the left upper lobe; and no suspicious lung lesions, lymphadenopathy or bone lesions.

    Evidence type: Imaging reportDocument date: 2020-10-06

13. Around 2020-10-17 (shortly before the laparoscopy of 17 October 2020 (date not stated)) Approximate date

    TestDocumented

    Diagnosis of ovarian cancer, stage IV (pleural effusion), poorly differentiated adenocarcinoma

    Ovarian cancer, stage IV because of a pleural effusion, with a diagnosis of poorly differentiated adenocarcinoma, as stated in the 2022 medical summary.

    Evidence type: Medical recordDocument date: 2022-05-18

14. 2020-10-17 Exact date

    ProcedureDocumented

    Laparoscopy at another institution

    Laparoscopy performed on 17 October 2020 at an institution other than the IMSS Oncology Hospital, according to the medical summary.

    Evidence type: Medical recordDocument date: 2022-05-18

15. 2020-10-17 Exact date

    TestDocumented

    Pleural fluid cytology positive for malignancy; pleural biopsy with metastatic adenocarcinoma

    Pleural fluid and a fragment of pleura taken on 17 October 2020 were reported on 22 October 2020 by a private pathologist: the cytology was positive for malignancy and the pleural biopsy showed metastatic infiltration by adenocarcinoma with zones of mucinous aspect.

    Evidence type: Laboratory reportDocument date: 2020-10-22

16. 2020-10-21 Exact date

    TestDocumented

    Diaphragmatic dome biopsy reported compatible with papillary serous cystadenocarcinoma of the ovary

    A biopsy of the diaphragmatic dome, reported on 21 October 2020 by a private pathologist, showed infiltration by a malignant epithelial neoplasm forming glands and papillae, compatible with papillary serous cystadenocarcinoma of the ovary.

    Evidence type: Laboratory reportDocument date: 2020-10-21

17. 2021-03-10 Exact date

    Confirmed administrationDocumented

    Adjuvant chemotherapy, four cycles, completed

    Adjuvant chemotherapy, four cycles, administered at the IMSS Oncology Hospital and completed on 10 March 2021, according to the medical summary.

    Evidence type: Medical recordDocument date: 2022-05-18

18. 2021-05-17 Exact date

    ProcedureDocumented

    Interval cytoreductive surgery, reported as optimal

    Interval cytoreductive surgery on 17 May 2021, reported as optimal: hysterectomy, bilateral salpingo-oophorectomy, omentectomy and bilateral pelvic lymphadenectomy, without complications.

    Evidence type: Medical recordDocument date: 2022-05-18

19. 2021-05-19 Exact date

    Clinical outcomeDocumented

    Hospital discharge after the cytoreduction

    Discharged on 19 May 2021 after the cytoreduction, without complications, according to the medical summary.

    Evidence type: Medical recordDocument date: 2022-05-18

20. 2022-01-26 Exact date

    TestDocumented

    Tumor marker reported negative at the gynecologic-oncology evaluation

    At the gynecologic-oncology evaluation of 26 January 2022 the tumor marker was reported negative, according to the medical summary.

    Evidence type: Medical recordDocument date: 2022-05-18

21. 2022-01-26 Exact date

    Clinical outcomeDocumented

    Evaluation of 26 January 2022: stable, no evidence of recurrence, ECOG 0

    At the last gynecologic-oncology evaluation recorded in the summary (26 January 2022) she reported no symptoms, was considered stable with no evidence of recurrence, and had an ECOG performance status of 0.

    Evidence type: Medical recordDocument date: 2022-05-18

22. 2022-05-18 Exact date

    Clinical outcomeDocumented

    No evidence of disease, stable, as of the medical summary

    As of the medical summary of 18 May 2022, the patient was reported without evidence of disease and stable.

    Evidence type: Medical recordDocument date: 2022-05-18

23. 2026-05-07 Exact date

    Clinical outcomeDocumented

    Death at home on 7 May 2026; the certificate records a hydro-electrolytic imbalance due to ovarian cancer

    The patient died at home in Mexico City on 7 May 2026, with medical attention during the illness, according to the death certificate certified that day by a physician. The certificate records the cause of death as a hydro-electrolytic imbalance (interval of about one day) due to ovarian cancer (interval of about six years), and lists non-Hodgkin lymphoma (about 26 years) as another significant condition that did not lead to the death. The death is recorded as due to illness, not accidental or violent; no necropsy was performed.

    Evidence type: Other documentDocument date: 2026-05-07

24. about four months after 26 January 2022, with a control CT (exact date not stated) Unknown date

    Scheduled appointmentDocumented

    Follow-up appointment with a control CT scan

    A follow-up visit was scheduled about four months after the 26 January 2022 evaluation, with a control CT scan, according to the medical summary.

    Evidence type: Medical recordDocument date: 2022-05-18

25. date not stated; the family associates it with the studies requested on 2 October 2020 Unknown date

    TestRetrospective family recollectionProbable

    The physician's explanation of the diagnosis, as the family recalls it

    As the family recalls the physician's explanation: an ovarian cancer that was hard to localize, found in the uterus rather than in the ovaries, producing ascites whose fluid was already causing a pleural effusion. Surgery to remove the ovaries and the surrounding tissue was suggested, with a biopsy after the operation.

    Evidence type: Family recollectionDocument date: No document date