Presenting history:

Mrs. B, a 61 year old lady, presents with a 4 week history of abdominal discomfort and bloating. She lost 4 Kgs in the last month and has had reduced appetite.

She has also noticed an increased shortness of breath on exertion for the  week prior to admission .

Mrs. B has mild asthma and no other relevant comorbidities.

She has not been to the gynaecologist and hasnt attended cervical screening for over 5 years as her daughter has been unwell and she has had to look after her.

Past surgical history:

• Total Abdominal Hysterectomy due to uterine Fibroid 10 years ago.
• Appendectomy as a child

On Examination:

• Abdomen distended, non-tender.
• Speculum: No abnormalities

Ultrasoound:

Minimal free fluid in the pelvis, 60x50mm solid tutor formation at the vaginal vault with increased Doppler perfusion.

Investigations

Biomarkers:

• CA-125: 894
• CEA and CA19-9 within normal
• SARS CoV2 Test: Positive ( Tested 4 days prior to admission)  

Imaging

• CT Scan Thorax: No abnormalities detected
• CT Scan Abdomen/Pelvis: 60×50 Tumor at vaginal vault, peritoneal carcinomas and omental cake