Integrated management of Pecoma of uterus with Ayurveda

Introduction

Case Report: A 58year old female Postmenopausal woman visited to our hospital with the complaints of weakness, on and off abdominal pain, irregular bowel habits, anorexia, loss of weight since 1 year. History revealed patient is a case of uterine Pecoma diagnosed 1 year back underwent total abdominal hysterectomy bilateral salpingo oophorectomy+RPLND=omentectomy and Appendectomy in March 2017. Inspite of operation patient could not recover from the condition except reduction in the bleeding. Later PET reports suggested involvement of other tissue which was progressive nature. Patient was started with 4 cycles of IV chemotherapy later followed by Oral chemotherapy with combination of 20 days in a course followed by 10days gap. Blood reports were done every 2 months once and Chemo medication was continued. In Feb 2018 PET Scan revealed progression of the condition involving secondary active lesions in Omentum, Kidney, soft tissue near liver, diaphragm and Lungs. Patient was advised to continue chemo therapy and patient approached for our hospital for alternate options.

O/E patient found anaemic with pallor in eye (++) and nails, abdominal examination revealed old previous operated scar with palpable nodular lesions in abdomen. Laboratory reports suggested patient is anaemic and mild hepatomegaly with mild Ascites.

Treatment: Patient was given sadhyo virechan with trivrut lehya and patient had 3 sukha virechana without any untoward complications. Later patient was advised fortified Amla Juice 20ml twice a day for 20days and patient was given hinguvachadi gulika one tab twice a day before food for 20days. Later patient was started with Haratala bhasma 125mg in divided dose for 20days and again asked to comeback Treatment was continued for 3months altering depending upon the complaints and condition of the patient is stable and responding to the therapy without any chemotherapy aid since 3 months.

Observations and Results: Patient visited to our hospital with the complaints of general debility, weakness and on and off giddiness with constipation since 4 days. Trivrut Lehya was given early morning and patient had 3 sukha virechana without any complications. Abdominal distension relived and patient felt comfortable. Patient was given Amla juice 20ml twice a day along with hinguvchadi gulika for a month which showed better improvement in debility and anorexia and patient started to have better appetite.

Patient was started Shudhha hartala bhasma 50mg after assessing Roga and Rogi bala and was asked to take early morning and advised to follow bland diet avoiding Pittakara ahara vihara. Amla juice was continued along with introduction of Dhatri loha 2 tab/day for a month and advised to followup. During second follow up, patient noticed significant improvement in general debility, was able to work independently. Abdominal pain relieved and head ache was not seen much.

During the third course patient was introduced indukantam kashaya gulika along with previous medications to improve agnibala and Deha bala. Patient showed good response with reduction in Anorexia, increased appetite, recovery from abdominal pain and palpable nodular masses were reduced in size and patient bowel and bladder were under control. Patient is now started with indukanta ghruta stopping haratala and bhalataka lavana and is under observation.

Patient showed significant improvement along with stable haemoglobin due to which Haratala bhasma continued for 20days and meanwhile patient USG abdomen showed mild heapatomegaly along with mild Ascites with minimal involvement of Lesions of omentum of abdomen, mesentry and diaphragm but were responding to treatment. Opinion of oncologist was taken and oral chemotherapy was stopped as the condition was responding well. Patient was asked report any pitta vruddhi or other lakshana. Patient found much more relief; pain relieved, weight gain was seen 4kgs from 3 months. Haemoglobin was stabilised and came to 8.9 from 7. Lipid profile and Liver function test showed moderate fluctuations which were reversible and under control.

Patient underwent PET scan in 19.09.18 and report were compared to previous USG scan, CT scan and PET report done in Feb (23.02.18) showed significant improvement in controlling active lesions in the body. Some lesions resolved completely and were normal. Some lesions reduced significantly in size which was evident along with clinical recovery.

Now patient is stable, with minimal symptoms and is not taking any oral chemotherapy medications since 2 months without any complications.

Discussion

Perivascular epithelioid cell tumour is a rare mesenchymal neoplasm originating from peri vascular epithelioid cell (PEC) line. Pecomas of female utrero-vaginal tract accounts from 25%of all PEComa cases and usually primarily seen in uterus and can also be seen in cervix too⁵ . Signs and symptoms initially starts with uncontrolled moderate to heavy bleeding not responding to haemostatic management usually after 40years of age. PEComa are presents with abnormal vagina or peritoneal bleeding, abdominal pain and uterine symptoms such as Rupture of uterus and haemoperitoneum⁶ . PEComa is classified based on ⁶ high risk criteria to consider it as Malignant. Surgery and chemotherapy are current standard treatment available but has potential organ toxicity also⁷ .

Management in Ayurveda

Ayurveda is currently considered always alternate therapy due to predominance of contemporary Medicine. Allopathy system has taken its prime place in the practice of cancer due to the advancement in medical researches and advanced equipment’s which support the basics of medical science. Researches in Ayurveda was also conducted but still questioned by much community for authenticity. Modern medicine tries to understand the concept of Ayurveda under the principles of Medicine hence fails to explore the potentials of Ayurveda Currently the dilemma in cancer management is integrating Ayurveda or any traditional system is to when, where and to what extent. If Ayurveda is integrated properly, it can aid in early detection, early prevention, aids faster healing of cancer tissues and minimises the complications of chemo therapy and prevents organ from chemo or radiation.

Understanding of cancer and Management in Ayurveda: understanding of cancer concepts totally differ from perspective of modern medicine. Dosha, Dhatu, Agni and other constituents of the body plays vital role in inflammation of the cell and carcinogenesis. Hence treating Dosha, Dhatu and Agni vaishamya plays vital role in cancer management which is called prakruti stapana. Once the body is stabilised, particular complaints of the patient is tackled through vyadhi pratyanika chikitsa which leads to suppression of the aggravated disease. This vyadhi pratyanika chikitas is disease specific as well stage specific (Avastha vishesha). Rasayana chikitsa should always be implemented as Vyadhi chikitsa or other conditions lead to deha bala kshaya and once the diseases stabilised Rasayana chikitsa will alleviated complications and makes sure that no other secondary metastasis or tissues involved again. Stress and anxiety are the major factors which triggers cancer and other conditions. Counselling, relaxation or yoga relieves stress and anxiety and guides us to follow healthy lifestyle and food habits which can be considered as Naishtiki chikitsa.

Case discussion

Patient came to our hospital with complains of daurbalya, Aadhmana, Shoola, Mala baddhata and paanduta in twak and netra which indicated in Agni mandya and Ama lakshana. Patient was given sukha virechana as she didn’t passed stool for 4 days. Patient had a palpable abdominal mass was assessed as Kapha vata and rakta avruta vyadhi. Amalaki juice was given initially which is Agni deepana, malashodhana, nadi balya and tridosha hara. All the complaints of the patient started with bleeding which can be considered as Rakta pitta and Amalaki is effective in management of rakta pitta and pandu. Hinguvachadi gulika was given to make sure there is no vibandha, shoola and mala baddata for which patient came to our opd. This tablet is also indicated in kaphavata vruddhi and pitta prakopa lakshan which was seen in present condition. Dhatri loha was given inview of panduta in twak and netra along with laboratory haematological Hb estimation.

Hartala Bhasma and Cancer Management: Haratala, Somala and other arsenic compounds which are explained in Ayurveda (Rasashastra) always been hindered in general practice or even in cancer practice as they were always taught as toxic rather than potential medicine. If properly prepared as per the standard classical text they can be safely administered in the cancer patients without any hinderance and can get wondrous results. Initially Haratala bhasma (50mg/Day) was given for 10days of resting period chemo drug for 2 months. Later patient started to show promising results and recovery. The dose was continued for 20 days for next 2 months. After discussing with oncologist, patient was withdrawn oral chemotherapy as patient was responding to the treatment but was under monitored under oncologist. Later patient was stopped for hartala bhasma and Bhallataka lavana was given which is also teekshna and does lekhana, bhedana which was needed to reduce the size of the lesion. Every 2 months once patient was advised to get a blood report to make sure the safety of liver and lipid status. All the changes were under control. Even after 4months of withdrawing oral chemo therapy. Patient was stable and recovering well and is under observation further.

Conclusion

Patient known Diabetic, Anaemic came to our setup with previously diagnosed and operated case of uterine PEcoma received IV chemotherapy, Radiation and secondary metastasis. Patient condition was assessed and treatment was given along with Haratala bhasma and Bhallataka lavana. Cancer and caner complications can be managed well even Ayurveda and this case enlightens if integration done properly can save the patient from disease as well as economic burden.