### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Dear Dr.Vineet, This query is regards your old patient Mrs.Gayatree Panda ,59 years ,who was diagnosed with CA Ovary stage III in Apollo ,HYd.She underwent cytoreductive surgery at RGCI on 5.5.08.HPE showed residual disease present,ascetic fluid positive.She was NED till march 2009 when she had inguinal lymph node enlargement FNAC positive CA 125-195 u/ml. Then inguinal lymph node dissection in mar 09.then 3 chemo cycles Gem+Carbo from 23.5.09-response ca 125-17 u/ml.then 3 more cycle chemo given till 3.11.09. presently (10/6/2010)again CA 125 gone up to 170.4 u/ml .RBC 11,Platelate 146000,TLC 6500,RBS101 mg/dl,CECT whole abdomen(8.6.10) Progressive disease by Recist criteria.The report says-There is ascites with 8mm size subhepatic peritoneal nodule. A 24x 20mm cystic space occupying lesion in left subphrenic region .rest unremarkable.We want to know after all these treatments why is coming back again and what is the next path forward? What options we have.

### output:

Respected user, his evaluated your query thoroughly. This is microscopic dissemination of the tumor cells giving this assembly of symptomsReason may be treatment effectiveness or emerging of other virulent microorganisms Next path should be conservative treatment planning in form of evaluation of the current status clinically as well as Ultrasound, Laboratory test of ascites Hope this clears your query. Thanks regards.