Case Conference June 22nd 2011

22-Jun-2011, Divisi ginekologi onkologi RSCM

Mrs. N/ 50 yo/ P3/ Jamkesmas

April  27  th   2011
Chief complaint
 Patient reffered from Awal Bros Hospital with Cervical Cancer

History
 Patient complained vaginal bleeding since 1 year ago and She also complained vaginal discharge since 6 months, white watery and smelled bad, She went to Awal Bross Hospital and performed Biopsi with result : Squamous Cell Carcinoma, poorly differentiated. The Doctor said : she got Cevical Cancer. The Patien feels post Coital Bleeding, urinate and defecation are normal

Generalist Status:
 CM, vital sign : BP 120/80 mmHg, HR 80x/minutes, RR 20 x/minutes, temp afebris
 Conjunctiva not anemic
 No enlargement of supraclavicular, axilla and both inguinal lymph node
 Cor and pulmo  : within normal limits 
Gynecologic Status:
 I : v / u within normal limits
 Io : eksofitik mass appeared on the portion size of 6x5x4 cm, fragile, easily bleeding
 RVT :, palpable eksofitik mass on the portion size of  6x5x4 cm, fragile, easily bleeding, the tumor spread  up to one thirds of the proximal vagina, spreading to the both parametrium  until it reaches the pelvic sidewall, smooth rectum mucosa, ampulla did not collapse.

Supportive Examination
• (17/06/11) : Laboratorium : HB : 8,8, WBC 10400, plt : 805.000, SGOT/SGPT : 32/43 , Ur/Cr : 16/0,5  HbsAg (-)

• (04/05/11) BNO-IVP : Secretion and excretion  both kidney normal. Cystitis with suspect infiltrated to the anterior bladder
• (4/05/11) Cystoscopy: within normal limits
• (28/04/11) Rectoscopy: no metastasis to rectum mucosal 
• (07/02/11) Ro Thorax : No metastasis nodul in lung.
• (16/06/11) Cardiology : within Normal Limits

• (16/2/2011) CT Scan  :
 mass on corpus uterine spread to superior, infiltrated uterine corpus, Inferior : infiltrated to vaginal until 1/3 distal, infiltrated to perivesical fat, compress to anterior bladder and a half infiltrated to posterior bladder, both parametrium and side wall pelvic ang infiltrated to  perirektal fat.
 Enlargement  multiple lymph nodes started from paraaortic, both parailiaca, right paracolica, perirectal and obturator
 Focal sparing fatty liver and simple cyst on right lobe of hepar
• (31/05/11) Histopathology Results (PA No. 1103960 /Review)
 Conclusion: Squamous Cell Carcinoma unceratinizing, poorly differentiated.
• Diagnosis : Cervical cancer stage III b ( Clinically)

Problem
Cervical cancer stage III b with Enlargement  multiple lymph nodes started from paraaortic, both parailiaca, right paracolica, perirectal and obturator

Treatment
1. Chemoradiation
2. We do biopsi first via retroperitoneal abdoment and waiting  result of  histophatology  for plant to the next therapy.