Case Conference July 6th 2011

06-Jul-2011, Divisi ginekologi onkologi RSCM

Mrs. T/ 39 yo/ P3/  JAMKESMAS

Oct 2010 à Patient was diagnosed as cervical cancer st IIIB.

PA result RS PMI Bogor no 101170: Squamous cell carsinoma, well differentiated

18 Oct 2011 Oncology ultrasound revealed:  bilateral hidronefrosis, cervical enlargement suspect malignancy, suspect benign left cystic ovarian neoplasm

 

15^th Dec 2010- 20^th Jan 2011 0 àChemo (Nemo) and External radiation 25x

31^st Jan 2011, 7^th Feb 2011, 14^th Feb 2011à Internal radiation

 

Evaluation post radiation:

Cytology 28 March 2011 : negative

 

CT-scan 21 April 2011 (RSCM) : cervical cancer st IIIB post external radiation and brachyteraphy, cervical size was normal,didnt suggested residual tumor. Left paraaortal enlargement size 19x11 mm.

 

CT-scan 21 June 2011 (Bogor): no cervical residual mass. Paraaortic, iliac, obturator lymph nodes enlargement, right pleural effusion.

 

27 June 2011 Patient was consulted from the radiotherapy departement for the response from the therapy given. There’s no complaining of vaginal bleeding. On the gynecology exmination, by inspeculo found vaginal stump was smooth, found tunneling area on the vaginal stump Æ0,5 cm. Patient was assessed with cervical cancer st III B post complete  chemo(Nemo)radiation, clinnically partial response with suspicion of paraaortic lymph node enlargement. The patient is considered for FNAB with radio intervention examination for cytologic examination or is considered for having chemotherapy directly with carbo-taxan.

 

History

On 30 June 2011 patient came to RSCM due to disable to have defecation for 5 days, cant flatus, abdominal discomfort, bloating. Patient was assessedas paralytic ileus due to radiation collitis. The patient got decompression and procinetic agent.

 

Physical examination :

Mildly ill BP 100/70 HR 90 T af

Lung    : vesiculer, rhales -/-

Abdomen: minimal Bowel Sound

Extr     : edema -/-

 

30 June 2011 à X-ray (3 abdominal position) result : correspond to obstruction illeus.

Laboratory result (30/06/2011) :

CBC: 12.3/ 37.5/ 10.340/560.000       UL: wnl OT/PT 14/8 Alb 3.79

Na/K/Cl  143/4.62/107                                    Ur/cr 15/0.8     CCT 72.12 RBG 106

 

Digestive surgery :

30/06/2011

Paralytic ileus susp due to post radiation colitis

Th/ conservative, NGT, fasting, yal colon

01/07/2011

NGT: Clear fluid

05/07/2011

Oral diet allowed, NGT clamped

 

Analysis

Cervical cancer  st IIIB ,post chemo(Nemo) radiotherapy, clinically partial respons and based on CT scan there is a paraaorta lymphnode enlargement.

 

Management plan :

 FNAB with radio- intervension  or Direct chemotherapy with Carbo Taxan