Case Conference July 27th 2011

27-Jul-2011, Divisi ginekologi onkologi RSCM

Mrs. D/44 yo/ P3/ Jamkesda

 

June 22^nd 2011

Patient came to RSCM due to vaginal bleeding since 10 months. August 2010  came to “F” hospital due to vaginal bleeding & postcoital bleeding for 2 months, performed biopsy, diagnosed as cervical cancer, suggested to perform hysterectomy. Patient looked for alternative medicine, initially the bleeding was stop, but since 1 month the bleeding was severe and there was foul vaginal discharge. Vaginal discharge (+) since 15 months.

Defecation & micturition were normal. Sometimes patient felt shortness of breath & cough.

Married once at age 18 yo, P3, youngest child 14 yo.

 

Physical Examination

General status: BP 120/80     

HR 94 RR 18 

No supraclavicular, inguinal or axilla lymph nodes enlargement.

Eye      : pale conjungtiva -/ -

Lung    : rhales -/-

Heart   : normal Heart Sound, murmur (-), gallop (-) 

Extremity: edema -/-

Gynecological status:

Io         : fragile exophytic mass, size 6x5x5 cm

RVE    : uterus normal, exophytic mass size 6x5x5 cm, infiltrated lateral fornix,  both 1/2  parametrium were noduler, rectal mucous was smooth  

 

Supportive Laboratories

Pathology Result no 1104788 ( June 23^rd 2011)

Adenocarcinoma, well differentiated, mild lymphocyte reaction, wide necrosis

 

Ultrasound result (July 18^th 2011)

Anteflexed uterus. Uterine’s shape and size were normal. Homogen myometrium. Uterine cavity was open contained of blood correspond with hematometra. Cervix was enlarged contained inhomogen and irreguler margin mass size 73x56 mm, originated from cervical malignancy. Infiltrated both parametria.

Both ovaries were normal.

Liver, spleen and both kidneys were normal. Paraaortic & parailliac lymph nodes were not enlarge. No Ascites.

Conclusion      : cervical malignancy, infiltated parametria

 

Chest X-Ray ( July 8^th 2011)

Multiple nodule on both lungs suggested metastase

 

BNO-IVP ( July 8^th 2011)

Both kidney secretion & exretion were normal. No sign of obstruction.

 

Laboratory Result (June 23^rd 2011)

CBC 9,7/ 31.4/ 12.950/ 278.000

Ur/Cr 15/ 0,8  

ALT/AST 44/28 

FBG/ PPBG 92/151          

Na/K/Cl 142/ 4.9/105

CCT 57.11

 

Cystoscopy  ( July 13^th 2011)

Cystitis

 

Rectoscopy (June 27^th 2011)

No metastasis to rectum

 

Analysis

Cervical cancer st IVB (lung metastases)

 

Management

Palliative Radiation

Chemoterapy for lung metastase