Case Conference September 14th 2011

14-Sep-2011, Divisi ginekologi onkologi RSCM

Mrs. S/ 57 yo/ P6

 

HISTORY

Patient was diagnosed as cervical cancer IIB since June 2010 and already completed her treatment with chemoradiation. The patient received Platosin and 25 times external radiation and 2 times internal radiation. Last chemotherapy was on July 7^th 2010 and last radiotherapy was on August 20^th 2010.

 

After complete chemoradiation, patient had underwent 3 times pap smear test and the result was negative, no malignant cell tumor, correspond with atrophic epithel.

 

A year after treatment, patient was consulted from radiotherapy department on August 26^th 2011. Patient brought her pelvic CT-Scan result which revealed there were multiple lymphadenopathy on paraaorta and hypodense lesion which enhanced after contrast on cervical region.

 

Right now patient only complain bleeding during defecation. No vaginal bleeding. No vaginal discharge.

 

 

PHYSICAL EXAMINATION

Compos mentis

BP : 130/80 mmHg           HR : 88 bpm        RR : 18 x/mnt                     T : 36.5

General Status

Conjunctiva        : not anemic

Lymph nodes     : no enlargement of supraclavicular/axilla/inguinal lymph nodes

Heart/lung          : wnl

Abdomen            : wnl

Extremities         : warm

 

Gynecologic Status

I                               : no vaginal bleeding

Inspeculo            : smooth vaginal stump

VRE                        : uterus wnl, no adnexal mass, smooth rectum mucose, feses (+),   blood (+)

                                                                                                                

PA Result (May 17^th 2011)

Non keratinized squamous cell carcinoma, mild differentiation cervix.

No lymphovascular invasion.

 

Pelvic CT-Scan (August 25^th 2011)

-          Right now, hypodense lesion with mild enhancement were still visible in cervical region

-          Multiple lymphadenopathy on paraaorta

 

Problem :

-          Cervical cancer IIB, post complete chemoradiation

-          Suspect residif

 

Management :

Diagnostic tool to diagnose this case as a residif case

 

Discussions :

-          We need to prove whether this case is residif or not

-          Is CT-Scan alone is enough to diagnose this  case as a residif case?

-          Do we need other diagnostic method and what diagnostic method do we need?

-          How can we take sample for pathology examination?

-          If this case proven as a residif case, what kind of management we should give to the patient (chemo vs radiotherapy)?