Case Conference September 26th 2012

26-Sep-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

September 26 ^th 2012

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Mrs. K, 60 yo, P4, 369 21 44, JAMKESDA

Stage II A Cervical Cancer , post NAC plan to  performed Radical Hysterectomy

 

July 12^th 2012

 

Patient  came to Policlinic RSCM. She was referred from Arifin Ahmad  Hospital (Pekan Baru)  with PA result squamous cell cervical carcinoma, keratinizing, well differentiated . Patient  complained about her vaginal bleeding since 1 ½ year ago. Fluor  albus (+) with smelly but no itchy. Post coital bleeding (+), pain (-), weight loss (-). Normal defecation and mixturition.

Patient came to  PHC (midwive)  5 times , only performed  external examination (never had inspeculo exam), got  medication but  still had her complain à she came to Arifin Ahmad  Hospital (obgyn) à biopsy à referred to RSCM.

 

Menopause 4 years ago, P4 (the youngest is 30 yo)

Married 1x, age 18 yo

 

BW : 70 kg           H : 155 cm   BMI  29 (overweight)

Gen state : wnl, no palpable lymph nodes (inguinal,axila and supraclav)

Gyn state :

Io: exophytic mass size 4,5X4,5X3  cm , fragile and easily bleed, nectrotic tissue (+).

V/RT : exophytic lession until fornix.  Cut normal. Anal sphincter normal, smooth mucosa.

 

 

Supportive data :

 

Cystoscopy : cystitis

Rectoscopy : no metastase

BNO IVP :  wnl

Chest x-ray : no sign of metastase

 

ONCOLOGY US  (July 31^st  2012) :

Uterus size 9x4x4 cm, AF, inhomogen hypoechoic parencym echostructure. No mass, endomterium can’t be seen, no fluid inside uterine cavity. Cervix with undistinct  and irregular border size 4,1x42x4,0 cm, more inhomogen hyperechoic than the corpus.

Both ovaries can’t be seen.

No enlargement of paraaota dan parailiac LNDs

Spleen, both kidneys, bladder and rectm normal.

No ascites

Assessment :

Enlargement of cervix due to malignancy

Hepatomgaly non specific

Hidronefrosis (-), ascites (-), pleural effusion (-)

 

 

PA result (RSUD Arifin Achmad Pekan Baru 30/5/12  no H.12.0757 )

Scuamos Cell Carcinoma, keratinizing, well differentiated

 

PA result ( RSCM July 24^th 2012) no 1205730    :

Condyloma acuminate with mild dysplasia

 

August 2^nd  2012

Staging by dr. Sigit P,SpOG(K) : Cervical cancer stg II A2

Plan for : NAC (cysplatin, ifosfamid  and Uromitexan)

ð Discussion with dr. Sigit P, obgyn (C): since there’s discrepancy between the PA result and clinical exam à take another biopsy with loup biopsy, take out the  biger specimen

 

August 7^th 2012

The patien had Colposcopy exam with the result : suspected invasive carcinoma

 

August 10^th 2012

PA no 1206522 result  :

Condiloma acuminate with squamous cell carcinoma, moderate differentiated. Hard lymphocyte reaction. Mild necrotic.

 

Assessment :

Stage IIA2 Cervical Carcinoma,

 

Planning :

NAC (cysplatin, ifosfamid  and Uromitexan)

Radical Hysterectomy

 

 

August 16^th 2012

Giving information and education about the plan à patient and family chose to have chemo and radiation only

 

August 23^rd  2012

Reinformation and education à patient and family agreed to have NAC  3 weekly before operation with cysplatin 85  mg, Ifosfamide 8,5 mg and Uromitexan 14,45 gr.

 

August 29^th 2012

First chemotherapy(cysplatin 85  mg, Ifosfamide 8,5 mg and Uromitexan 14,45 gr)

 

 

 

September  19^th  2012 :

Second chemotherapy (cysplatin 85  mg, Ifosfamide 8,5 mg and Uromitexan 14,45 gr)

 

 

 

Grand round with Dr. dr. Laila Nuranna, OBGYN (C):

Considering

·        Age : 72 yo à re anamnesis the age is 60 yo, but still the performance status looks like more than 70 years old

·        BMI : overweight

·        Planning for radical hysterectomy must be evaluated, compared with chemo+ radiation

discussion in CC