Case Confrence 14 April 2010

14-Apr-2010, Oncology Gynecology Division RSCM

Woman, 50 y.o, P7. 
Chief complain : abdominal enlargement since 3 mouth ago. She has been felt abdominal dyscomfort, like hardened sensation on her abdomen since 2 months ago.
Defecation and mixturition still normal. There is no symptom of loss body weight and appetite as well.

History:
Oct 28th  2008      :  Cervical Cancer Stage IIIB with histopathology result : Non keratinizing
                       squamous cell carcinoma and performed external radiotherapy and bracytherapy (Des 12th   2008 – Feb 6th 2009)

On physical examination (Des 28th 2009) foud  right lymph node inguinal enlargement with Ø 2 cm, and suggested to perform FNAB but patient refused.
Unually papsmear until Des 29th 2009  negative smear.

CXR (Des 29th 2009): metastase (-), bronchopneumonia

On physical examination (Jan 20th 2010) found  abdominal enlargement with solid mass palpated until 2 fingers above navel on right abdomen (measuring 15x12x10 cm), limited in mobility.

Inspekulo : vagina wall were smooth.
VT/RT     : revealed solid pelvic mass measuring 15x12x10 cm, fixed, vagina wall and rectum mucosa were smooth.

USG Abd (Jan 19th , 2010)    : pelvic mass, DD: metastase ?
CT Scan Abd (Feb 4th, 2010)  : Ca Cx III B with enlargement of paraaortic n parailliaca nodes.
                               Other organ : wnl

Dx : Ca Cervix Residif post complete chemo-radiation.
Planning : radiotherapy paliatif

Consult to Radiotherapy : patient with recurrent pelvic mass and enlargement of paraaortic and
                          parailliaca nodes  radiation should be extended radiation  more
                          side effect and complication.

Problem : probably to many complication for extended radiation.
Problem solving: should we change to chemotherapy modality or no treartment for this patient?