Case Conference May 18th 2011

01-Jun-2011, Divisi ginekologi onkologi RSCM

Mrs. I/  54 years old/ P4

November 04th 2010
Chief complain from this patient is iregular vaginal bleeding since 2 mo before admission. Bleeding was not profuse, 1-2 pads/day. Menopause since 2008 ( 3 years ago) . No abdominal enlargement, There were  also history of vaginal discharge  since 3 mo and  post coital bleeding. Pt already came to RSUD bekasi „³ Diagnos as Cervical Cancer Stg IIB  „³ done Biopsy , PA no 0101585 result : Ceratinized Squamous Cell Carsinoma with good differentiated , after that pt was reffered to RSCM
 
History of Hypertension (+)
Married 3 x 

1. 1st Husband --> 1 st Child
2. 2nd Husband --> 2nd child
3. 3th Husband -->3th & 4th child 
all spontaneous deliveries, youngest child 17 y.o

General status:
Compos mentis BP : 140/90   HR 90 x /mnt  RR 18 x/mnt  Temp 37 C
No enlargement of LND, others wnl

Ginecological status:
I : v/u within normal limit.
Io : there was nodularity lession , fragile and easily bleed until 1/3 distal vagina
RVT : uterine corpus wnl, there was nodularity lession size 5 x 5 x5 cm ,until 1/3 distal vagina, frigile and easily bleed,  parametrium was rigid,  Smooth rectal mucous, RTA normal.

Oct 27th 2010
Cystoscopy : Cystitis

Oct 28th  2010
Rectoscopy : No involvement of the rectum

Nov 2nd  2010
BNO IVP : No disfunction of both kidney
                  Excretion and Secretion of both kidney good
                  No sign of dam on both Kidney
CXR : wnlx

Nov 2nd  2010
Review Slide No 1007759
Keratinized Squamous Cell Carsinoma Cx with good - intermediate differentiated. Limfosit reaction was hard. There was invasion of the limfovascularization

Nov 11th  2010
Hb 8,1 / L 10670/ Tr 684.000   MCV/ MCH/ MCHC : 85,4/23,8/80,2
Ur / cr : 24/ 0,1   AST/ ALT : 20/6   Alb : 3,68
Fasting Glucose/ 2 h PP : 102/106  Hep B : Non Reactive

Nov 30th 2010
Staging by consultant : Cervical Ca stg IIIB  P/ Chemoradiation

Assesement: 
Cervical Cancer Stg  IIIB
Anemia due to vaginal bleeding

Plan :
Tranfusion until Hb > 10 gr/dl
Chemoradiation

After Transfusion Nov 13th 2010
Hb 10.6/ L 9850/ Tr 555.000 MCV/ MCH/MCHC : 83.5/26.1/31.3

Nov 30th 2010
Hb 10,7/ Ht 33,6/ L 13.360/Tr 565.000   Ur/cr  22/0.9  CCT : 155.92

1st Chemotherapy

Dec 31th 2010
Patient underwent RE Co 60  curative dose 2 Gy /day 12 x, Technique Convensional 2 Dimension: AP/PA

On May  11th 2011 (After about 4 mo)
Chief Complain :
Control for continue the therapy in Policlinic
No Vaginal Beleeding, Defecation and urinate were normal. Patient loss of control due to Administration problem (Because Pt have to administered Social health insurance /jamkesda in Bekasi)

General status:
Compos mentis BP : 140/90   HR 90 x /mnt  RR 18 x/mnt  Temp 37 C
No enlargement of LND, others wnl

Ginecological status:
I : v/u within normal limit.
Io : there was nodularity lession , fragile and easily bleed until 1/3 distal vagina
RVT : uterine corpus wnl, there was nodularity lession size 3 x 5 x 3 cm ,until 1/3 distal vagina, ,  parametrium was rigid,  Smooth rectal mucous, RTA normal, palpated nodularity lession on the rectum.

Re-evaluated the investigation

April 27th 2011
Cardiology Consuktation
A/ Hypertention gr II, Cervical Ca st IIIB
P/ Captopril 3 x 25 mg, No other special therapy from the cardiology

April 28th 2011
Rectoscopy : No involvement of the rectum

May 4th 2011
CXR : wnl
Cystoscopy : Cystitis
BNO IVP : No disfunction of both kidney
                  Excretion and Secretion of both kidney good
                  No Sign of Dam on both Kidney

May 10th 2011
Laboratory
Hb 11.6/ Ht 35/L 11350/ Tr 525000 MCV/MCH/MCHC : 80/26.4/33
Other lab  still process

Ultrasound : hasn't performed yet because the patieny have to extend the Jamkesda

May 11th 2011
Staging by Consultant :  ~ Cervical Cancer St IIIB Post RE 12 x and Chemo 1x ( Loss of Follow Up
Due to Finacial Problem Cervical Cancer

Plan  :  considered : 1. Recalculated radiation by Radiotherapy Consultant
                                2. Technique of the radiation 

Assesment:
Cervical Cancer St IIIB Post RE 12 x and Chemo 1x ( Loss of Follow Up )
Due to Finacial Problem

Plan  :  considered  : 1. Recalculated radiation by Radiotherapy Consultant
                                 2. Technique of the radiation