Case Conference May 18th 2011

01-Jun-2011, Divisi ginekologi dan onkologi

Mrs. R/ 49 y.o/ P5A0

August 5th  2009

Chief complain

Chief complain from this patient is vaginal bleeding since 1 month before admission. Bleeding was not profuse, 1 pads/day. Pts cannot remember her last menstrual due to irregular bleeding. No abdominal enlargement, there were history of vaginal discharge and post coital bleeding.
Patient reffered from RSUD Abdul Moeloek Bandar Lampung.
She was married for 20 years, with P5A0.

General status: within normal limit
Ginecological status:
I : v/u within normal limit.
Io : exofitic mass at portio, fragile.
RVT : exofitic mass from portio until 1/3 proximal vagina, sized 8x6x6 cm,loose parametrium, both adnexa unpalpable, smooth rectal mucouse

August 7th  2009
PA No. 0905048
Unceratinized squamous cell carcinoma cervix, moderate differentiation. There were limfatik invasion
Assesement:  Carcinoma cervix st IIA

August 28th 2009
Consultan staging: Carcinoma cervix st III B
Plan: Chemoradiation

September 9th 2009 until October 13th 2009
Patient received 4 series of Platosin 42 mg

November 23rd 2009
Completed external and internal radiation (7100 Gy)

Follow up until May 5th 2010
Pap smear (2x): there were no malignancy cell tumor

November 8th 2010
Found exofitic mass on portio, sized 3x2x1,5 cm, fragile  biopsy.
Pathology result (November 30th 2010)
Unceratinized squamous cell carcinoma cervix, moderate differentiation

February 2nd 2011
Patient came to policlinic
CT Scan abdomen: mass on cervix area, spreading to both parametrium, infiltrated right side of rectosigmoid wall.
Consult to dr.Sigit P, SpOG(K):
Reradiation

May 5th 2011
Patient came to policlinic
Left supraclavicular limphnode enlargement sized Ø 2 cm  FNAB

May 6th 2011
PA result from FNAB: positive, matastase of carcinoma

Working diagnosis
Carcinoma cervix st III B, residif with left supraclavicular limphnode metastase.

Plan:
Chest X-Ray

Discussion:
Based on the pathological result and clinical finding, what is the appropriate therapy to the patient:
- paliative chemotherapy   or
- supportive management.