Case Conference August 3rd 2011

03-Aug-2011, Divisi ginekologi onkologi RSCM

Mrs. F/ 42 th/ P2/ SKTM

 

HISTORY

 

Agt 2^nd 2011

Patient came to Ciptomangunkusumo Hospital with chief complaining: vaginal bleeding. Normal micturition and defecation. P2 (alive child 1).

 

PHYSICAL EXAMINATION :

 

General status :

• Still within normal limit
• No enlargement of supraklavicular or inguinal lymph node

 

Gynecological Status (staging consultant):

•      Insp v/u : normal

•      Inspeculo : exophitic  mass at the cervix sized 6 x 5 x 5 cm (LL-AP-CC),

•      VT and RT : exophitic and endophitic portio, both parametrium were noduler reached the pelvic wall, retal mucous was smooth.

•      Cervical lesions clinically corresponded to cervical cancer stage IIIB

 

SUPPORTIVE EXAMINATION:

Pathology Result RS Sukanto Polri  ( July 7^th 2010):

Adenocarcinoma cervix, moderate  differentiated, mild lymphocyte reaction.

 

Review slide PA no: 2100857 (august 18th 2010) :

Adenocarcinoma cervix endocervical type, moderate differentiated. Limfatic invasion (+),mild lymphocyte reaction, minimal necrosis.

 

Chest X-Ray ( august 6^th 2010)

No signs of metastase.

 

BNO-IVP (august 6^th 2010)

Both kidney secretion & exretion were normal. No sign of obstruction.

 

Cystoscopy : Suspected bladder metastases

Hystopathology : chronic cystitis

 

Assessment on August 26th 2010 :

Ca Cx IIIB

 

Management on August 26th 2010:

Chemoradiation for cervical metastatic lesions

Ovareksis (patient refused it due to financial problem)

September 22th – November  30th 2010:

Chemoradiation followed by internal radiation were performed.

 

February 2^nd 2011 :

Control 3 months after radiation with chief complain: contact bleeding.

Gen status : no lymph node enlargment.

Gyn status :

Io :  hyperemis Portio, fluxux (+), bleeding (+)

RVT : not done

Plan :

Cervical smear in 1 month.

 

March 30^th 2011 :

CC : vaginal bleeding,  leucorrhea

Gen status : no lymph node enlargment.

Gyn status :

Io :  exophytic mass size 3 x 2 x 2 cm reached 1/3 vagina.

RVT : portio was nodule, stiff parametrium reached pelvic wall.

Ass: Ca cx partial respon

Plan : biopsy was done

           Staging consultant

 

April  14^th 2011 :

CC : vaginal bleeding

Gen status :no lymph node enlargment.

Gyn status :

Io :  exophytic mass  reached 1/3 vagina,easy to bleed.

RVT : nodule portio, stiff parametrium reached pelvic wall.

Plan: Pelvic Radiation

 

August 1^st 2011 :

Patient came to oncology clinic . She is still on radiation (after the 11^th radiation).

Consult from the radiotherapy : whether it is possible to give chemotherapy as sensitizer with Taxan?

CC : Nodul in inguinal area since the 5^th radiation.

Gen status : right inguinal lymph node enlargment.

Gyn status :

Io :  exophytic mass  size 2 x 2 x 2 cm reached 1/3 vagina,easy to bleed.

RVT : portio noduler, stiff parametrium reached pelvic wall.

 

PROBLEM:

Ca Cx progression disease during treatment.

Still need for chemotherapy ?

What kind of chemotherapy?

 

 

PLAN :

FNAB  right inguinal  lymph node enlargement.

Chemotherapy.

Radiation?