Case Conference October 19th 2011

19-Oct-2011, Divisi ginekologi onkologi RSCM

Mrs. A/ 50 yo/ P8A1

 

April 25^th 2011

Patient was referred to RSCM from Cirebon with cervical cancer st III B

Defecation & micturition were normal.

Married age 16 yo, P3A0, youngest child 27 yo.

 

Physical Examination

General status: BP 110/80      HR 88 RR 18 

No supraclavicular, inguinal or axilla lymph nodes enlargement.

Eye      : pale conjungtiva -/ -

Lung    : rhales -/-

Heart   : normal Heart Sound, murmur (-), gallop (-) 

Extremity: edema -/-

Gynecological status: (consultant)

Io         :  exophytic mass, size 5x7x3 cm

RVE    : uterus normal, exophytic mass size 5x7x4 cm

both  parametrium were noduler reached pelvic wall,rectal mucous was smooth . 

 

Supportive Laboratories

Pathology Result no 1103183 ( April 25^th 2011)

Squamous cell carcinom of cervix,non keratinized,  moderate differentiated.

 

Chest X-Ray ( August  23^rd 2010)

Within normal limit

 

BNO-IVP (August  23^rd 2010)

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

Cystoscopy 

Cystitis. Indentasion of the mass in the bottom of trigonum.

 

 

Rectoscopy

No metastasis to rectum

 

 

05/07/11-09/08/11 : chemothearapy 1x + external radiation

12/08, 26/08/11  : internal radiation

 

Sept 14th 2011  : first control after radiation

I : V U wnl

Io : suspected  granulation mass at the cervix.

RVT : palpated  stiff  parametrium and the cervix.

 

October 3rd 2011:

Chief complain  about  leukorrea.

St gen : no lymphnode enlargement

St gyn:  

I      : Vu wnl

Io    :  Porio flat, no necrotic tissue, vagina smooth.

RVT: stiff portio, both parametrium are also stiff à suspected  stable disease dd/ fibrotic tissue?

 

US FM (Oct 4th 2011) :

Cervical mass size 48 x 56 mm with hipervascularisation (active mass).  Invasion are reached the OUI and both parametriium.  Lymphnode enlargement at paraaorta and parailiaka.  Bilateral hydronefrosis.

 

Re assesment Consultant (dr Sigit Purbadi SpOGk):

Stable Disease

 

Analysis

Cervical cancer st IIIB post chemoradiation  stable disease.

 

Management

Possibility implant radiation.