Case Conference Feb 8th 2012

08-Feb-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

FEBRUARY8^th 2012

 

 

Mrs. S/, 36yo, 353-69-27, Jamkesmas

G6P4A1 16wga with cervical cancer stage II B,

 

HISTORY

 

January 25^th, 2012

 

Patient was referred from RSUP G6P4A1 14-15 WGA  with cervical cancer suspected stage III B

 

Patient came with chief complain ofleukorea and vaginal bleeding.

Patient complain of leukorea since 1 year ago, vaginal bleeding since 3 month ago, post coital bleeding since 3 month ago, body weight is stable, defecation and urinary within normal limit, appetite was good, nausea (+), vomit (+), fever (-).

Her LMP was 14-10-2011, due date : 21-8-2012 , correspond to 14 weeks+4 days

of pregnancy

At 3 month of pregnancy, she complained about vaginal bleeding, the doctor said there was mass in her cervix, they performed biopsy in RSU PasarReboand the result was stratifiedsquamosa cell carcinoma with moderate differentiation. Then she was referred to RSCM.

 

Previous history: DM(-), HT (-), cor/pulmo disease (-),history of tumor/cancer(-)

Previous history in family: DM (-), HT (-), cor/pulmo (-), history of tumor (+) from her father with intestinal tumor à op à benign à healthy

 

 

Menstruation history:

Regular menstruation, 28-30 day, long of menstruation 7 day,  dismenorrhea (-), change pad 2-3x

Marital history:

She was married when she was 23^rd years old, divorced 3 year ago. This is the second marriage for both patient and the husband.

 

 

Obstetrical history : G6P4A1:  (This is the first pregnancy from second husband)

                1. Abortion

                2. Boy, 10 year

                3. Boy, 8 year

                4. Boy, 5,5 year

              5. Boy, 3 year

Family Planning history: 1 month injection

Social history :Husband works as a reseller and the patient works as a housewife

 

PHYSICAL EXAMINATION on admission

 

General status, Compos mentis

BP 110/70 mmHg Pulse 84x/min RR 18x/min T 36⁰ C

Height 158 cm           BW 41 kg       BSA 1.37

 

Conjunctiva    : not anemic

Heart/lung     :wnl

Abdomen       : according to 16 weeks of pregnancy

Extremities     : edema -/-

Lymph node     :no enlargement in supraclavicular, inguinal lymph node

 

Gynecological status

Inspection      :wthin normal limit

Inspeculo       :exophytic mass in portio, fragile with necrotic tissue

RVT     : uterus enlarge correspond 15 WGA, there was   lobulated exophytic mass with the size 7x5x3 cm, full filled all the portio, leftparametrium was tender and right parametrium was smooth, adnexal mass (-), pain (-).

 

 

 

 

 

 

 

 

 

 

 

US examinationon February 2^nd 2011

 

•         Uterine: normal shaped with life fetal single intrauterine

•         Cervix: size 4x4,3x4,0x6,0 cm, hyperechoic, inhomogen with patchy calcification, border of the left lateral was not seen, the border is irregular bulging to the right

•         Non visualized Adnexa and adnexalmass

•         There is no free fluid in Douglas pouch

•         In intraabdomen organ, found:

•                      Liver no nodul/SOL, homogenous echoparenchim

•                      Abdominal aorta: normal caliber, no enlargement of paraaortal

andparailiaca lymph node

•                      Right and left kidney: no dilatation of pelviocalyces system

•                      There is no free fluid in pleural danperitoneicavum.

Conclusion:

Cervical carcinoma on gravida 15w+6d, no hydronephrosis

 

PA Result (Review Slide) on January 31^th 2012

Stratified Squamosa cell carcinoma with moderate differentiation, mild lymphochyte reaction and necrosis was found.

 

February6^th 2012

Assessment by consultant: Dr. dr. Laila N, OBGYN (C)

From clinical staging, patient was diagnosed as cervical cancer stage IIB in G6P4A1 16 wga

 

The next plan will be discussed in clinical conference.

 

 

ASSESMENT

Cervical cancer stage II B in G6P4A1 16 wga

 

PLAN

The discussion would be based on family  willingness to continue the pregnancy. If the patient and the family want to continue her pregnancy à plan to chemotheraphy

If the patient and the family don’t want to continue the pregnancy, plan for direct radiation or hysterotomy  continue with chemoradiation