Case Conference June 6th 2012

06-Jun-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

June 6th 2012

 

Mrs. ST, 36yo, 353-69-27, Jamkesmas

G6P4A1 32-33 wga with cervical cancer stage II B,

 

HISTORY

 

January 25^th, 2012

 

Patient was referred from RSUPasarRebowith 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 (-).

 

 

 

 

 

 

 

 

 

 

 

 

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

 

From CC Result ( February 8^th 2012 ) :

1.      Termination of the pregnancy (hysterotomy) à continue with chemoradiation

2.      If the patient and family choose to conserve the pregnancy à to give platinum base chemotherapy  until the baby viable to deliver

 

 

Family consent :

Continuing the pregnancy and agree to get chemotherapy               

 

FM US ( May 22th 2012)

31 wga, normal fetal growth and activity, FW 1600 gr, no fetal anomaly, malignancy cervix

 

1^st  chemotherapy à April 17^th 2012

2^nd chemothetary à May 3^rd 2012

3^rd à May 25^th 2012

4^th à Plan on June 6^th 2012

 

June 4^th 2012 à Assesmen by DR.dr.Laila,OBGYN(C)

Portio hyperemic with smoother surface than before, size 5x5x2 cm, smooth parametria

 

A/ G6P4A1 32-33 wga with cervical cancer stage IIB post chemotherapy 3 series with partial respond

 

P/ Cesarean section after lung maturation

 

Considering : 1. Radiation post Cesarean section

Or                     2. Cesarean section continue with radical hysterectomy