Case Conference July 25th 2012

25-Jul-2012, Divisi Ginekologi Onkologi RSCM

Cervical Cancer Stage IVB , with Lung Metastasis

 

Identity

Mrs.T, 36 y.o, 3698561

  

CC

Patient was refered from RSU Tangerang with  cervical carcinoma

 

HISTORY

Patient’s been had fouly odor discharge since 6 moths ago followed with pain in the abdomen. Normal voiding and  defecation difficulty since 6 days ago. History of post coital bleeding (+) since March 2012

In June 2012  Came to Tangerang Hospital, was done biopsy and the result was cervical carcinoma, patient was hospiralized for transfusion then reffered to RSCM . Now , bleeding still  (+)

Pts is still on her regular cycle. Married at 14 yo,

P4(only 3 alive) the smallest 2 yo.

Contraception (-)

 

Prev Illness

No significant illness.

 

Physical examination

Gen st

Pale conjungtiva

No palpable lymph nodes.

 

Gyn st

I v/u wnl

Io :exophitic mass, fragile, easy to bleed

RVT :   a little bit enlarged , exophitic  and endophitic mass 6x6x4 cm extending until 1/3 distal of right vaginal and 1/2 anterior vaginal wall, bilateral parametrium was involved, extending to  right pelvic side wall.

 

PA result (RSUD Tangerang)

Cervical squamous cell carcinoma non-keratinized, moderate-differentiated. ( PA slide is still reviewing, not finished yet)

 

Chest X-Ray (10/7/2012)

Multiple nodules in both lungs, according to lung metastasis

 

BNO-IVP (10/7/2012)

Good excreting and secreting function of both kidneys.

Right hydronephrosis

Left ureter kingking

 

Cystoscopy (11/7/2012)

Polyploidy Chronic Cystitis

 

Rectoscopy (6/7/2012)

No metastasis.

 

Lab (5/7/12)

CBC 9,7/31,7/14.470/346.000

AST/ALT  21/37. Ur/Cr 31/0,58 Fasting blood glucose/2 h PP : 65/127.

E: 145/4,19/105,9.

 

Asessment  

Cervical cancer stage IVB , with lung metastasis

 

Assessment by DR. dr.Laila N,  OBGYN(C)

Consideration: cervical cancer stage IV B, with bleeding and lung metastasis, à paliatif

Planning: radiation for the bleeding

Discuss :

-         regiment chemotherapy for lungs nodules ( for decreasing tumor size)

-         do we still need  lung CT-scan examination for making diagnosis  lung    metastasis?