Case Conference September 5th 2012

05-Sep-2012, Divisi Ginekologi Onkologi RSCM

Cervical Cancer Stage III B  Residif Post Complete Radiation ( Sept 2011)

with Suspected Lung Metastasis,  On dj-stent with Bilateral Hydronephrosis, Impaired Renal Function

 

Identity

Mrs. SA, 53 yo, 3571349

 

June  30 ^th  2011

Refered by OBGYN with cervical cancer

History of vaginal bleeding since 5 months before admission

P1 ( 26 yo) 1X

Menopause 3 years

Contraseption(-)

 

Physical exam

Gen state ;wnl, no lymphnodes palpated

Gyn state :

Io: endophytic mass 4x4x3 ccm, fragile, bleeding(+)

RVT : endhopytic mass 4X4X3 cm, firm parametria, cut was athropy  , smooth ectal mucouse

 

Supportive data :

PA result (review) : carcinoma in situ, ceraninized , mild limfosit reaction, necrosis (-)

Cystoscopy: systitis

Rectoscopy: no metastases

Ro thorax: wnl

BNO IVP : bilateral hydronefrosis

 

 

 

US 8/7/2011

Cervix enlarge, with hipervascular heterogen mass size 51x58x38 mm.  The mass invasion to the anterior until bladder (it seems that the mass infiltrated  vaginal mucosa until bladder mucosa) and invasion to posterior (vaginal mucosa) and the mass adhered to rectovaginal organ. Cervical canal difficult to identify.

There were infiltration to both parametrium.

Conclusion: Cervical malignancy. Invasion to surround organs.

 

Assessment : cervical cancer III B

 

Performed :

25/7/2011 – 5/9/2011

ER 10/11 2008 until 16/12 2008à 25 x

 

9/9 & 29/9/2011

IR 19/1/2008 until 5/2 2008à 3x

Notes : sinechia of vagina (+)

Mass 1x1x1 cm, palpated on portio

 

Oct 24^th

Patient controlled at policlinic.

Physical  exam :

Io: mass with necrotic tissue, biposy

RVT : cervical mass 1x1x1 mm, firm parametria.

A/ cervical carcinoma post  complete radiation susp residu

Biopsy result ( 24/10/11) PA  no :  1108275 : wide necrotic tissue. No sign of malignancy

 

Discussion with Dr. dr. Laila N, OBGYN(C) à there’s no complain, the patient do locoregional follow up in another 2 months.

 

 

 

US post radiation 20/12/2011

Inhomogen mass in cervic, irregular and unsharped  border,  size 242 x 25 mm, no vascularization, originated from malignancy mass. No invasion to rectovagina space.

à Malignancy of cervical mass post radiation. No active mass in cervix.  Left hydronefrosis.

è Compared with previous US (08-07-2011) : the mass was shrinking, and no infiltration to surround organ

 

July 30 ^th 2012

Patient controlled with vaginal bleeding from vagina and anus (patient on gastro-depart therapy due to proctitis radiation), insertion dj-sten due to hydronephrosis at pebruary 2012

Gys state : process in cervix area, easily bleeding, firm both parametria

Biopsy result (PA :1206270)

SCC non ceratinized, moderate differentiation, wide necrosis

US 31/07/2012

Cervix : unsharped irregular cervix, size 1,5 x 2,8 x 2,0 cm

è Enlarge cervix size and  left moderate hydronefrosis

 

Ro thorax : Soliter nodul in right paracardial, probably metastasis.

Lab :

24 hours urin creatinin : 0,31 g/24 hours,

CCT : 25,34 ml/menit

 

Discussion with Dr.dr.Laila,obgyn (C);

Patient with local residif (based on PA result)

Susp lung metastasis

Impaired renal function ( low CCT) à no treatment

Discussion in CC