Case Conference October 3rd 2012

03-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

October 3 ^rd 2012

________________________________________

Mrs.MT 3205135, GAKIN

 

Vaginal carcinoma  stage IVA post complete radiation ,partial respons

 

HISTORY

 

February 24th, 2012

 

•      Reffered by Islamic Hospital by OBGYN

•      Chief complain of pain in genital area since 2011

•      History of vaginal discharge (-)

•      Difficulty in urinary à went to Koja Hospital

 

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

                          History of tumor /cancer(-)

Previous history in family: DM (-), HT (-), cor/pulmo (-)

Marital history: 1x

Obstetrical history: P6, youngest 5 yo

 

PHYSICAL EXAMINATION

 

General status

Compos mentis

BP 120/80 mmHg Pulse 98x/min RR 18x/min T 36.7⁰ C

Conjunctiva          : pale +/+

Heart/lung   : wnl

Abdomen    : wnl

Extremities : edema -/-

Lymph node     :enlargement in left inguinal lymph node

 

 

 

Gynecological status

Inspection   : smooth vulva, exophitic mass in uretra and anterior vagina (+), right major labia bulging, pus (+)

Inspeculo    :  can not be done due to vaginal anterior mass

RVT            : there was exophytic mass along anterior vaginal until 1/3  proximal vagina. Smooth portio, uterus N, AF, both parametrium was smooth, smooth rectal mucose

 

PA Result Koja Hospital, January 18th, 2012:

Histologically transtitional cell carcinoma, well to moderate differentiation, clinically from urethral biopsy

Chest x-ray , February 2nd, 2012:

Bronchitis, no sign of pneumonia or active pulmonary TB, cor wnl

 

BNO-IVP February 3rd, 2012:

Both renal in good function

No sign of obstruction

Spina bifida

sacralisation

 

Pelvic and Abdominal CT scan, February 3rd, 2012:

Pelvic cavity tumor from uterus until vagina

àsusp uterine tumor spreading towards vagina

Meteorismus with fecal mass in colon

 

Rectoscopy February 27th, 2012:

No metastase on rectal mucosa

 

 

Cystoscopy February 29th, 2012:

Evaluation can not be performed due to tissue obstruction in urethra, fragile, easily bleed

 

Review slide March 6th, 2012, PA no. 1201889:

histologically squamous cell carcinoma, keratinized, well differentiated

 

Oncology US March 22nd, 2012:

Vaginal cancer

Left inguinal lymphadenopathy

No metastase to liver and spleen

 

ASSESMENT

Vaginal cancer susp std IVA (susp vesical metastase)

Assessment by consultant: Prof.Dr. dr. Andrijono, OBGYN (C)

From clinical staging, patient was diagnosed as vaginal cancer susp std IV A

 

 April – June 2012 : performed complete radiation.

RE 19/4-29/5/12 and RI :19/5-21/6/12  

 

September 11 ^th 2012

 

Patient control with cancer pain, from vagina to anus

Gyn state :

I: oedema right vulva

Io : there is a  anterior vaginal mass, 1/3 distal of vagina. Smooth portio

RVT : a mass in 1/3 anterior vagina, smooth rectal mucousa.

 

Assessment :

Vaginal carcinoma post complete radiation (21/6/12) ,partial respons

 

Discussion with Dr.dr.Laila,OBGYN (C):

Considering :

1.     Length of life with paliative  chemo

2.     QOL : free of pain

 

Discussion in CC