Case Conference December 12th 2012

12-Dec-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                  

 

 

Mrs. A

 

 

17/9/12

Patient came to ER. third floor RSCM with vaginal bleeding 1 day before admission , refered from Fatmawati hospital with cervical carcinoma stage IIIB

At June 2012,  patient started complain vaginal bleeding, came to Kuching Hospital, Malaysia and was diagnosed with with cervical carcinoma. Because of financial problems, patient came to Fatmawati Hospital, got 9 bags of transfusion , was diagnosed with cervical carcinoma stage IIIB and refered to RSCM.

Normal defecation but there was mixturition problems, and had chateter urine .

 

 

Menarche 13 yo,maried 18 yo

P3

Contraseption : DMPA

 

Clinical Examination

I: v/u normal

IO : endophytic mass at portio 6x6x5 cm

V/RT : portio endophytic, 6x6x5 cm, fragile, easily bleed tumor infiltrated  right and left parametrium, untul pelvic wall

 

US (20/9/12):

Cervical enlargement ec malignancy

Para-iliaca LNds –enlargement

No hydronephrosis, ascites, pleural efusion

 

 

Rectoscopy : no rectal metastasis

Cystoscopy ( 3/12/12) : cystitis

 

Cervical byopsi ( Kuching-Medical Center): invasive large cell, non-keratinizing squamos carcinoma

 

CT-scan ( fatmawati Hospital ):

Cervical malignancy  appearance  sized 8x7,3x8 cm; right ovaria cyst 2,8x3x3,3 cm

 

Assessment :

Cervical carcinoma IIIB

 

Performed external radiation ( September 29 ^th: december 4^th 2012)

 

7/12/12

Patient was hospitalized in the ward with bleeding , had intravaginal tampon

Got transfusion with Hb;7.44. patient has been hospitalized for several times because the bleeding.

Clinical examination:

Gyn state :

I: v/u normal

Io : cervical tissue, necrotic and easily bleeding, carcinomatotic 4x4 cm, fixed and noduler  until right pelvic wall and fixed to left pelvic wall.

Assessment : Cervical carcinoma stage IIIB, post RE ( 36 )  last at 4/12/12, partial respons

 

Assessment  and discussion with Dr.dr.Gatot.OBGYN ©:

Patient with residual disease, history of repeat bleeding

Planning :

1.chemotherapy à taxan + carbo or

2.observation until 3 months

 

Discuss in CC

 

 

 

 

 

 

 

 

 

 

 

19/9/12	Hospitalized bleeding; hb:8,9
27/9	Howpitalized; bleeding
4/10	Hospitalized ; bleeding; hb’ 8.04