CA Cervix Case presentation

A clinical presentation on Carcinoma Cervix

1. Welcome Case Presentation on Cervical Cancer

2. Particulars of the Patient Name: Mrs. Rahela Begum Age: 55 years Religion: Islam Occupation: Shopkeeper Marital Status: Married for 40 years Blood Group: B (+ ve ) Husband’s Name: Mr. Abdur Jabbar Husband’s occupation: Shopkeeper Address: Taraganj , Rangpur

3. Continuation Hospital Record: Bed No. 11 Ward No. 12 Unit No. 01 Department of Obs. & Gynecology Rangpur Medical College, Rangpur Date of Admission: 27/12/2015 Date of Examination: 30/12/2015

4. Chief Complaints Post coital bleeding for 1 year Foul smelling per vaginal discharge for 6 months Per vaginal bleeding on straining for 4 months Back pain for 4 months

5. History of Present Illness According to the statement of the patient she was reasonably well 1 year back then she suddenly developed post coital bleeding that was excessive in amount and bright red in color. She also gives history of foul smelling dirty brown colored per vaginal discharge for 6 months that was thick in consistency but not associated with itching. She further mentioned about per-vaginal bleeding on straining occasionally for 4 months. She has continuous low back pain for 4 months which was insidious in onset with no radiation and no aggravating and reliving factor. On query she also complains of anorexia and weight loss. Her bladder habit is normal but she is constipated.

6. History of Past Illness She has no significant past medical, past surgical and past gynecological history.

7. Family History No significant family history given

8. Personal History She took betel nut and tobacco for 30 years

9. Spouse History Her husband has been married for three times and she is his second wife. His other two wives died during giving child birth.

10. Drug History She took some drugs prescribed by a Registered Doctor but she can not mention those drug’s name.

11. Immunological History She is well immunized with TT vaccine. She wasn’t immunized against HPV.

12. Socioeconomic Status Her socioeconomic status is below average.

13. Menstrual History Menopaused for 10 years

14. Obstetric History Married for 40 years Para: 4(-1)+0 Age of last child: 15 years

15. General Physical Examination Appearance: Ill looking Body Built: Cachectic Decubitus: On choice Nutritional Status: Below average Anaemia : Severe Jaundice: Absent Oedema : Absent Pulse: 72beats/min Blood pressure: 140/90mmHg

16. GPE Continuation Respiratory Rate: 17/min Temperature: 99 °F Cyanosis: Absent Lymph Node: Not enlarged Dehydration: Absent Heart: Normal Lung: Clear Thyroid Gland: Normal

17. Systemic Examination Abdominal Examination: Shape of the Abdomen: Scaphoid Colour of the skin: Normal Liver: Not Enlarged Spleen: Not Palpable Superficial & Deep Palpation: No mass found Vaginal Examination (i)Inspection: Foul smelling dirty brown thick discharge found. She was using vulval pad.

18. Systemic Examination Cont. Per Speculum Examination: A cauliflower like growth which bleeds on touch, replaces the cervix. Bimanual Examination: The cervix is fixed, hard in consistency, friable & bleeds on touch. The fornices are obliterated, whole vaginal wall is involved and the growth extends to the parametrium & adjacent organ. Digital Rectal Examination (DRE): Post. fornix adhered with the Ant. wall of rectum.

19. Provisional Diagnosis My provisional diagnosis is it is a case of Carcinoma of Cervix Stage Iva (In operable Stage)

20. Differential Diagnosis Chronic Cervicitis Myomatous Polyp Cervical Tuberculosis Metastatic Choriocarcinoma

21. Investigation Intravenous urography Cystoscopy Sigmoidoscopy CT scan MRI

22. Salient Features Mrs. Rahela Begum, 55 years old, para 4(-1)+0, ALC-15years, post menopausal Muslim patient, wife of Mr. Abdul Jabbar a shopkeeper hailing from Taraganj , Rangpur . Got admitted into Rangpur Medical Hospital 27Dec2015 with the complaints of postcoital bleeding for 1 year, foul smelling dirty brown colour vaginal discharge for 6 months, P/V bleeding on straining for 4 months, back pain for 4 months. She married at 12 years of age. Her husband has three wives and she is 2 nd of them, and other two had died during child birth. She had BLTL 10 years back. On examination she is severely anaemic , cachectic, weight loss. Abdominal examination reveal nothing significant, On P/S examination A cauliflower like growth that replaces the cervix. & on Bimanual examination whole vagina is involved, cervix is fixed, hard, friable, bleeds on touch, fornices are obliterated. On DRE ant. Rectal wall is adhered with post. fornix.

23. Treatment Before Staging: Blood transfusion to correct anemia & antibiotic to prevent secondary infection. Specific Treatment For this patient: 1. Chemoradiation 2. Ultraradical Surgery & Palliation