Case Report Presentation Cervix Cancer

1. CASE PRESENTATIONCASE PRESENTATION
A 50-year-old patient, para 5 was referred A 50-year-old patient, para 5 was referred
to gynecologic oncology service after an to gynecologic oncology service after an
evaluation for abnormal vagina bleeding led evaluation for abnormal vagina bleeding led
to cervical biopsies which demonstrated to cervical biopsies which demonstrated
invasive adenocarcinoma of the cervix. invasive adenocarcinoma of the cervix.
Her general and systemic physical Her general and systemic physical
examination was normal. examination was normal.

2. CASE PRESENTATIONCASE PRESENTATION
Pelvic examination showed 7cm barrel Pelvic examination showed 7cm barrel
shape cervical lesion, invading the upper 1/3 shape cervical lesion, invading the upper 1/3
of the anterior vaginal wall, other vaginal of the anterior vaginal wall, other vaginal
walls are free of disease.walls are free of disease.
The left parametrium was invaded up to The left parametrium was invaded up to
1cm from the pelvic sidewall1cm from the pelvic sidewall
The medial third of the right parametrium The medial third of the right parametrium
was also involved by the lesion.was also involved by the lesion.
Rectal mucosa free of disease.Rectal mucosa free of disease.

3. CASE PRESENTATIONCASE PRESENTATION
Cystoscopy showed Bulging in the trigone Cystoscopy showed Bulging in the trigone
area but no evidence of disease, both area but no evidence of disease, both
ureteric orifices seen with difficulty but free ureteric orifices seen with difficulty but free
of disease. of disease.
The patient was staged as FIGO IIB. The patient was staged as FIGO IIB.
Metastatic workup revealed an incidental Metastatic workup revealed an incidental
finding of an ectopic left pelvic kidney finding of an ectopic left pelvic kidney
without hydronephrosis. without hydronephrosis.

4. CASE PRESENTATIONCASE PRESENTATION
The renal isotope scan showed that the The renal isotope scan showed that the
right kidney is normally located with right kidney is normally located with
normal function, but the left kidney is an normal function, but the left kidney is an
ectopic, located in the pelvis with good ectopic, located in the pelvis with good
function. function.
Split function was 79% in the right kidney, Split function was 79% in the right kidney,
and 21% in the left one. and 21% in the left one.

5. CASE PRESENTATIONCASE PRESENTATION
Because the left kidney was not functioning Because the left kidney was not functioning
properly, and the right kidney is properly, and the right kidney is
functioning normally.functioning normally.
we offered the patient radiotherapy with we offered the patient radiotherapy with
cisplatin-based chemotherapy with curative cisplatin-based chemotherapy with curative
intent and to sacrifice the left kidney. intent and to sacrifice the left kidney.

6. CASE PRESENTATIONCASE PRESENTATION
The patient received a radical course of The patient received a radical course of
:external beam therapy )EBRT( as follows:external beam therapy )EBRT( as follows
4500 cGy/25frs/5weeks to the whole pelvis; 4500 cGy/25frs/5weeks to the whole pelvis;
box technique; concomitantly with weekly box technique; concomitantly with weekly
cisplatinum )i.v( 40mg/m2, for 5 cycles. cisplatinum )i.v( 40mg/m2, for 5 cycles.
540 cGy/3frs/0.6 weeks – boost to the 540 cGy/3frs/0.6 weeks – boost to the
parametrium with midline shielding, she parametrium with midline shielding, she
completed the EBRT part of her treatment completed the EBRT part of her treatment
with fair tolerance.with fair tolerance.

7. CASE PRESENTATIONCASE PRESENTATION
Thereafter, she received 2500 cGy/5frs Thereafter, she received 2500 cGy/5frs
using high dose rate )HDR( – using high dose rate )HDR( –
microselectrone technology over 3 weeks, microselectrone technology over 3 weeks,
with good tolerance.with good tolerance.
 She completed her treatment in 9weeks She completed her treatment in 9weeks
period. period.
It has been 24 months since her treatment It has been 24 months since her treatment
and the patient remains free of disease, and and the patient remains free of disease, and
her serum creatinine and urea nitrogen are her serum creatinine and urea nitrogen are
still within normal valuesstill within normal values..

8. CASE PRESENTATIONCASE PRESENTATION
DISCUSSION:DISCUSSION:
 Evaluation of the kidney function before Evaluation of the kidney function before
therapy is essential.therapy is essential.
In this case, the pelvic kidney was In this case, the pelvic kidney was
marginally functional and the oftehr kidney marginally functional and the oftehr kidney
was fully functional.was fully functional.
Standard treatment of locally advanced Standard treatment of locally advanced
cervix cancer “ chemo radiation” was given.cervix cancer “ chemo radiation” was given.

9. CASE PRESENTATIONCASE PRESENTATION
Two years later, the patient was free of Two years later, the patient was free of
disease. disease.
Blood pressure and kidney function tests Blood pressure and kidney function tests
were normal.were normal.

10. CASE PRESENTATIONCASE PRESENTATION
Literature review:Literature review:
Bakri et al reported a case of stage IIB Bakri et al reported a case of stage IIB
cervix cancer with ectopic kidney.cervix cancer with ectopic kidney.
They performed radical Hyster. with PLND They performed radical Hyster. with PLND
and resection of the distal ureter and and resection of the distal ureter and
ureteric reimplantaion into urinary bladder ureteric reimplantaion into urinary bladder
using Boari-flap technique.using Boari-flap technique.
Adjuvant chemotherapy was needed.Adjuvant chemotherapy was needed.

11. CASE PRESENTATIONCASE PRESENTATION
Rosenshein et al, reported a case of cervical Rosenshein et al, reported a case of cervical
cancer with ectopic kidney.cancer with ectopic kidney.
The kidney was mobilized into the Lt iliac The kidney was mobilized into the Lt iliac
fossa and was fixed to the psoas muscle.fossa and was fixed to the psoas muscle.
Radiotherapy was the definitive treatment.Radiotherapy was the definitive treatment.

12. CASE PRESENTATIONCASE PRESENTATION
Roth et al, reported a case of bilateral pelvic Roth et al, reported a case of bilateral pelvic
kidneys and stage IIB cervix cancer.kidneys and stage IIB cervix cancer.
Anterior exenteration without vaginal Anterior exenteration without vaginal
reconstruction and a distal ileal urinary reconstruction and a distal ileal urinary
conduit were performed.conduit were performed.
This was complicated by Lt ureteroileal This was complicated by Lt ureteroileal
anastomotic leak that required reoperation anastomotic leak that required reoperation
on 2 occasions and Lt nephrectomy.on 2 occasions and Lt nephrectomy.
The LN were negative with no adjuvant The LN were negative with no adjuvant
treatment required.treatment required.

13. CASE PRESENTATIONCASE PRESENTATION
Another option, not yet reported, to Another option, not yet reported, to
use neoadjuvant chemotherapy use neoadjuvant chemotherapy
followed by radical hyster. And PLND.followed by radical hyster. And PLND.
Pretreatment PET scan help to define Pretreatment PET scan help to define
any metastatic disease.any metastatic disease.

14. CASE PRESENTATIONCASE PRESENTATION
CONCLUSION:CONCLUSION:
Reported treatment experience is limited to Reported treatment experience is limited to
sporadic case reports.sporadic case reports.
Because of the rarity of the condition, each Because of the rarity of the condition, each
case must be managed on its merits, with case must be managed on its merits, with
the use of a multidisciplinary team that the use of a multidisciplinary team that
consist of a gyne-onc, radiation oncologist consist of a gyne-onc, radiation oncologist
and a medical oncologist.and a medical oncologist.