gulabo_devi_ca_cervix_finalll.pptxbbvvdff

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1. Department: Obstetrics and Gynaecology Case Presentation by: Dr. Ankita Date: 25.6.19 TMH & MTMH Tumor Board Patient Name: Gulabo Devi Age/Sex: 80 years, female Patient ID: MR/19/062746

2. Presenting complaints & examination 80 Yrs old post-menopausal female came to opd on 25/5/19 with complaints of : Off & on vaginal bleeding x 2 months H/o anorexia , weight loss & constipation for last 2 months No known medical or surgical illness . Menopause – 30 yrs back

3. On examination GC- fair . Pallor, edema , icterus - nil Vitals-stable Breast & thyroid –NAD No palpable lymph node. Chest & CVS -NAD

4. Per abdominal exam- soft , no palpable lump Per speculum- vagina appears normal, cervix pulled up exfoliative growth replacing entire cervix , bleeds on touch Per vaginum - uterus normal size ,soft , growth in cervix fragile, bleeds on touch , bilateral parametrium indurated Per rectal- cervical growth 4 x 4 cm hard in consistency , rectal mucosa free, bilateral parametrium involved. Clinical stage IIB

5. . MRI Abdomen + pelvis MTMH (REVIEWED) 03.06.2019. A well defined lesion size 4.7 x 2.9 cm arising from cervix obliterating the endocervical canal completely, causing retention of fluid with debris level in endometril cavity. Extension into the anterior fornix and ant vaginal wall upto 1 cm No parametrial involvement Mass abuting posterior urinary bladder however not infilterating the bladder wall. Fat plane with rectum is maintained. No significant lymphadenopathy seen.

6. Impression – Malignant cervical mass with endocervical canal stenosis causing pyometra , with involvement of upper anterior vaginal wall Usg in TMH on 20/6/19– No pyometra seen , uterus 6 x 2.7 cm Et –thin b/l ovaries normal.

7. Relevant investigations value CBC- HB-11.8, TLC-8700, PLATELET COUNT-2.81 Lakhs /mm3 SEROLOGY-( HIV,HBSAg ) – NR URINE R&D – 5 pus cells , C/S – NAD Creatinine 1.0 mg/dl ( 0.5-1.5) LFT REPORTS AWAITED

8. Cervical Biopsy done on 7/6/19 in TMH Examination under anasthesia - Clinical stage CA cervix stage II B HPE report-11/6/19 Invasive moderately to poorly differentiated keratinizing squamous cell carcinoma .

9. Provisional diagnosis: Stage II B CA cervix (with radiology negative for adenopathy ) Treatment: PELVIC EBRT +CONCURRENT CISPLATIN CONTAINING CHEMOTHERAPY+ BRACHYTHERAPY(category 1)

10. Suggestion from Tumor Board on the planned treatment