Case report

Cervical Cancer Grade IIIB post EBRT + AFN +

Anemia Suspect Residif Post Radiotherapy

Suharto,S.Ked

Faculty of Medicine
Tanjungpura University
dr. Soedarso General Hospital
Pontianak
2014
IDENTITY

Name : Mrs. Syamsinah

Age : 47th years
Job : IRT
Address : Jl. Daeng Manambon, Mempawah Timur
No. MR : 767756
Admitted : 7-6-2014
ANAMNESIS

Chief compliant:

Hip pain and Bloody stool

 .. Current history
3 years ago

The patient often fell the tenderness of

lower abdomen and spotting from vagina
beside of mens period.
she felt pain within intercourse and bloody.
not satisfy when pup and toilet
abdominal discomfort
She performed examination to the general
doctor and referred to Pontianak Hospital.
 2 years ago

The patient have hospitalization to Antonius hospital

and diagnosed as cervical cancer grade IIIB
The patient referred to Dharmais hospital to get
advanced therapy.
In Dharmais hospital, the patient got EBRT 3 times and
brachytherapy 25 times.
Before it, the patient have been performed
chemotherapy, but the condition is worth and have be
do hemodialysis.
After radiotherapy, based on pathologic anatomic
examination, not found again the cancer cell.
 6 month ago

The patient feel the hip pain and bloody stool.

The patient came to Rubini hospital and be performed
blood transfusion.
 Admit to
Soedarso

In Mei 2014, the patient still get bloody stool, pain in

pelvic, and weakness.
The patient have cured to Rubini hospital and
perform blood transfusion again.
The patient admit to Antonius Hospital and referred
to Soedarso hospital.
 Histories

Cancer history (-)

Lochia history (+)
Families Health Histories
No Cancers history in family

Sosio-economical histories
The patient no job. Her husband is a bus driver. Have public health
insurance.
 Obstetric history
No. Place labor Year Concepti Type Sex Body Child
on result labour weight conditio
n

1. Midwifes clinic 1990 S female 2900 gr live

A P

2. Midwifes clinic 1995 T O male 3100 gr live

E N
R T
3. Midwifes clinic 2001 female 3100 gr live
M A
N
4. Midwifes clinic 2007 male 3500 gr live
Gynecological history

The first menstruation age is 14 years old, regular mens period, and
have amenorhea since a year ago.
She often feel lochia, spotting, and smelling.
Physical Examination

Vital Sign
general condition : good, compos mentis
BP : 120/80 mmHg
heart rate : 68 x/ min
breathing frec. : 20 x/ min
General Status
a. head : normocephali, no tenderness, conjunctiva anemia (+/+)
b. neck : normal
c. chest : normal
d. heart : normal
e. pulmo : normal
f. abdomen : flat, bowel movement (+) normal, tenderness (+) at epigastrium
and lower abdomen, no hepatomegaly.
g. genitalia : not be performed
i. anus & rectum: not be performed
j. Extremity: normal
k. Limf node : no abnormal
Laboratory Examination

Laboratory (2-6-2014)
Hemoglobin : 6,8 gr/dl
Leukosit : 4.800 /ul
Trombosit : 371.000 /ul
Hematocrit : 21,4 %
Ureum : 32 mg/dl
Creatinin : 1,43 mg/dl
GDS : 98 mg/dl
Radiology (CT scan abdomen)
Liver, vesica felia, spleen, and kidneys are normal
No mass/ nodul in liver
No mass/obstruction in tractus digestivus, no deletion.
Suggest: thickened in bladder et causa DD/
Suspect residif tumor in bladder
Cystitis post radiation
Problem list

Bloody in rectum
Dyspepsia
Hip pain
Anemia
Cervical cancer stadium IIIB
Diagnosis

Cervical cancer grade IIIB post EBRT and Brachytherapy with anemia,
suspect residif post radiotherapy.
DD/ cystitis post radiotherapy
Suggestion Examination

Rectosigmoidoscopy (proctoscopy)
colposcopy
biopsy cervix
rontgent thorax
Management

IVFD RL 20 gtt
Transfusion PRC until Hb > 10 gr/dl
Tranexamid acid 3 x 500 mg iv bolus
Diet high calories and protein
Pro palliative chemotherapy
Prognosis

Ad vitam : dubia ad malam

Ad functionam : malam
Ad sanactionam : malam
 Hematochezia Anemia Transfusion

Pelvic pain
Pro-
Susp. Ca. Chemotherapy
Cerviks residif P
Vagina bleeding
R
ad vitam : dubia ad malam
O ad sanactionam : malam
Biopsy N ad fungsionam : malam
Ca. cervix IIIB Post EBRT Colonoscopy O
+ AFN Rontgen Thorax
S
Thickened of bladder I
wall S
Conclusion

Case of cervical cancer residif post radiotherapy is poor prognosis

Any examination needed to diagnosis the residif case, so it can be
treatment properly. Although it can be treated with palliatif
treatment, the supportif and quality of life is the most important.
Thank You
Tgl Subjektif Objektif Assessment Planning

7-6-2014 Nyeri ulu hati KU: baik, kesadaran: Ca. cervix Cek Hb, Obs KU,
hilang timbul kompos mentis, TD: 130/90, stadium IIIB post TTV, perdarahan.
BAB kadang HR: 60 x/mnt, RR: 16 x/mnt EBRT +
berdarah Konjungtiva anemis (+/+) AFN+Anemia
Riwayat transfusi 2 Cor: S1-S2 tunggal, gallop (-
minggu lalu ), murmur (-)
Pulmo: vesikuler (+/+),
rhonki (-/-), wheezing (-/-)
Abd: sufel, BU (+) normal,
nyeri tekan (+) epigastrium
8-6-2014 Nyeri ulu hati KU:baik, Kes: Ca. Cervix IIIB post Inf RL:D5% 20 TPM
(+) hilang compos mentis, TD: EBRT + AFN + Transfusi PRC s/d Hb 10
timbul 110/60 mmHg, HR:60 Anemia g%
Perdarahan x/mnt, RR: 20 x/mnt Inj. Kalnex 500mg/12 jam/iv
saat BAB (+) Konjungtiva anemis Pro CT-scan abdomen
(+/+) rectosigmoidoscopy
Cor: S1-S2 tunggal Tx/ Paliatif Chemoterapi
Pulmo: vesikuler
(+/+), rhonki (-/-),
Wheezing (-/-)
Abd: soefel, BU (+) N,
NT (+) epigastrium
Ext: anemis, CRT <
2dtk
Hb: 6,8 gr/dl
9-6-2014 BAB berdarah KU: baik, kes: CM, TD Ca. cervix stadium Observasi KU, TTV,
(-), nyeri ulu 140/80, HR: 88 x/mnt, IIIB post EBRT + perdarahan
hati (-) RR: 20 x/mnt AFN + anemia Infus RL:D5% 20 TPM
Abd: soefel, BU (+), Transfusi PRC, target Hb 10