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Case Report Presentation  Cervix Cancer
 

Case Report Presentation Cervix Cancer

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    Case Report Presentation  Cervix Cancer Case Report Presentation Cervix Cancer Presentation Transcript

    • CASE PRESENTATION
      • A 50-year-old patient, para 5 was referred to gynecologic oncology service after an evaluation for abnormal vagina bleeding led to cervical biopsies which demonstrated invasive adenocarcinoma of the cervix.
      • Her general and systemic physical examination was normal.
    • CASE PRESENTATION
      • Pelvic examination showed 7cm barrel shape cervical lesion, invading the upper 1/3 of the anterior vaginal wall, other vaginal walls are free of disease.
      • The left parametrium was invaded up to 1cm from the pelvic sidewall
      • The medial third of the right parametrium was also involved by the lesion.
      • Rectal mucosa free of disease.
    • CASE PRESENTATION
      • Cystoscopy showed Bulging in the trigone area but no evidence of disease, both ureteric orifices seen with difficulty but free of disease.
      • The patient was staged as FIGO IIB.
      • Metastatic workup revealed an incidental finding of an ectopic left pelvic kidney without hydronephrosis.
    • CASE PRESENTATION
      • The renal isotope scan showed that the right kidney is normally located with normal function, but the left kidney is an ectopic, located in the pelvis with good function.
      • Split function was 79% in the right kidney, and 21% in the left one.
    • CASE PRESENTATION
      • Because the left kidney was not functioning properly, and the right kidney is functioning normally.
      • we offered the patient radiotherapy with cisplatin-based chemotherapy with curative intent and to sacrifice the left kidney.
    • CASE PRESENTATION
      • The patient received a radical course of external beam therapy (EBRT) as follows:
      • 4500 cGy/25frs/5weeks to the whole pelvis; box technique; concomitantly with weekly cisplatinum (i.v) 40mg/m2, for 5 cycles.
      • 540 cGy/3frs/0.6 weeks – boost to the parametrium with midline shielding, she completed the EBRT part of her treatment with fair tolerance.
    • CASE PRESENTATION
      • Thereafter, she received 2500 cGy/5frs using high dose rate (HDR) – microselectrone technology over 3 weeks, with good tolerance.
      • She completed her treatment in 9weeks period.
      • It has been 24 months since her treatment and the patient remains free of disease, and her serum creatinine and urea nitrogen are still within normal values .
    • CASE PRESENTATION
      • DISCUSSION:
      • Evaluation of the kidney function before therapy is essential.
      • In this case, the pelvic kidney was marginally functional and the oftehr kidney was fully functional.
      • Standard treatment of locally advanced cervix cancer “ chemo radiation” was given.
    • CASE PRESENTATION
      • Two years later, the patient was free of disease.
      • Blood pressure and kidney function tests were normal.
    • CASE PRESENTATION
      • Literature review:
      • Bakri et al reported a case of stage IIB cervix cancer with ectopic kidney.
      • They performed radical Hyster. with PLND and resection of the distal ureter and ureteric reimplantaion into urinary bladder using Boari-flap technique.
      • Adjuvant chemotherapy was needed.
    • CASE PRESENTATION
      • Rosenshein et al, reported a case of cervical cancer with ectopic kidney.
      • The kidney was mobilized into the Lt iliac fossa and was fixed to the psoas muscle.
      • Radiotherapy was the definitive treatment.
    • CASE PRESENTATION
      • Roth et al, reported a case of bilateral pelvic kidneys and stage IIB cervix cancer.
      • Anterior exenteration without vaginal reconstruction and a distal ileal urinary conduit were performed.
      • This was complicated by Lt ureteroileal anastomotic leak that required reoperation on 2 occasions and Lt nephrectomy.
      • The LN were negative with no adjuvant treatment required.
    • CASE PRESENTATION
      • Another option, not yet reported, to use neoadjuvant chemotherapy followed by radical hyster. And PLND.
      • Pretreatment PET scan help to define any metastatic disease.
    • CASE PRESENTATION
      • CONCLUSION:
      • Reported treatment experience is limited to sporadic case reports.
      • Because of the rarity of the condition, each case must be managed on its merits, with the use of a multidisciplinary team that consist of a gyne-onc, radiation oncologist and a medical oncologist.