A woman presented with complaints of heavy vaginal bleeding, vomiting, nausea, foul vaginal discharge, increased urination frequency and severe psychosocial distress. She was diagnosed with stage IVB cervical cancer. Her treatment plan involved hemostatic radiation, counseling on her prognosis, and discussing palliative options like stenting or dialysis. Her symptom management focused on controlling bleeding, pain, odor, nausea and fatigue. She also received psychosocial support through counseling and home care visits.

1. Presentation

2. TREATMENT PLAN
• Patient seen by medical oncologist – suggested to discuss in joint
clinic for further management
• Received 10 fractions of hemostatic radiation first
• Counselled regarding disease status and prognosis
• Option of stenting/ PCN, dialysis discussed with attendant

3. DIAGNOSIS
• Carcinoma Cervix IV-B
Cervix biopsy – Squamous cell carcinoma, moderately differentiated

4. PRESENTING COMPLAINTS
• Heavy bleeding per vaginum
• Multiple episodes of vomitings since a week
• Persistent nausea
• Foul odour per vagial discharge
• Severe psychosocial distress
• Increased frequency of urination

5. PSYCHOSOCIAL ASPECTS
• Advocate by profession
• Lived alone and independent
• Family collusion
• Divorcee
• Fair insight into disease
• Seven siblings living in station
• Family- not supportive
• Primary caregiver – Colleague
• Inability to do ADLs due to severe fatigue
• Suicidal thoughts

6. HISTORY OF ILLNESS
• HISTORY Of
-Heavy bleeding PV since 7 months
-White discharge in between bleeding episodes
• Consultation in government hospital – Advised: CBC, RFT, LFT, USG
Abdomen, CT Abdomen and pelvis and Uterine & Cervical biopsy.
• Diagnosed as Ca Cervix (non keratinising SCC) with uremia
-H/O 4 units of blood transfusion in September 2021
-H/O Spontaneous miscarriages- 2 times in the past (no children)

7. TREATMENT PLAN
• Seen by medical oncologist and suggested to discuss in joint clinic for
further management
• Received 10 fractions of hemostatic radiation first
• Counselled regarding the disease status and prognosis
• Options for stenting/ PCN , dialysis discussed with attendant – pros
and cons explained, potential futility of care explained,
• Guarded prognosis explained by oncology and palliative care
• Shared decision making for conservative management and
observation
• Planned for best supportive care

8. SYMPTOM MANAGEMENT
• Correcting the Correctable
• Bleeding- palliative Radiation and Tranexamic acid
• Pain- Step 3 Opioids and adjuvants
• Odour -Tab. Metronidazole 400mg for 5 days and 200mg of
maintenance dose
• Nausea/ vomiting – Tab. Olanzepine 2.5mg HS
• Fatigue Burst doses of Dexa( steroid)

9. PSYCHOSOCIAL INTERVENTIONS
• Supportive counselling of both patient and caregiver
• On regular phone call follow up to know the status
• Home Care Visit- Empowered patient and caregiver.