Case Report Presentation Cervix Cancer


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Case Report Presentation Cervix Cancer

  1. 1. CASE PRESENTATION <ul><li>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. </li></ul><ul><li>Her general and systemic physical examination was normal. </li></ul>
  2. 2. CASE PRESENTATION <ul><li>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. </li></ul><ul><li>The left parametrium was invaded up to 1cm from the pelvic sidewall </li></ul><ul><li>The medial third of the right parametrium was also involved by the lesion. </li></ul><ul><li>Rectal mucosa free of disease. </li></ul>
  3. 3. CASE PRESENTATION <ul><li>Cystoscopy showed Bulging in the trigone area but no evidence of disease, both ureteric orifices seen with difficulty but free of disease. </li></ul><ul><li>The patient was staged as FIGO IIB. </li></ul><ul><li>Metastatic workup revealed an incidental finding of an ectopic left pelvic kidney without hydronephrosis. </li></ul>
  4. 4. CASE PRESENTATION <ul><li>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. </li></ul><ul><li>Split function was 79% in the right kidney, and 21% in the left one. </li></ul>
  5. 5. CASE PRESENTATION <ul><li>Because the left kidney was not functioning properly, and the right kidney is functioning normally. </li></ul><ul><li>we offered the patient radiotherapy with cisplatin-based chemotherapy with curative intent and to sacrifice the left kidney. </li></ul>
  6. 6. CASE PRESENTATION <ul><li>The patient received a radical course of external beam therapy (EBRT) as follows: </li></ul><ul><li>4500 cGy/25frs/5weeks to the whole pelvis; box technique; concomitantly with weekly cisplatinum (i.v) 40mg/m2, for 5 cycles. </li></ul><ul><li>540 cGy/3frs/0.6 weeks – boost to the parametrium with midline shielding, she completed the EBRT part of her treatment with fair tolerance. </li></ul>
  7. 7. CASE PRESENTATION <ul><li>Thereafter, she received 2500 cGy/5frs using high dose rate (HDR) – microselectrone technology over 3 weeks, with good tolerance. </li></ul><ul><li>She completed her treatment in 9weeks period. </li></ul><ul><li>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 . </li></ul>
  8. 8. CASE PRESENTATION <ul><li>DISCUSSION: </li></ul><ul><li>Evaluation of the kidney function before therapy is essential. </li></ul><ul><li>In this case, the pelvic kidney was marginally functional and the oftehr kidney was fully functional. </li></ul><ul><li>Standard treatment of locally advanced cervix cancer “ chemo radiation” was given. </li></ul>
  9. 9. CASE PRESENTATION <ul><li>Two years later, the patient was free of disease. </li></ul><ul><li>Blood pressure and kidney function tests were normal. </li></ul>
  10. 10. CASE PRESENTATION <ul><li>Literature review: </li></ul><ul><li>Bakri et al reported a case of stage IIB cervix cancer with ectopic kidney. </li></ul><ul><li>They performed radical Hyster. with PLND and resection of the distal ureter and ureteric reimplantaion into urinary bladder using Boari-flap technique. </li></ul><ul><li>Adjuvant chemotherapy was needed. </li></ul>
  11. 11. CASE PRESENTATION <ul><li>Rosenshein et al, reported a case of cervical cancer with ectopic kidney. </li></ul><ul><li>The kidney was mobilized into the Lt iliac fossa and was fixed to the psoas muscle. </li></ul><ul><li>Radiotherapy was the definitive treatment. </li></ul>
  12. 12. CASE PRESENTATION <ul><li>Roth et al, reported a case of bilateral pelvic kidneys and stage IIB cervix cancer. </li></ul><ul><li>Anterior exenteration without vaginal reconstruction and a distal ileal urinary conduit were performed. </li></ul><ul><li>This was complicated by Lt ureteroileal anastomotic leak that required reoperation on 2 occasions and Lt nephrectomy. </li></ul><ul><li>The LN were negative with no adjuvant treatment required. </li></ul>
  13. 13. CASE PRESENTATION <ul><li>Another option, not yet reported, to use neoadjuvant chemotherapy followed by radical hyster. And PLND. </li></ul><ul><li>Pretreatment PET scan help to define any metastatic disease. </li></ul>
  14. 14. CASE PRESENTATION <ul><li>CONCLUSION: </li></ul><ul><li>Reported treatment experience is limited to sporadic case reports. </li></ul><ul><li>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. </li></ul>