A 40-year-old woman presented with a 4-month history of increased menstrual bleeding and intermenstrual bleeding. On examination, the physician discovered a 2x2 cm cauliflower-like growth on the anterior lip of her cervix that bled easily. Further examination found involvement of the parametrial tissues without lymph node enlargement, consistent with Stage IIB cervical cancer.

1. Mrs R , 40 year female, P2L2, not sterilised ,a cook hailing from Porur belonging to
socioeconomic class III came with
C/O Increased bleeding per vaginum during menstrual cycles associated with inter menstrual
bleeding for 4 months.
C/O white discharge PV for past 3 months.
No complaints of
HISTORY OF PRESENTING ILLNESS
• H/o Increased bleeding per vaginum during mesntrual cycles,Associated with passage of clots
changed 4-5 pads a day(previously changed 2 pads a day)
• Seen at an outside hospital where she was Given T.Meprate(as per patients knowledge) unsure
of dosage two times a day for 1 month ,however symptoms did not subside.
• H/o white discharge p/v for 4 months
• Watery in consistency non blood stained
• Not foul smelling
• Not associated with itching

2. • H/o low back ache- vague pain , relieved by medication, no
aggravating factors for on and off for the last year
• H/o loss of weight for 4kg in 4 months
• H/o loss of appetite
• No h/o increased frequency of micturition, painful micturition, blood
stained urine
• No h/o pedal oedema, leg pain, loin pain.
• No h/o forgotten pessary/ IUCD.
• No h/o post coital bleeding
• No h/o dyspaerunia

3. • MENSTRUAL HISTORY:
• Menarche 15years of age
• Regular periods 4-5/30days with moderate flow
• No h/o dysmenorrhea
• LMP: 12/12/18
• for 4 months history of increased bleeding per vaginum ,changes 4-5 pads a
day ,associated with passage of clots.
• MARITAL HISTORY:
• Married for 24 yrs, living with husband ;Driver by occupation
• Age at marriage 17 years of age
• No h/o contraceptive usage.

4. • OBSTETRIC HISTORY : P2L2
• I: conceived 3months after marriage ,
male, 23 yrs alive and healthy, FTNVD at home
antenatal and postnatal period uneventful
breast fed for 1year
• II: conceived after 1 yr of first delivery.
female, 20 yrs ,alive and healthy, FTNVD at a hospital in vadapalani.
antenatal and postnatal period uneventful
breast fed for 1 year
H/O copper T usage for 2 years between pregnancies,removed to plan next pregnancy.

5. • PAST HISTORY:
• Not a known c/o DM,HT, TB, epilepsy, heart disease
• No h/o blood transfusion, drug allergy, any prior treatment
• No history of any oral contraceptive use
• PERSONAL HISTORY:
• Vegetarian
• Normal bowel and bladder habits
• No addictive habits
• FAMILY HISTORY:
• No h/o any gynecological malignancies in her family.

6. GENERAL EXAMINATION
• Well built ,moderately nourished.
• No Pallor present, not icteric, not cyanosed, no pedal edema , no
clubbing
• No lymphadenopathy
• Thyroid ,breast , spine : normal
• Height : 145cm weight : 54kg BMI: 25
• Vitals:
• Temp: normal
• PR: 88/min
• BP: 110/70 mm/hg

7. • CVS: S1,S2 heard , no murmur
• RS: b/l air entry equal, normal vesicular breath sounds heard
• ABDOMINAL EXAMINATION
• INSPECTION:
• Scaphoid, umbilicus in midline, inverted
• All quadrants moves equally with respiration
• No scars, dilated veins, visible pulsations
• Hernial orifices free

8. • PALPATION:
• Soft, non tender, no mass palpable , no organomegaly
• PERCUSSION:
• No fluid thrill, no free fluid.
• AUSCULTATION:
• Normal bowel sounds heard
• Local examination: external genitalia appears normal for age.
sparse pubic hair.
labia majora and minora normal.
vulva normal.

9. • PER SPECULUM :
• Cervix congested, irregular
• Friable, cauliflower like growth from anterior lip of 2x2cm
• Bleeding pv+
• BIMANUAL EXAMINATION :
• Cervix irregular, hard consistency, bleeds on touch
• Anterior and posterior cervix replaced by hard irregular growth
• bleeds on touch
• Mobile , movement of cervix not tender
• Uterus anteverted, normal size
• Fornices free
• Vaginal mucosa free
• PER RECTAL :
• Nodules palpated in the parametrium
• rectal mucosa free.
• Rectovaginal septum not involved.

10. Summary:
40yr old multiparous women with h/o
Menometrorhaggia with history of white discharge per
vaginum presents with a 2x2 cm growth over the
anterior lip of the cervix with parametrial involvement

11. DIAGNOSIS:
• 45 Yrs old multiparous women with menometrorhagia with anemia,
with an exophytic growth of the cervix, which bleeds on touch, with
parametrial involvement,No palpable lymph nodes probably a case of
carcinoma cervix stage II B for further evaluation and management.