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 tissue. The diagnosis was likely stage II B carcinoma of the cervix requiring further evaluation and treatment.

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.