This document presents a case study of carcinoma cervix. It begins with an overview of the epidemiology, pathogenesis, risk factors, symptoms, diagnosis, staging, treatment and prevention of cervical cancer. It then discusses the specific case of a 45-year-old woman who presented with irregular bleeding, post-coital bleeding, and foul-smelling discharge. Her examination revealed a cauliflower-like growth on the cervix. Tests showed stage 2B carcinoma cervix. She was given conservative treatment including antibiotics and blood transfusion to improve her general health before definitive treatment. The document concludes with an open discussion and review of the case.
1. Cancer of the vulva accounts for 1-5% of all genital cancers and commonly presents as squamous cell carcinoma in elderly women.
2. Staging of vulvar cancer ranges from Stage 0 (preinvasive lesions) to Stage IV (distant metastasis). Treatment depends on staging and may include surgery, radiation, chemotherapy, or a combination.
3. Prognosis depends on factors like tumor size, grade, lymph node involvement, and completeness of excision, with 5-year survival rates ranging from 90% for Stage I to 15% for Stage IV disease.
This document discusses menopause and postmenopausal bleeding. It defines menopause as the permanent cessation of menstruation from loss of ovarian activity, which can only be determined after 12 months of amenorrhea. Postmenopausal bleeding occurs in 4-11% of menopausal women and requires evaluation. Causes include atrophic changes, polyps, hormonal therapy, and malignancy such as endometrial cancer. Evaluation involves history, exam, ultrasound, and endometrial biopsy to diagnose and treat any identified issues.
This document discusses the symptoms, signs, objectives, types, diagnosis, and management of premalignant vulval lesions. The types discussed are vulval intraepithelial neoplasia (VIN), Paget's disease, and lichen sclerous. Symptoms may include pruritus vulvae, bleeding ulcers, and white, gray, pink or dull lesions. Diagnosis is confirmed through multiple biopsies. Management options include topical medications like triamcinolone, betamethasone, 5-FU or surgical procedures like local excision, laser therapy, or vulvectomy.
Surgical management of carcinoma cervixDrAyush Garg
This document summarizes the surgical management and classification of stages of carcinoma of the cervix. It outlines the different types of surgical procedures used to treat various stages of cervical cancer, from conization for stage IA1 to radical hysterectomy for stage IB and chemoradiation for stages II-IV. It describes 5 types of surgical procedures ranging from simple hysterectomy to exenteration based on the extent of resection. Radical trachelectomy is mentioned as a fertility-preserving option for early stage disease in younger patients.
This document discusses ovarian germ cell tumors (OGCTs), including their subtypes, malignant potential, tumor markers expressed, routes of spread, grading systems, and treatment approaches. The main subtypes of OGCTs are dysgerminoma, endodermal sinus tumor, embryonal carcinoma, polyembryoma, choriocarcinoma, teratoma, and mixed germ cell tumors. Staging, grading, and the presence of certain subtypes and tumor markers determine the need for chemotherapy or surveillance following surgery. Long-term surveillance involves physical exams, serum tumor marker checks, and radiographic imaging for 5 years or more to monitor for recurrence.
Endometrial cancer is the most common gynecologic cancer. It has a lifetime risk of 2.4% in white women. Risk factors include obesity, late menopause, diabetes, and unopposed estrogen exposure. Diagnosis is usually made with endometrial biopsy. Treatment involves hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection. Adjuvant radiation and/or chemotherapy may be used in high risk cases. With early stage diagnosis, endometrial cancer has a good prognosis.
Cervical cancer is a major health problem worldwide, especially in developing countries like Egypt where it is the second most common cancer in women. Screening is important for early detection and treatment of pre-cancerous lesions to prevent the development of invasive cancer. The document discusses various screening methods for cervical cancer including cytology-based tests like Pap smears and HPV testing as well as visual inspection methods. It also reviews the prevalence of pre-cancerous lesions in Egypt and limitations of screening in low resource settings.
This document discusses the diagnosis and management of morbidly adherent placenta (MAP). It notes that the incidence of MAP has increased substantially in recent decades. Ultrasound is the primary tool for antenatal diagnosis, with findings like myometrial thinning and placental lacunae. MRI can be used as an adjunct. Treatment options include preterm cesarean hysterectomy or conservative approaches like leaving the placenta in situ or attempting placental resection. Conservative approaches aim to reduce morbidity while preserving fertility but carry risks of hemorrhage.
1. Cancer of the vulva accounts for 1-5% of all genital cancers and commonly presents as squamous cell carcinoma in elderly women.
2. Staging of vulvar cancer ranges from Stage 0 (preinvasive lesions) to Stage IV (distant metastasis). Treatment depends on staging and may include surgery, radiation, chemotherapy, or a combination.
3. Prognosis depends on factors like tumor size, grade, lymph node involvement, and completeness of excision, with 5-year survival rates ranging from 90% for Stage I to 15% for Stage IV disease.
This document discusses menopause and postmenopausal bleeding. It defines menopause as the permanent cessation of menstruation from loss of ovarian activity, which can only be determined after 12 months of amenorrhea. Postmenopausal bleeding occurs in 4-11% of menopausal women and requires evaluation. Causes include atrophic changes, polyps, hormonal therapy, and malignancy such as endometrial cancer. Evaluation involves history, exam, ultrasound, and endometrial biopsy to diagnose and treat any identified issues.
This document discusses the symptoms, signs, objectives, types, diagnosis, and management of premalignant vulval lesions. The types discussed are vulval intraepithelial neoplasia (VIN), Paget's disease, and lichen sclerous. Symptoms may include pruritus vulvae, bleeding ulcers, and white, gray, pink or dull lesions. Diagnosis is confirmed through multiple biopsies. Management options include topical medications like triamcinolone, betamethasone, 5-FU or surgical procedures like local excision, laser therapy, or vulvectomy.
Surgical management of carcinoma cervixDrAyush Garg
This document summarizes the surgical management and classification of stages of carcinoma of the cervix. It outlines the different types of surgical procedures used to treat various stages of cervical cancer, from conization for stage IA1 to radical hysterectomy for stage IB and chemoradiation for stages II-IV. It describes 5 types of surgical procedures ranging from simple hysterectomy to exenteration based on the extent of resection. Radical trachelectomy is mentioned as a fertility-preserving option for early stage disease in younger patients.
This document discusses ovarian germ cell tumors (OGCTs), including their subtypes, malignant potential, tumor markers expressed, routes of spread, grading systems, and treatment approaches. The main subtypes of OGCTs are dysgerminoma, endodermal sinus tumor, embryonal carcinoma, polyembryoma, choriocarcinoma, teratoma, and mixed germ cell tumors. Staging, grading, and the presence of certain subtypes and tumor markers determine the need for chemotherapy or surveillance following surgery. Long-term surveillance involves physical exams, serum tumor marker checks, and radiographic imaging for 5 years or more to monitor for recurrence.
Endometrial cancer is the most common gynecologic cancer. It has a lifetime risk of 2.4% in white women. Risk factors include obesity, late menopause, diabetes, and unopposed estrogen exposure. Diagnosis is usually made with endometrial biopsy. Treatment involves hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection. Adjuvant radiation and/or chemotherapy may be used in high risk cases. With early stage diagnosis, endometrial cancer has a good prognosis.
Cervical cancer is a major health problem worldwide, especially in developing countries like Egypt where it is the second most common cancer in women. Screening is important for early detection and treatment of pre-cancerous lesions to prevent the development of invasive cancer. The document discusses various screening methods for cervical cancer including cytology-based tests like Pap smears and HPV testing as well as visual inspection methods. It also reviews the prevalence of pre-cancerous lesions in Egypt and limitations of screening in low resource settings.
This document discusses the diagnosis and management of morbidly adherent placenta (MAP). It notes that the incidence of MAP has increased substantially in recent decades. Ultrasound is the primary tool for antenatal diagnosis, with findings like myometrial thinning and placental lacunae. MRI can be used as an adjunct. Treatment options include preterm cesarean hysterectomy or conservative approaches like leaving the placenta in situ or attempting placental resection. Conservative approaches aim to reduce morbidity while preserving fertility but carry risks of hemorrhage.
This document discusses gestational trophoblastic disease (GTD), specifically hydatidiform moles. It defines a hydatidiform mole as a pregnancy characterized by vesicular swelling of placental villi, usually with the absence of an intact fetus. Molar pregnancies can be complete or partial based on whether there is a fetus present. Complete moles have no fetus and are diploid, while partial moles may contain defective fetuses and are usually triploid. Symptoms include vaginal bleeding and an enlarged uterus. Diagnosis involves beta-hCG levels and ultrasound showing a "snowstorm" pattern. Treatment is surgical evacuation followed by chemotherapy for high-risk cases to prevent invasive tumors.
The document discusses the cervix and cervical intraepithelial neoplasia (CIN). Some key points:
1) The cervix contains two types of epithelium that meet at the squamocolumnar junction (SCJ), which shifts locations throughout life. The transformation zone (TZ) is the area at risk for developing pre-cancerous and cancerous lesions.
2) CIN is characterized by abnormal cell growth in the cervix and is graded from I to III based on severity. Left untreated, some CIN lesions can progress to cervical cancer over many years.
3) Human papillomavirus (HPV) infection is required for cervical cancer but most infections clear on
The document discusses cervical histology and screening for cervical cancer. It describes the squamocolumnar junction (SCJ) and transformation zone of the cervix. The location of the SCJ changes with age due to regenerative changes. Screening guidelines from ACOG and WHO are provided regarding what ages to screen and what tests to use. Screening methods like Pap smear, HPV testing, visual inspection with acetic acid are outlined. Management of abnormal screening results including follow up testing and treatment options like cryotherapy, LEEP, and hysterectomy are summarized.
1) The document discusses the approach to evaluating a patient presenting with a breast lump, including obtaining a thorough history, conducting a physical examination, and ordering appropriate investigations.
2) The differential diagnosis for a breast lump includes benign conditions like fibrocystic disease, cysts, and fibroadenoma, as well as breast cancer.
3) Treatment depends on the diagnosis, with benign lumps often excised for confirmation, while malignant breast cancer may require total mastectomy or lumpectomy along with further treatment and follow-up testing.
Postmenopausal bleeding (PMB) refers to bleeding from the genital tract at least one year after menopause. It can indicate underlying malignancy and should be promptly evaluated. The most common causes are atrophic vaginitis (60-80% of cases) and hormone therapy (15-25% of cases). Evaluation of a patient with PMB includes history, exam, endometrial biopsy, and further tests if needed. Common pathologies found are polyps, hyperplasia, and cancer. Treatment depends on diagnosis but may include hormone therapy, surgery, or other options.
Genital tuberculosis (TB) commonly affects females aged 20-40 years. It is usually secondary to pulmonary or other organ involvement. The fallopian tubes are most frequently involved (90-100%), followed by the endometrium (50-60%). Common presenting symptoms include infertility (40-50%), abnormal bleeding (25-30%), and pelvic pain (15-25%). Diagnosis involves clinical suspicion, imaging such as ultrasound or HSG, and microbiological tests on samples from the endometrium or tubes. Treatment consists of a multi-drug regimen containing isoniazid, rifampin, pyrazinamide and ethambutol for 2 months, followed by isoniazid and rif
The document discusses management dilemmas in cervical cancer. It notes that cervical cancer is the third most common cancer worldwide yet is preventable. Treatment options depend on the stage of cancer and may involve surgery such as radical hysterectomy or radiation therapy. Close follow up is important after treatment due to the risk of recurrence. Proper screening and early detection are emphasized to improve outcomes for cervical cancer patients.
Rh negative pregnancies can lead to isoimmunization of the mother if she has a Rh positive baby. This occurs due to a fetomaternal hemorrhage which allows the fetus's Rh positive blood cells to enter the mother's circulation and trigger an immune response. Testing for isoimmunization involves indirect Coombs testing of the mother. Unsensitized Rh negative mothers receive anti-D immunoglobulin injections to prevent isoimmunization. Sensitized pregnancies require careful monitoring and may involve amniocentesis, intrauterine transfusions or early delivery to prevent fetal complications like hydrops fetalis. The baby may also require treatments like phototherapy or exchange transfusion if affected by hemolytic anemia or
Cervical cancer is caused by HPV infection and is the leading cause of cancer deaths in many developing countries. HPV is present in over 99% of cervical cancers. Risk factors include young age of first sexual activity, multiple partners, early pregnancy, and smoking. Precancerous lesions usually develop over 10-15 years. Cervical cancer spreads locally through the cervix and vagina, and can metastasize to nearby lymph nodes and distant sites like the lungs and liver. Diagnosis involves identifying dysplastic cervical cells, and treatment depends on the cancer stage.
Basics To Ca Cx Screening (Eastern Biotech)Pankaj Sohaney
Detecting HPV means better understanding of the risk of cervical cancer was the major focus of Dr. Dinesh Gupta. He spoke on “Opportunistic Screening for Cervical Precancer Lesions” and informed why the combination screening is vital for prevention and detection of cervical cancer. According to Dr. Gupta, combined screening with liquid based cytology and hybrid capture2 HPV DNA test would identify who’s at risk for high-grade disease and cancer and reduce missed disease caused by false-negative Pap Smear. HPV DNA test is the only FDA approved test to detect 13 high risk HPVs associated with virtually all cervical cancer, he added.
The document discusses three case scenarios involving pregnant women with reactive syphilis serology. It provides details on interpreting syphilis serology, the stages of syphilis infection, and recommendations for treatment and follow up after treatment. The key points are: syphilis should be suspected in pregnant women who are sexually active or have partners with risk factors; reactive nontreponemal and treponemal tests indicate current or past untreated syphilis; and pregnant women with reactive tests should be treated with penicillin to prevent transmission to the fetus.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
This document discusses the treatment of ovarian carcinoma. It begins with an overview of the epidemiology, patterns of spread, symptoms, diagnostic workup and surgical staging of the disease. It then describes the histopathological classification and various chemotherapy regimens used as adjuvant treatment, including platinum-based drugs like cisplatin and carboplatin, and taxanes like paclitaxel. The standard first-line regimen for early-stage high-risk ovarian cancer is 6 cycles of paclitaxel and carboplatin given every 3 weeks.
Maternal Near Miss Operational GuidelinesRajesh Ludam
Maternal Near Miss guidelines is designed for the program managers at different levels of public health system.to provide quality services and identify the best practices.
Gestational trophoblastic disease is a heterogeneous group of lesions arising from abnormal placental trophoblast proliferation. It includes premalignant conditions like complete and partial hydatidiform moles, as well as malignant gestational trophoblastic neoplasia (GTN). GTN has varying potential for local invasion and metastasis. While rare, GTN is highly curable even with widespread dissemination. Treatment involves chemotherapy, with single or multi-agent regimens depending on risk factors and disease stage according to the FIGO scoring system. Careful monitoring of beta-hCG levels is important for diagnosis and follow-up.
This document discusses carcinoma of the vulva, including its various types and stages. It describes preinvasive lesions like vulvar intraepithelial neoplasia (VIN), as well as invasive lesions including squamous cell carcinoma, melanoma, adenocarcinoma and sarcoma. It covers the presentation, investigations, staging and treatment of invasive vulvar carcinoma, noting that surgery is often the primary treatment and lymph node involvement determines need for lymphadenectomy. Prognosis depends on stage, with 5-year survival rates of over 90% for stage I disease but dropping significantly with increased stage.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
This document discusses visual inspection techniques for cervical cancer screening in developing countries. It begins by explaining the limitations of Pap smear screening in developing countries due to infrastructure and resource constraints. It then describes visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) as alternative screening methods that are simpler, cheaper, and do not require a laboratory. The document provides details on the procedures for VIA and VILI, including how to interpret the results. It finds that VIA and VILI have reasonable sensitivity and specificity for detecting precancerous lesions compared to Pap smears, making them effective screening tools for developing world contexts.
The document summarizes the anatomy, physiology, histopathology, clinical features, investigations, staging, and management of thyroid gland tumors. It discusses the key points of thyroid anatomy and blood supply. The primary role is production of thyroid hormones which regulate metabolism. Benign and malignant tumors are described including papillary carcinoma which is the most common type. Clinical features, investigations like ultrasound and biopsy, TNM staging, and surgical treatment including total thyroidectomy are summarized. Post-operative management involves radioiodine therapy and thyroid hormone replacement.
Cervical cancer is the fourth most common cancer in women. There are approximately 450,000 new cases and 300,000 deaths from cervical cancer worldwide each year. Cervical cancer is caused by human papillomavirus infection and is preventable through screening programs like the cervical smear test. Early stage cervical cancer is usually treated surgically through procedures like LEEP, while advanced stages can spread through direct extension or lymphatic dissemination to nearby organs and lymph nodes. Precancerous lesions are identified through tests like colposcopy, biopsy, and acetic acid visualization of abnormal cells.
This document discusses gestational trophoblastic disease (GTD), specifically hydatidiform moles. It defines a hydatidiform mole as a pregnancy characterized by vesicular swelling of placental villi, usually with the absence of an intact fetus. Molar pregnancies can be complete or partial based on whether there is a fetus present. Complete moles have no fetus and are diploid, while partial moles may contain defective fetuses and are usually triploid. Symptoms include vaginal bleeding and an enlarged uterus. Diagnosis involves beta-hCG levels and ultrasound showing a "snowstorm" pattern. Treatment is surgical evacuation followed by chemotherapy for high-risk cases to prevent invasive tumors.
The document discusses the cervix and cervical intraepithelial neoplasia (CIN). Some key points:
1) The cervix contains two types of epithelium that meet at the squamocolumnar junction (SCJ), which shifts locations throughout life. The transformation zone (TZ) is the area at risk for developing pre-cancerous and cancerous lesions.
2) CIN is characterized by abnormal cell growth in the cervix and is graded from I to III based on severity. Left untreated, some CIN lesions can progress to cervical cancer over many years.
3) Human papillomavirus (HPV) infection is required for cervical cancer but most infections clear on
The document discusses cervical histology and screening for cervical cancer. It describes the squamocolumnar junction (SCJ) and transformation zone of the cervix. The location of the SCJ changes with age due to regenerative changes. Screening guidelines from ACOG and WHO are provided regarding what ages to screen and what tests to use. Screening methods like Pap smear, HPV testing, visual inspection with acetic acid are outlined. Management of abnormal screening results including follow up testing and treatment options like cryotherapy, LEEP, and hysterectomy are summarized.
1) The document discusses the approach to evaluating a patient presenting with a breast lump, including obtaining a thorough history, conducting a physical examination, and ordering appropriate investigations.
2) The differential diagnosis for a breast lump includes benign conditions like fibrocystic disease, cysts, and fibroadenoma, as well as breast cancer.
3) Treatment depends on the diagnosis, with benign lumps often excised for confirmation, while malignant breast cancer may require total mastectomy or lumpectomy along with further treatment and follow-up testing.
Postmenopausal bleeding (PMB) refers to bleeding from the genital tract at least one year after menopause. It can indicate underlying malignancy and should be promptly evaluated. The most common causes are atrophic vaginitis (60-80% of cases) and hormone therapy (15-25% of cases). Evaluation of a patient with PMB includes history, exam, endometrial biopsy, and further tests if needed. Common pathologies found are polyps, hyperplasia, and cancer. Treatment depends on diagnosis but may include hormone therapy, surgery, or other options.
Genital tuberculosis (TB) commonly affects females aged 20-40 years. It is usually secondary to pulmonary or other organ involvement. The fallopian tubes are most frequently involved (90-100%), followed by the endometrium (50-60%). Common presenting symptoms include infertility (40-50%), abnormal bleeding (25-30%), and pelvic pain (15-25%). Diagnosis involves clinical suspicion, imaging such as ultrasound or HSG, and microbiological tests on samples from the endometrium or tubes. Treatment consists of a multi-drug regimen containing isoniazid, rifampin, pyrazinamide and ethambutol for 2 months, followed by isoniazid and rif
The document discusses management dilemmas in cervical cancer. It notes that cervical cancer is the third most common cancer worldwide yet is preventable. Treatment options depend on the stage of cancer and may involve surgery such as radical hysterectomy or radiation therapy. Close follow up is important after treatment due to the risk of recurrence. Proper screening and early detection are emphasized to improve outcomes for cervical cancer patients.
Rh negative pregnancies can lead to isoimmunization of the mother if she has a Rh positive baby. This occurs due to a fetomaternal hemorrhage which allows the fetus's Rh positive blood cells to enter the mother's circulation and trigger an immune response. Testing for isoimmunization involves indirect Coombs testing of the mother. Unsensitized Rh negative mothers receive anti-D immunoglobulin injections to prevent isoimmunization. Sensitized pregnancies require careful monitoring and may involve amniocentesis, intrauterine transfusions or early delivery to prevent fetal complications like hydrops fetalis. The baby may also require treatments like phototherapy or exchange transfusion if affected by hemolytic anemia or
Cervical cancer is caused by HPV infection and is the leading cause of cancer deaths in many developing countries. HPV is present in over 99% of cervical cancers. Risk factors include young age of first sexual activity, multiple partners, early pregnancy, and smoking. Precancerous lesions usually develop over 10-15 years. Cervical cancer spreads locally through the cervix and vagina, and can metastasize to nearby lymph nodes and distant sites like the lungs and liver. Diagnosis involves identifying dysplastic cervical cells, and treatment depends on the cancer stage.
Basics To Ca Cx Screening (Eastern Biotech)Pankaj Sohaney
Detecting HPV means better understanding of the risk of cervical cancer was the major focus of Dr. Dinesh Gupta. He spoke on “Opportunistic Screening for Cervical Precancer Lesions” and informed why the combination screening is vital for prevention and detection of cervical cancer. According to Dr. Gupta, combined screening with liquid based cytology and hybrid capture2 HPV DNA test would identify who’s at risk for high-grade disease and cancer and reduce missed disease caused by false-negative Pap Smear. HPV DNA test is the only FDA approved test to detect 13 high risk HPVs associated with virtually all cervical cancer, he added.
The document discusses three case scenarios involving pregnant women with reactive syphilis serology. It provides details on interpreting syphilis serology, the stages of syphilis infection, and recommendations for treatment and follow up after treatment. The key points are: syphilis should be suspected in pregnant women who are sexually active or have partners with risk factors; reactive nontreponemal and treponemal tests indicate current or past untreated syphilis; and pregnant women with reactive tests should be treated with penicillin to prevent transmission to the fetus.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
This document discusses the treatment of ovarian carcinoma. It begins with an overview of the epidemiology, patterns of spread, symptoms, diagnostic workup and surgical staging of the disease. It then describes the histopathological classification and various chemotherapy regimens used as adjuvant treatment, including platinum-based drugs like cisplatin and carboplatin, and taxanes like paclitaxel. The standard first-line regimen for early-stage high-risk ovarian cancer is 6 cycles of paclitaxel and carboplatin given every 3 weeks.
Maternal Near Miss Operational GuidelinesRajesh Ludam
Maternal Near Miss guidelines is designed for the program managers at different levels of public health system.to provide quality services and identify the best practices.
Gestational trophoblastic disease is a heterogeneous group of lesions arising from abnormal placental trophoblast proliferation. It includes premalignant conditions like complete and partial hydatidiform moles, as well as malignant gestational trophoblastic neoplasia (GTN). GTN has varying potential for local invasion and metastasis. While rare, GTN is highly curable even with widespread dissemination. Treatment involves chemotherapy, with single or multi-agent regimens depending on risk factors and disease stage according to the FIGO scoring system. Careful monitoring of beta-hCG levels is important for diagnosis and follow-up.
This document discusses carcinoma of the vulva, including its various types and stages. It describes preinvasive lesions like vulvar intraepithelial neoplasia (VIN), as well as invasive lesions including squamous cell carcinoma, melanoma, adenocarcinoma and sarcoma. It covers the presentation, investigations, staging and treatment of invasive vulvar carcinoma, noting that surgery is often the primary treatment and lymph node involvement determines need for lymphadenectomy. Prognosis depends on stage, with 5-year survival rates of over 90% for stage I disease but dropping significantly with increased stage.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
This document discusses visual inspection techniques for cervical cancer screening in developing countries. It begins by explaining the limitations of Pap smear screening in developing countries due to infrastructure and resource constraints. It then describes visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) as alternative screening methods that are simpler, cheaper, and do not require a laboratory. The document provides details on the procedures for VIA and VILI, including how to interpret the results. It finds that VIA and VILI have reasonable sensitivity and specificity for detecting precancerous lesions compared to Pap smears, making them effective screening tools for developing world contexts.
The document summarizes the anatomy, physiology, histopathology, clinical features, investigations, staging, and management of thyroid gland tumors. It discusses the key points of thyroid anatomy and blood supply. The primary role is production of thyroid hormones which regulate metabolism. Benign and malignant tumors are described including papillary carcinoma which is the most common type. Clinical features, investigations like ultrasound and biopsy, TNM staging, and surgical treatment including total thyroidectomy are summarized. Post-operative management involves radioiodine therapy and thyroid hormone replacement.
Cervical cancer is the fourth most common cancer in women. There are approximately 450,000 new cases and 300,000 deaths from cervical cancer worldwide each year. Cervical cancer is caused by human papillomavirus infection and is preventable through screening programs like the cervical smear test. Early stage cervical cancer is usually treated surgically through procedures like LEEP, while advanced stages can spread through direct extension or lymphatic dissemination to nearby organs and lymph nodes. Precancerous lesions are identified through tests like colposcopy, biopsy, and acetic acid visualization of abnormal cells.
Cervical cancer arises from the transformation zone of the cervix due to persistent HPV infection. It is the 4th most common cancer in women worldwide but more common in developing countries. Screening programs using Pap smears have reduced incidence and mortality in developed nations. Treatment depends on staging and may include LEEP, radical hysterectomy, radiation, chemotherapy, or a combination. Prognosis depends on stage, with 5-year survival rates ranging from over 90% for stage I to less than 20% for stage IV.
This document discusses cervical cancer, including its causes, diagnosis, staging, and treatment. It begins with the histology and embryological development of the cervix. Precancerous lesions called cervical intraepithelial neoplasia can develop from persistent HPV infection and potentially progress to cancer over many years if left untreated. Diagnosis involves Pap smear, colposcopy, and biopsy. Staging uses the FIGO system and determines treatment, which may include surgery, radiation therapy, or chemoradiation depending on the stage. The choice of treatment also considers the patient's age and fitness.
Endometrial cancer most commonly presents with postmenopausal vaginal bleeding. Histopathology shows endometrioid adenocarcinoma in 75-80% of cases. There are two types - type I is estrogen-dependent and has a better prognosis, while type II is more aggressive and has a poorer prognosis. Diagnosis involves endometrial biopsy or dilation and curettage. Staging involves surgical procedures like total abdominal hysterectomy and lymph node sampling or dissection. Prognosis depends on factors like age, grade, histology, lymph node involvement and stage.
General Colorectal Review/ DiverticulitisKevinClimaco
This document discusses diverticular disease and provides information on incidence, definitions, pathogenesis, epidemiology, clinical manifestations, evaluation, differential diagnosis, and management, including both non-operative and surgical treatment options. Diverticular disease is increasingly common, affecting over 50% of people over age 80. It is associated with low-fiber diets and risks like smoking. Clinical manifestations range from acute diverticulitis to chronic complications. Treatment depends on severity and includes antibiotics, percutaneous drainage, or surgery.
This document contains a panel of unknown cases presented by Dr. Tejas Mehta at NERRS: Women's Imaging on April 5, 2013. The first case involves a 61-year-old woman with a family history of breast and ovarian cancer who presented for routine screening mammography. The second case discusses the imaging and biopsy findings of a 54-year-old woman with bilateral lymph node calcifications found on screening mammography. The third case presents a 65-year-old woman with a left breast mass and nipple change, whose mammogram and ultrasound revealed a grade 2 invasive lobular carcinoma.
The document provides information on cervical cancer including:
1. Statistics on global cancer incidence and mortality with cervical cancer among the most common cancers.
2. Risk factors for cervical cancer including human papillomavirus infection, young age of first intercourse, multiple sexual partners, and smoking.
3. Screening guidelines recommend co-testing with cytology and HPV testing every 5 years for women aged 30-65 or cytology alone every 3 years.
updated overview in management of ovarian cancerSajan Thapa
The document provides information on epithelial ovarian cancer including its epidemiology, classification, risk factors, diagnosis, staging, and management. It discusses that epithelial ovarian cancer is the 12th most common cancer in Bangladesh. The standard treatment involves surgical staging and debulking followed by platinum-based chemotherapy, with the goal of optimal cytoreduction to 1cm or less residual disease. Additional treatments discussed include targeted therapies like bevacizumab and PARP inhibitors for certain patients.
This document provides an overview of endometrial carcinoma, including its epidemiology, risk and protective factors, classification, clinical presentation, diagnosis, staging, treatment, prognosis, and prevention. Endometrial carcinoma is the most common gynecological cancer and occurs most often in postmenopausal women. Risk factors include older age, early menarche, late menopause, nulliparity, obesity, and unopposed estrogen exposure. Treatment involves surgery, with additional chemotherapy, radiation, or hormonal therapy depending on the stage and grade of cancer. Prognosis depends on histologic grade and stage, with 5-year survival rates ranging from 83% for stage I to 27% for stage IV disease.
Cyst Assist: Pancreatic Cyst Evaluation & ManagementPatricia Raymond
This document provides an overview of pancreatic cyst evaluation and management. It discusses the prevalence of incidentally detected pancreatic cysts on imaging and categorizes cysts as benign, pseudocysts, or one of four subtypes of pancreatic cystic neoplasms (PCNs): serous cystic tumors, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and solid pseudopapillary neoplasms. For each PCN subtype, it describes characteristics such as patient demographics, location, risk of malignancy, and management guidelines. It also reviews guidelines for managing pseudocysts and outlines the endoscopic, percutaneous, and surgical drainage options with expected outcomes. In summary,
This document discusses the evaluation and differential diagnosis of breast lumps and nipple discharge. It begins by outlining the objectives, anatomy, history, and physical exam findings relevant to evaluating a patient with a breast lump or nipple discharge. It then reviews the differential diagnosis for breast lumps and types of nipple discharge. Investigations like mammography, ultrasound, and biopsy are discussed. Common benign breast conditions like fibrocystic disease and fibroadenomas are also summarized. The document concludes with an overview of breast cancer including epidemiology, risk factors, pathology, staging, treatment, and prognosis.
This document discusses screening guidelines for various cancers in women, including cervical, ovarian, endometrial, and breast cancer. It provides details on:
- The purpose and criteria for effective cancer screening programs
- Screening recommendations and techniques for each cancer type, including cervical cytology, colposcopy, transvaginal ultrasound, and mammography
- Management of abnormal screening results, such as follow up tests or procedures for lesions of different grades
- Challenges with screening for some cancers like ovarian cancer due to limitations in current screening tests
- The most common benign ovarian tumor is a cystadenoma, while the most common ovarian carcinoma is a papillary serous cystoadenocarcinoma.
- Germ cell tumors are classified as benign, such as mature teratomas, or malignant, including dysgerminoma, endodermal sinus tumors, and immature teratomas. Tumor markers help identify specific germ cell tumors.
- Sex cord-stromal tumors include granulosa cell tumors and Sertoli-Leydig cell tumors, which can secrete testosterone.
- Metastatic tumors to the ovaries also occur, such as the Krukenberg tumor from gastric cancer.
- Risk factors
Globally, over 600,000 new cases and 300,000 deaths were estimated for cervical cancer in 2020 .
Third most common gynecological cancer in Palestine.
Palestine has a higher age-standardized mortality rate than other countries in the region
Cervical cancer is the third most common gynecologic cancer worldwide. Human papillomavirus (HPV) infection is central to its development and is detected in nearly all cases. Risk factors include early onset of sexual activity, multiple sexual partners, and immunosuppression. It develops through four main steps: HPV infection, viral persistence, progression to precancer, and invasion. Symptoms can include abnormal bleeding or discharge, but early cancers may be asymptomatic. Diagnosis involves biopsy and staging evaluates extent of disease through physical and imaging exams. Treatment options include surgery, radiation therapy, chemotherapy, or a combination based on cancer stage and patient factors.
This document outlines a plan for discussing cervical intraepithelial neoplasia (CIN) and cervical cancer screening. It covers the incidence, pathogenesis and prevention of CIN, describing how persistent high-risk HPV infection can lead to precancerous lesions and cancer. It then discusses cervical screening guidelines, procedures for Pap tests and HPV tests, and approaches for diagnosing and treating abnormal screening results, including excision or ablation depending on factors like lesion size and margins. Follow-up testing and surveillance is recommended based on screening and treatment outcomes.
1. Ovarian cancer is the seventh most common malignancy among women worldwide and the most lethal gynecologic malignancy in developed nations. Late detection is common, with 67% of patients presenting with advanced disease.
2. Imaging plays a crucial role in detecting adnexal lesions, characterizing masses, and determining likelihood of malignancy to guide treatment planning. Ultrasound is the first-line imaging modality for evaluating adnexal masses.
3. Morphologic features on ultrasound suggestive of ovarian cancer include irregular solid masses, irregular multilocular cystic masses, solid components or papillary vegetations in cyst walls, ascites, and peritoneal nodules. The risk of malignancy
1. Testicular neoplasm is a rare malignancy that affects men aged 20-40 years old. It presents most commonly as a painless testicular mass.
2. Diagnostic workup includes physical exam, tumor markers, imaging, and biopsy. Seminomas and nonseminomas are the two main types and have different characteristics and treatment approaches.
3. Treatment depends on stage but may include surgery, chemotherapy, and radiation. The prognosis is generally good even for advanced or relapsed disease.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
2. 1st
• Understanding Ca cervix
• Its diagnosis, Treatment & prevention
2nd
• History of a particular patient
• Management of that particular patient
3rd
• Open discussion
• Review
OBJECTIVES
4. • Cervical carcinoma is 12th most common and 5th most
deadly cancer in women.
• It affects 16 per 100000 (1 lac) women per year and kills
about 9 per 100000 (1 lac) per year
• Approximately 80% cervical cancer occur in developing
countries
• Worldwide in 2008 it was estimated that there were
473000 cases of cervical cancer and 25300 deaths per
year
Epidemiology
6. What is Carcinoma cervix?
It is the malignant neoplasm of the cervical
epithelium -- the squamous epithelium of ectocervix
(part of cervix that is next to vagina) and
columnar/glandular epithelium of endocervix.
7. The Squamo-Columnar junction(SCJ) is the meeting point of
the columnar epithelium that lines the endocervix, with
squamous epithelium that lines ectocervix.it is a dynamic
point. The process of carcinogenesis starts in the
transformation zone(TZ).It is an area where squamous
metaplasia takes place in the columnar cells.
8. The location of transformation zone varies among
women. In teenagers it is in the ectocervix and more
susceptible to infection than adult. In older women it
may be higher in the cervical canal
9. • It is the pre-malignant(pre-invasive) condition of cervical
epithelium that is graded upon the degree (from mild,
moderate to severe degree) of dysplasia, in which cervical
epithelium is replaced by varying degrees of atypical cells.
• It has two classifications-
1. WHO classification
2. Bethesda system
What is CIN?
Dysplasia CIN (WHO) Limit of histologic
change
Bethesda
Mild CIN-1 Basal 1/3 LSIL
Moderate CIN-2 Basal half to 2/3
HSIL
Severe(CIS) CIN-3 Whole thickness
10. Pathogenesis of CIN and Ca Cervix in Short
Squamocolumnar junction
Replacement of
columnar epithelium
Squamous
epidermadization
(in growth of
sq.cell under the
columnar cell)
Metaplasia of
sub-columnar
reserve cell
Immature unstable cell
Carcinogen
1.HPV
2.seminal flud histones
3.unknown factors
Physiologic
metaplasia
Host response+ -
Well differentiated
squamous epithelium
Atypical metaplasia
CIN CIS
Invasive carcinoma
13. • Early sexual intercourse ( < 16 years)
• Early age of pregnancy
• Too many/frequent births
• Low socio-economic status
• Multiple sexual partners
• STDs
• Infections: HPV(16,18,31,33),HIV,Chlamydia.
• Immunosuppressed individuals
• OCP
• Smoking
• Husband whose previous wife died of cervical malignancy
Risk factors for CIN & Ca Cervix
14. • HPV plays central role in development of cervical carcinoma. HPV is
epitheliotropic and its DNA is found in 99.7% of all cervical carcinoma.
Once epithelium is acutely infected with HPV one of the 3 clinical
scenarios ensues:
1) Asymptomatic latent infection
2) Active infection but no genome integration
3) Neoplastic transformation following integration of
oncogenic HPV DNA into human genome.
Natural history of cervical carcinogenesis
19. • Squamous cell Ca
• Adenocarcinoma
• Verrucous Ca
• Adenoma Malignum
• Adenoid cystic Ca
• Adenosquamous Ca
• Neuroendocrine Ca
• Direct extension to cervix from
endometrium,
rectum, bladder
Types of carcinoma cervix
Histological Type
• Exophytic--- arise from ectocervix,
cauliflower like growth,
friable, bleed to touch
• Ulcerative--- Initially superficial,
later deep with indurated
edge
• Infiltrative--- Arise from endocervix and
cervix become barrel shaped
Naked eye
20. Mode of spread
• By lymphatics
• By blood
• By direct
implantation
21. • Abnormal P/V bleeding in the form of :
1) Blood stained leucorrheal discharge
2) Scanty spotting
3) frequent leucorrhea which is usually serosanguinous,
purulent, odorous and non pruritic
4) Post coital bleeding.
• Pelvic pain often unilateral, radiates to hip/thigh
(advanced case)
• Involuntary loss of feces and urine through vagina(sign of
fistula)
• Generalized weakness, anemia, weight loss
Symptoms of carcinoma cervix
22. Diagnosis of Ca cervix
Diagnosis
Preclinical
Incidental on
histopathology
During
screening
procedures
Clinical
History
Clinical
examination
Investigation
23. • General investigations
CBC
S.creatinine
PPBS
Urine R/M/E
SGPT
ECG
• For confirming the diagnosis
Tissue biopsy & histopathology:
1) Colposcopy guided or
2) multiple punch biopsy from schiller’s unstained area (when
colposcopy not available)
• For detection of metastasis
USG of W/A
CXR
CT scan
IVU
MRI
PET scan
Investigations
24. • Primary surgery
• Primary radiotherapy
• Chemotherapy
• Combination therapy
Treatment Modalities for Ca cervix
25. Treatment protocol for CIN
Pap's smear
Normal Abnormal
Routine
screening
Colposcopy &
biopsy
CIN-1 CIN-2 CIN-3
Normal Abnormal
Conservative Rx
LEEP
Cryotherapy
Cone excision
Definitive Rx
Hysterectomy
Follow up
colposcopy
Routine
screening
Conservative Rx
26. Radical hysterectomy with
therapeutic
lymphadenectomy(+adjuvant
P/O radiotherapy with
concomitant chemotherapy
for high risk group)
• Stage
1A-2A
Primary radiation
(External beam +
Brachy therapy)
• Stage
2B-4A
Palliative Rx +
chemotherapy
(combination of
paclitaxel,
cisplatin &
ifosfamide)
• Stage
4B
Treatment of Ca cervix according to stage
27. Rx in special situation(Pregnancy with Ca cervix)
Early Pg with Ca cervix(stage 1-2A)
• Radical hysterectomy with therapeutic lymphadenectomy
with fetus left in situ unless pt. is unwilling to terminate
pregnancy
Gestational age closer to viability or
unwilling to lose the baby
• Continuation after counseling about the maternal risk
Pg with cervical dysplasia and CIS
• NVD can be allowed
Pg with carcinoma and stromal invasion
• LSCS
• Caesarian hysterectomy with therapeutic
lymphadenectomy(as soon as fetal maturity established)
29. • In asymptomatic patients
3 month interval in 1st year
4 month interval in 2nd year
6 month interval in 3-5 year
• In symptomatic patients
Pt. should be evaluated with appropriate
examinations immediately when sign & symptoms occur.
positive cytology,
palpable tumor,
pain in lower limb,
unilateral lower limb edema,
vaginal bleeding/discharge,
ascites,
unexplained weight loss,
supraclavicular lymphadenopathy
Post treatment Follow-Up
30. • Methods of prevetion
1)Raising health awareness.
2)Identification of high risk group
3) Screening ( VIA test, Pap’s smear)
4) Vaccination ( Cervarix, Gardasil)
5) Using condoms
• Screening reduces the incidence & mortality of ca cervix
in developing countries
• Vaccination reduces the risk of cancerous & precancerous
change in cervix
• Condom is useful in treating potentially precancerous
changes in cervix
Prevention
31. • Complications of carcinoma cervix depends upon the site,
invasion, necrosis, infection & metastasis of the tumor.
• Complications are:
1. Pyometra
2. V V F
3. R V F
4. Ureteric pain
5. Pyelitis
6. Pyelonephritis
Complication
33. • Methods of screening
1. VIA (Visual Inspection with Acetic acid) test
2. Pap’s smear
3. HPV testing
4. Cervicography
• Schedule of screening
Start --- with onset of sexual act or at 18 yrs. age
Interval--- yearly up to 30 yrs. age then,
3 year interval after 30 yrs. age(if 3 consecutive
negative test occur)
Duration-- up to 65 yrs. Age(stop screening if she is in routine
schedule, if not at least 2 screening
should offer)
Screening methods and schedule
Others
35. • Name: Mrs.Shonai
• Age: 45 yrs
• Address: Mudrapur, Dhunot thana, Bogra
• Marital status: Married for 32 yrs
• Date of admission:
• Date of examination:
Demographic Details
36. • Intermenstrual bleeding for 1 year
• Post coital bleeding for 6 month
• Per vaginal leucorrhea discharge for 6
month
Chief complaints
37. • According to patients statement she had normal
menstrual cycle 1 year back. After that she is having
heavy irregular P/V bleeding which has become
excessive for last 3 month. She is also suffering from
post coital bleeding for 6 months. And for the last 6
months she is having blood stained leucorrheal
discharge which is sometime foul smelling. She also
gave history of weight loss since last 6 month. There
is no history of rectal pain and backache. Her bowel
and bladder habit are normal.
History of presenting illness
38. • No history of HTN, DM, Asthma, IHD
• All other family members are well according to
the patients statement.
History of past illness
Family history
39. • Patient having low socio-economic status. Lives in
kacha house, drinks water from arsenic free tube
well and uses sanitary latrine.
• Age of menarche: patient couldn’t mention
• MP/MC: 4/30 days
• MF: Average
• For the last 1 year cyclical pattern of menstruation is
absent
• Contraceptive: H/O using injectable contraceptives for
Socio-economic history
Menstrual history
40. • Married for 32 years
• Husband’s previous wife
died in cervical cancer
• Para: 3+1
• ALC: 5 years(dead)
• Appearance: ill looking
• Body built: Avg.
• Nutritional status: malnourished
• Co-operation: co-operative
• Decubitus: on choice
• Anemia: absent
• Jaundice: absent
• Edema: absent
• State of hydration: not dehydrated
• Lymph node: not palpable
• Pulse: 88 bpm
• BP: 110/70 mm Hg
• Temperature: 99⁰ F
• Respiratory rate: 16/min
Obstetrical history General examination
41. • NAD
• Inspection
healthy looking vulva and vagina
• Speculum examination
Cauliflower like growth arising from ectocervix & bleeds on
touch
• Bimannual exmination
Cervix is friable and bleeds on touch
Both the fornix are involved and growth is extended to
both parametrium but not to the pelvic side wall
Per abdominal examination
Per vaginal examination
42. • Rectal mucosa is free
• A case of carcinoma cervix (stage 2B)
• Myomatous polyp
Digital rectal examination(DRE)
Clinical/Provisional diagnosis
Differential diagnosis
43. • Mrs.Shonai,45 years married, non-diabetic, normotensive
women of low socio-economic condition hailing from
Mudrapur,Dhunot,Bogra to SZMCH with the complaints of
inter menstrual bleeding for 1 year which is heavy and
irregular, and become excessive for last 3 month. She also
complains of post coital bleeding for 6 month and blood
stained leucorrheal discharge for 6 month which is often
foul smelling. She had regular menstrual cycle with
regular menstrual flow. She gave H/O using injectable
contraceptives for years. She is married for 32 years,
para 3+1 and previous wife of her husband died in
carcinoma cervix.
• O/G/E she is ill looking with avg. body built and she is
neither anemic nor icteric. There is no palpable lymph
node. Her pulse 88 bpm, BP 110/70 mm Hg, temperature
99⁰ F, respiratory rate 16.
Salient feature
44. • Per abdominal examination revealed no
abnormality on inspection, palpation, percussion
and auscultation.
• Per vaginal examination revealed healthy looking
vulva and vagina on inspection. Per speculum
examination revealed a cauliflower like growth
arising from ectocervix that bleeds to touch.
Bimanual examination revealed friable cervix with
involvement both fornix and parametrium with
out pelvic side wall.
45. • CBC
TC: WBC-7000 cu-mm
DC: N-68%
L-26%
M-02%
E-04%
B-0%
Hb% - 11.5%
ESR- 60 mm in 1st hr
• S.creatinine 1.0 mg/dl
• Urine R/M/E
Physical Exm: straw coloured
Chemical Exm: acidic, albumin
trace amount, no reducing
substance
Microscopic Exm: pus cell 1-2
Epith.cell 1-2
RBC 2-3
• Biopsy taken from the lesion and
sent for histopathological
examination.
• Biopsy report: Infiltrating SCC,
moderately differentiated
• CXR(P/A view)- normal chest
skiagram
• USG of L/A- irregular
heterogenous mass(4.7x4.4)cm
in cervix
• IVU
Investigations
For General condition For confirming Dx
For detection of metastasis
46. • Diet : Normal
• Tab.Ciprofloxacin (500mg)
• Tab.Metronidazole (400mg)
• Cap.Traxyl (500mg)
• Cap.Omeprazole(20mg)
• Anemia correction (2 unit blood tansfused)
• Improvement of general health condition
Treatment
Conservative treatment