Mrs. Rahela Begum, a 55-year-old shopkeeper, presented with postcoital bleeding, foul-smelling discharge, bleeding with straining, and back pain for several months. Examination revealed severe anemia and a cauliflower-like cervical growth involving the whole vagina. The provisional diagnosis was stage IVa cervical cancer. Treatment options included blood transfusion, antibiotics, chemoradiation, or ultraradical surgery and palliation given the advanced stage.

1. Welcome
Case Presentation on Cervical Cancer

2.  Particulars of the Patient
 Name: Mrs. Rahela Begum
 Age: 55 years
 Religion: Islam
 Occupation: Shopkeeper
 Marital Status: Married for 40 years
 Blood Group: B (+ve)
 Husband’s Name: Mr. Abdur Jabbar
 Husband’s occupation: Shopkeeper
 Address: Taraganj, Rangpur

3.  Continuation
 Hospital Record:
Bed No. 11
Ward No. 12
Unit No. 01
Department of Obs. & Gynecology
Rangpur Medical College, Rangpur
 Date of Admission: 27/12/2015
 Date of Examination: 30/12/2015

4.  Chief Complaints
Post coital bleeding for 1 year
Foul smelling per vaginal discharge for 6
months
Per vaginal bleeding on straining for 4
months
Back pain for 4 months

5.  History of Present Illness
According to the statement of the patient she was
reasonably well 1 year back then she suddenly
developed post coital bleeding that was excessive
in amount and bright red in color. She also gives
history of foul smelling dirty brown colored per
vaginal discharge for 6 months that was thick in
consistency but not associated with itching. She
further mentioned about per-vaginal bleeding on
straining occasionally for 4 months. She has
continuous low back pain for 4 months which was
insidious in onset with no radiation and no
aggravating and reliving factor. On query she also
complains of anorexia and weight loss. Her bladder
habit is normal but she is constipated.

6.  History of Past Illness
 She has no significant past medical,
past surgical and past gynecological
history.

7.  Family History
 No significant family history given

8.  Personal History
 She took betel nut and tobacco for 30 years

9.  Spouse History
 Her husband has been married for three
times and she is his second wife. His other
two wives died during giving child birth.

10.  Drug History
 She took some drugs prescribed by a
Registered Doctor but she can not
mention those drug’s name.

11.  Immunological History
 She is well immunized with TT vaccine.
She wasn’t immunized against HPV.

12.  Socioeconomic Status
 Her socioeconomic status is below
average.

13.  Menstrual History
 Menopaused for 10 years

14.  Obstetric History
Married for 40 years
Para: 4(-1)+0
Age of last child: 15 years

15.  General Physical Examination
 Appearance: Ill looking
 Body Built: Cachectic
 Decubitus: On choice
 Nutritional Status: Below average
 Anaemia: Severe
 Jaundice: Absent
 Oedema: Absent
 Pulse: 72beats/min
 Blood pressure: 140/90mmHg

16.  GPE Continuation
 Respiratory Rate: 17/min
 Temperature: 99°F
 Cyanosis: Absent
 Lymph Node: Not enlarged
 Dehydration: Absent
 Heart: Normal
 Lung: Clear
 Thyroid Gland: Normal

17.  Systemic Examination
 Abdominal Examination:
Shape of the Abdomen: Scaphoid
Colour of the skin: Normal
Liver: Not Enlarged
Spleen: Not Palpable
Superficial & Deep Palpation: No mass found
 Vaginal Examination
(i)Inspection: Foul smelling dirty brown thick
discharge found. She was using vulval pad.

18.  Systemic Examination Cont.
 Per Speculum Examination: A cauliflower like
growth which bleeds on touch, replaces the
cervix.
 Bimanual Examination: The cervix is fixed, hard
in consistency, friable & bleeds on touch. The
fornices are obliterated, whole vaginal wall is
involved and the growth extends to the
parametrium & adjacent organ.
 Digital Rectal Examination (DRE): Post. fornix
adhered with the Ant. wall of rectum.

19.  Provisional Diagnosis
 My provisional diagnosis is it is a case of
Carcinoma of Cervix Stage Iva (In operable
Stage)

20.  Differential Diagnosis
Chronic Cervicitis
Myomatous Polyp
Cervical Tuberculosis
Metastatic Choriocarcinoma

21.  Investigation
Intravenous urography
Cystoscopy
Sigmoidoscopy
CT scan
MRI

22.  Salient Features
Mrs. Rahela Begum, 55 years old, para 4(-1)+0, ALC-
15years, post menopausal Muslim patient, wife of Mr. Abdul
Jabbar a shopkeeper hailing from Taraganj, Rangpur. Got
admitted into Rangpur Medical Hospital 27Dec2015 with the
complaints of postcoital bleeding for 1 year, foul smelling
dirty brown colour vaginal discharge for 6 months, P/V
bleeding on straining for 4 months, back pain for 4 months.
She married at 12 years of age. Her husband has three wives
and she is 2nd of them, and other two had died during child
birth. She had BLTL 10 years back. On examination she is
severely anaemic, cachectic, weight loss. Abdominal
examination reveal nothing significant, On P/S examination A
cauliflower like growth that replaces the cervix. & on
Bimanual examination whole vagina is involved, cervix is
fixed, hard, friable, bleeds on touch, fornices are obliterated.
On DRE ant. Rectal wall is adhered with post. fornix.

23.  Treatment
 Before Staging: Blood transfusion to
correct anemia & antibiotic to prevent
secondary infection.
 Specific Treatment For this patient:
1. Chemoradiation
2. Ultraradical Surgery & Palliation