Case Confrence 7 April 2010

07-Apr-2010, Oncology Gynecology Division RSCM

woman / 53 yo / P2

Chief complain : vaginal bleeding and mucous discharge since 1 year ago.
Referred by x Hospital due to cervical cancer.

Patient complaining vaginal bleeding and mucous discharge since 1 year ago, not periodicly came out and no pain.
The vaginal bleeding was not often and not profuse, just in little amount.
History of post coital bleeding (+) with no pain. There was no significant disturbance in mixturition and defecation.
There is no symptom of loss body weight and appetite as well.

From gynecological examination (Apr 1st 2010) revealed endophytic lession on the serviks, 3,5x4x4 cm, fragile and easily bleeding.
Left parametrium was fixed to pelvic wall, noduler, Right parametrium noduler, not fixed to pelvic wall.
Uterus wnl, revealed cystic mass measuring Ø 8 cm on left adnexa, mobile. Rectum mucosa were smooth.  

Biopsy result in RSCM (PA No. 1002036) : adenocarcinoma serosum moderate-poorly differentiated (the histologic pattern resemble to ovarian tumor),
                                         what is the clinical conditions of the ovary?

Mar 23th  2010 CXR and laboratory results  were normal.

Mar 24th 2010 Cystoscopy  :  wnl, no metastase
Mar 28th 2010 Cardiology  : wnl
Mar 28th 2010 Rectoscopy  :  wnl, no metastase
Mar 30th 2010 BNO/IVP     :   normal secretion and exretion on both kidney

April 1st  2010 US Onco :   Retroflexi uterus, measuring 10,5x6,1x6,4 cm inhomogen 
                            echostructure, post corpus revealed hypoechoic lesion with clear and
                            Regular border, measuring 4,2x3,5x3,9 cm, no vascularization.
                            Endometial thickness 2 mm
                            Hypoechoic inhomogen cervix with unclear border, measuring 3,7 x 2,8 x 3,7 cm (transabdominal);
              measuring 4,7x3,8x3,9 cm (transrectal) RI 0,29
                            Adnexa : multilocular cyst on left adnexa, measuring 8,8x7,3x8,4 cm,
                            septum thickness 1,4 mm, solid part (+), papil (-), RI 0,44
                            Others organ abdominal : wnl.
                                             
       Conc : Enlargement of cervix due to malignant proses
                                   Myoma uteri on corpus posterior, vol 30 cm3
                                   Cystic ovarian mass with soild part,  vol 300 cm3 susp maligna

DD : -Ca Cx st. IIIB metastase to ovary
     -Cystic ovarian mass metastase to cervix

Problem : What is the best management for this patient?