133^thInterinstitue conference

Gynecologic Oncology Department , National Cancer Institue

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Patient identification

A 52 year-old Thai woman

Occupation      :Agriculture

Payment           :Universal coverage scheme

Hometown       :Kanchanaburi

Chief complaint

Palpable vulvar mass 6 months PTA

Present illness

6 months PTA , she felt tense and palpated indurated mass at right side of vulva. The mass size was about 1 cm. and it proceeded in size. She refused to see doctor because of embarrassing.

1 moth PTA , She could not sit in normal position due to press on the mass.

She came to NCI for her underlying cervical cancer surveillance.

She had no abnormal vaginal bleeding or discharge , no pelvic pain .

No weight loss , Normal appetite

Past history

2007    :Diagnosis       : squamous cell carcinoma of cervix stage IB1

:Treatment       : RHND BSO

: Post operative adjuvant CCRT ( Metastatic left pelvic LN )

: Continuous surveillance ( last time :1 year PTA : normal )

No history of DM , HT

No history of food and drug allergy

Obstetrics and Gynecologic history

G3P3 last 29 years

Surgical menopause

Family history

No history of cancer in her family

Physical examination

BW 54 kg.        HT 158 cm.      BMI 21.6 kg/m2

V/S       :BT 370C        PR 68 /min       RR 20 /min       BP 119/74 mmHg

HEENT             : Not pale , No jaundice , No SCLN enlargement

Heart & Lung. : No murmur, Normal breath sound

Breast              : No palpable abnormal mass

Abdomen         : Soft, no tenderness , no palpable mass

: Impalpable liver and spleen

Groin LN          : No enlargement

Pelvic examination

MIUB / vagina

A firm consistency , dark gray mass 5x3x1.5 cm. at Rt labia minora , extended to urethral orifice , anterior vaginal wall and vaginal vault and 2 cm distance from anal verge

No palpable pelvic mass

RV examination :Smooth rectal mucosa

Tumor extended from both paravaginal tissue to pelvic wall

No mass above vaginal stump

Discussion      :What is a provisional diagnosis and investigation?

:What are proper managements?