Gynecologic Oncology Department , National Cancer Institue
A 52 year-old Thai woman
Payment :Universal coverage scheme
Palpable vulvar mass 6 months PTA
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
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
No history of cancer in her family
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
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?