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Abstract: Patient Auntie Zhang, 49 years old, came to the outpatient clinic for examination due to symptoms of bleeding during intercourse. All items of the routine body suggested normal, and the patient was requested to undergo gynecological examination, which revealed a 1 cm cauliflower-like swelling of the cervix, and pathology after biopsy suggested cervical squamous cell carcinoma, a kind of cervical malignancy. The patient was admitted to the hospital for open extensive hysterectomy + bilateral adnexal resection + pelvic lymph node dissection. The wound healed well after surgery and the disease was controlled.
Basic information】Female, 49 years old
Disease Type】Squamous cell carcinoma of the uterine cervix
Hospital】Beijing Chaoyang Hospital, Capital Medical University
Date of consultation】April 2022
Treatment plan】Surgical treatment (open extensive hysterectomy + bilateral adnexal resection + pelvic lymph node dissection)
Treatment Period】Hospitalization for 10 days, regular review
Treatment effect] The disease has been controlled
I. Initial consultation
Auntie Zhang had occasional vaginal bleeding after intercourse and went to a medical checkup center for TCT, gynecological ultrasound and tumor markers, all of which came back normal. However, she was still unsure and came to our hospital for consultation. Although the results of all gynecological items in the patient’s physical examination suggested normal, because the patient had repeated symptoms of bleeding after intercourse, even if the results were normal, the possibility of serious diseases of the cervix and endometrium could not be excluded. The patient was then put on the examination bed for another gynecological examination, and a cauliflower-like mass of about 1 cm in diameter was found in the cervix. A colposcopic biopsy was performed, suggesting cervical squamous cell carcinoma, and a diagnostic cervical conization was performed to increase the diagnostic credibility. The tumor was relatively early and suitable for surgical treatment, and admission to the hospital for surgery was arranged as soon as possible.
II. Treatment history
After admission, the patient underwent a comprehensive physical examination and perfected pelvic enhancement MRI, lung CT, abdominal ultrasound and other examinations, and no signs of metastasis in other areas were found. A functional screening of vital organs was performed, except for contraindications to surgery. After detailed communication with the patient and family about the condition and recommended treatment plan, the patient expressed willingness to undergo surgical treatment. So, an open extensive hysterectomy + bilateral adnexal resection + pelvic lymph node dissection was performed. The postoperative pathology showed no signs of peripheral metastasis and other high-risk factors, and radiotherapy was not required.
III. Treatment results
The operation was relatively large but went well with minimal bleeding and smooth wound healing. After 10 days of hospitalization, the patient recovered well from the wound without abnormalities such as pus flow and infection, and without surgery-related complications such as lymphatic cysts, postoperative lower limb edema, and urinary retention, etc. Relevant follow-up examinations showed no abnormalities, and the patient reported better symptoms and was discharged. Before discharge, patients are advised to review regularly and seek medical consultation if there is any special discomfort, and pay attention to bringing all relevant documents, mainly discharge diagnosis certificate, discharge record, operation record, pathology report, etc. when reviewing.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but the patient needs to pay attention to rest, but not to be bedridden for a long time, which may lead to the elevated risk of venous thrombosis in the lower limbs. It is enough to pay attention to basic normal in diet, not only soup, porridge and easily digestible vegetarian food, otherwise it will easily lead to lack of nutrients and slow recovery. Patients are advised to maintain a good mood, and if they are not in a good mood, they can increase communication with their relatives and friends, and seek help from doctors if necessary. In addition, follow the established review program regularly after discharge from the hospital to avoid delaying treatment.
V. Personal insight
TCT is more sensitive to precancerous lesions, but normal TCT test results do not necessarily mean that there is no problem, as in the case of this patient. In the case of cancerous lesions, since most of the surface is necrotic cells, only necrotic cells can be detected during TCT examination, and these necrotic cells will be destroyed in the preservation solution, so the pathologist cannot find the cancerous cells during examination, and will issue a normal result report. Therefore, it is very important to perform gynecological examination during cervical malignancy screening, and its can directly identify the suspected lesion site. In case of telemedicine, clear colposcopic photos are required, and at least the description of the patient’s cervical appearance in the doctor’s outpatient medical record is required, not just the laboratory report.