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Abstract: A 65-year-old female patient reported that she had menopause 14 years ago, but 3 years ago she started to bleed vaginally again with a small amount of dark red blood and no abdominal pain, and the bleeding stopped after half a day. After systematic examination, she was diagnosed with stage IB2 cervical cancer and underwent open radical cervical cancer surgery, the uterus was completely removed and the vaginal bleeding disappeared.
Basic information】Female, 65 years old
Disease Type】Cervical cancer
Hospital】Hunan Provincial Maternal and Child Health Hospital
Date of consultation】June 2022
Treatment plan】Surgical treatment (open extensive hysterectomy + double adnexal resection + pelvic lymph node dissection + abdominal para-aortic lymph node dissection)
Treatment period】In-hospital treatment for 10 days + long-term follow-up
Treatment effect】Surgery went well, postoperative radiotherapy was recommended
I. Initial consultation
At the first interview, the patient complained of menopause 14 years ago, but 3 years ago, she suddenly found a small amount of dark red blood coming out of her vagina without abdominal pain, and the bleeding lasted for half a day. Four days ago, I noticed a small amount of vaginal bleeding again, but this time the bleeding did not go away. After listening to the patient’s explanation, I first performed a gynecological examination. The patient’s vulva was normal in appearance, a small amount of dark red bloody discharge was seen in the vagina, and the cervix was enlarged with ulcerative changes and obvious blood on palpation. The uterus was normal in size and no abnormality was found in the bilateral adnexal region. Triple diagnosis: no thickening and nodules in bilateral main sacral ligaments, smooth rectal mucosa, and no blood in finger sleeve withdrawal. TCT and HPV were completed, and colposcopic cervical biopsy was performed: suggesting: medium-differentiated squamous carcinoma of the cervix. When imaging was performed, the patient was found to have an enlarged cervix with slightly hypoechoic, interspersed with slightly hyperechoic photophores, the endometrial line was poorly displayed, and a fluid dark area about 1.6 cm wide was seen inside the uterine cavity, which was diagnosed as cervical cancer. According to the patient’s relevant medical history, physical examination and auxiliary examination, the diagnosis was cervical cancer stage IB2.
II. Treatment history
After the diagnosis of cervical cancer was confirmed, I fully communicated with the patient and her family that the patient was not contraindicated to surgery and suggested to perform surgery as soon as possible to prevent the tumor cells in her body from spreading and spreading and damaging her health. After hearing this, the patient expressed her understanding and agreed to take surgical treatment. She underwent open extensive hysterectomy + double adnexal resection + pelvic lymph node dissection + abdominal para-aortic lymph node dissection, and the operation went smoothly.
III. Treatment effect
On the day the operation was completed, I arrived at the ward and observed that the patient’s heart rate, respiration and other basic vital signs were stable, and there was no fever or large amount of dark red drainage fluid from the drainage tube, indicating that the operation went well. Two days after the operation, he had exhaustion, bowel movement was restored, and he could get out of bed. The surgical wound was free of infection and fat liquefaction, and the vaginal wound healed well. The postoperative pathological examination suggested that: 1. Intermediate differentiated squamous carcinoma of the uterine cervix, invading the myofibrous layer of the cervical canal (depth >2/3), invading the lower part of the uterine cavity (depth >1/2), cancerous emboli were seen in the plexus, and the vaginal vault and vaginal wall cut margins were negative. No metastasis was seen in the lymph nodes sent for examination. The patient was advised to supplement radiotherapy after surgery.
IV. Notes
I was happy for the patient when I saw that her symptoms were gradually reduced and her mental state was gradually improved, and at the same time, I advised her that she should pay attention to her recuperation after discharge. The patient should pay attention to rest and nutrition, pay attention to vulva hygiene, keep the perineum clean, change underwear regularly, forbid intercourse within 3 months, and forbid heavy physical exertion within 6 months. If you have chills and fever, abdominal pain and vaginal bleeding, you should follow up in time. Take postoperative anticoagulants to prevent blood clots until 4 weeks after surgery, and pay attention to monitoring for subcutaneous bleeding and petechiae and ecchymosis. Postoperative supplemental radiotherapy is recommended. In addition, attention should be paid to regular follow-up, which is recommended every 3-6 months for 2 years after treatment, every 6-12 months for years 3-5, and once a year after 5 years.
V. Personal insight
The prognosis of early stage cervical cancer is relatively good, and early treatment of the disease can usually be better controlled. The common symptoms of cervical cancer patients are bleeding during intercourse, vaginal bleeding, fluid flow and other adverse manifestations, and there are also many patients who do not have any symptoms and are detected by screening. The 65-year-old female patient in this case, although she had stopped menstruating herself, did not take treatment measures in the early stage because of the small amount and short duration of vaginal bleeding, and waited until the disease progressed before seeking medical attention. Fortunately, after surgical treatment, her condition has been stabilized, and I feel very happy.