Soleymani Majd Hooman, Watermeyer Sean, El Hamamy Essam, Ismail Lamiese
Milton Keynes General Hospital, Department of Obstetrics & Gynaecology, Standing Way, Eaglestone, Milton Keynes, MK6 5LD, UK.
Cases J. 2008 Dec 16;1(1):401. doi: 10.1186/1757-1626-1-401.
Globally cervical cancer kills millions of women every year. There is a wealth of evidence suggesting that cervical screening is one of the best defences against the development of cervical cancer. Lives could be saved if medical practitioners make a point of routinely enquiring about the date and result of the patient's last cervical smear test and if they repeatedly emphasize the importance of attendance for cervical smear tests, especially in post-menopausal women.
A 66 year old caucasian woman presented with symptoms of a lower respiratory tract infection, weight loss, anorexia and night sweats. There was no history of post menopausal bleeding. She was admitted for intravenous antibiotics. A few days later she developed vomiting, abdominal pain and a brown vaginal discharge.She then had a CT scan which showed a pyometra extending to the umbilicus, with an intrauterine contraceptive device noted inside. After re-taking the history, it emerged that a Lippes loop was inserted 25 years previously. The patient was not given relevant information at the time and then unfortunately was lost to follow up.The pyometra was drained and the coil removed. However, at operation cervical cancer was suspected and biopsies taken. The patient's sepsis improved after pyometra drainage but histology subsequently confirmed stage 1B squamous cell cervical carcinoma. She was referred for a radical hysterectomy.
Every consultation is an opportunity for health education and promotion. Patients need to be encouraged to utilize cervical screening programmes. It is also important to remember that cervical cancer can present with non-specific symptoms, thus the onus is on all doctors to take a good history and perform a thorough examination. Failing to do so may delay making the right diagnosis, with associated morbidity and mortality.
在全球范围内，宫颈癌每年导致数百万女性死亡。大量证据表明，宫颈筛查是预防宫颈癌发生的最佳防御措施之一。如果医生能够例行询问患者上次宫颈涂片检查的日期和结果，并反复强调进行宫颈涂片检查的重要性，尤其是对绝经后女性而言，那么许多生命可能会得以挽救。
一名66岁的白人女性出现下呼吸道感染症状、体重减轻、厌食和盗汗。无绝经后出血史。她因静脉注射抗生素入院。几天后，她出现呕吐、腹痛和褐色阴道分泌物。随后进行的CT扫描显示积脓延伸至脐部，宫内有一个宫内节育器。再次询问病史后发现，25年前放置了一个利普斯环。当时患者未被告知相关信息，不幸的是随后失去了随访。积脓引流，取出节育器。然而，手术中怀疑有宫颈癌并进行了活检。积脓引流后患者的败血症有所改善，但组织学检查随后证实为1B期宫颈鳞状细胞癌。她被转诊进行根治性子宫切除术。
每次会诊都是进行健康教育和促进的机会。需要鼓励患者利用宫颈筛查项目。同样重要的是要记住，宫颈癌可能表现为非特异性症状，因此所有医生都有责任详细询问病史并进行全面检查。不这样做可能会延迟做出正确诊断，从而导致相关的发病率和死亡率。
