Skill Checkup: A 40-Year-Old Woman With Diagnosed and Treated Stage IIA Cervical Cancer Presents With Persistent Cough

Sarah Ackroyd, MD, MPH


June 01, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 40-year-old woman in the United States previously diagnosed with stage IIA cervical cancer presents with a persistent cough during her follow-up surveillance visit. She was initially diagnosed 11 months ago when she presented with postcoital vaginal bleeding and a visible cervical lesion on pelvic examination. On the physical examination, the tumor measured 4.5 cm and involved the upper vagina but had not spread to the nearby parametrial tissues. A biopsy of the lesion confirmed a diagnosis of human papillomavirus type 18 positive adenocarcinoma of the cervix. She initiated treatment 9 months ago. Consistent with guideline recommendations, she received pelvic external beam radiation therapy with concurrent platinum-based chemotherapy followed by brachytherapy. She had a PET/CT at the completion of her treatment course, which revealed a complete response to treatment.

She now presents to her surveillance visit with new pelvic pain and a persistent cough. The pelvic exam reveals the abnormal appearance of the cervix (radiation changes and friable tissue), nodularity of the pelvic floor, and pulmonary exam with decreased breath sounds bilaterally and mild wheezing. These findings are highly suspicious for recurrent disease.


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