Cervical Cancer

A 32-year-old woman tells you that she has had generalized weakness;swelling of the face, arm, and legs; diffuse myalgias; and a facial rashfor several weeks. Her main concern is her inability to keep her arms elevatedor get out of bed. Her history is significant for cervical cancer.

A34-year-old woman presents to the emergency department(ED) with rapidly progressive dyspnea.The patient has a history of metastatic vaginal clearcell adenocarcinoma secondary to diethylstilbestrol exposurein utero. Following her diagnosis in 1990, she wastreated with surgery, chemotherapy, and radiation. Shehad done well for years until a recurrence of the cancer tothe left lung was found last year. She completed a courseof chemotherapy with doxorubicin hydrochloride andcisplatin 1 month ago.

An 83-year-old woman-who had not visited a physician for 20 years-presented to the emergency department with a 1-day history of urinary retention and a 1-month history of gross vaginal bleeding. The mass on the left side of her face was a secondary finding.

A 48-year-old woman was hospitalized following 10 days of rectal bleeding. One year earlier, she had undergone combined external-beam radiation and brachytherapy for stage IIIA carcinoma of the cervix. The patient was orthostatic and pale on admission, and her hemoglobin level was 6 g/dL. After receiving a transfusion of packed red cells, she underwent colonoscopy. Several telangiectases were seen in the rectum, the mucosa was friable, and blood oozed from one of the lesions.