JD is a 46-year-old woman who calls the women’s health CRNP’s office with a report of one episode of post-coital bleeding. She reports that it resembled a menstrual flow, and she now has a small amount of vaginal spotting. She has not been seen in the office in six years, however, and would like to come in for an exam.
She presents to the office, and the CRNP obtains an updated medical history. The patient is a poor historian but reports that she has a past history of diabetes, high cholesterol, and hepatitis C, which she believes she acquired during a brief history of IV drug use as a teen. She reports that two years ago she had a hysterectomy for cancer but does not know what kind and that she was treated with “some beam and liquid that went into my arm.”
The CRNP is unable to obtain her medical records from this surgery prior to the exam and decides to proceed and evaluate her symptoms. Her GYN exam reveals bilateral inguinal adenopathy, a 4cm firm, friable mass at the vaginal apex, which is felt to extend into the left parametrium. The mass is also palpated on rectovaginal exam.
Without knowing a full history, your initial differential diagnosis is recurrent cervical cancer.
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