Cervical cancer hypothetical case studies
This video series follows the hypothetical cervical cancer journeys of Anna, Jane and Arabella - from screening and diagnosis through all aspects of their multidisciplinary cancer care.
The series was developed from the Cancer Institute NSW's Gynaecological
Cancer Professional Education Forum 2011, and features
discussion by a multidisciplinary panel of experts, facilitated by
Dr Norman Swan.
Part One - Screening,
diagnosis and initial treatment
Introduction
Dr Norman Swan introduces the hypotheticals and the
multidisciplinary panel of experts.
Anna diagnosis
Anna is a 50 year old, married, Muslim woman with no children.
She has never had a pap test and visits her GP to discuss
post-coital bleeding.
The panel discusses Anna's diagnosis and cervical screening
rates in NSW communities.
Jane diagnosis
Jane is a 38 year old married woman who lives in Orange with her
husband and two children. She has been trying to conceive another
child, and in this video she visits her rural GP to discuss
abnormal intermenstrual and post-coital bleeding.
Arabella diagnosis
Arabella is a 29 year old single woman who lives independently.
She visits her GP to discuss contraception in the context of new
relationship. She hasn't had a pap test since completing the HPV
vaccination and is unaware of the need for ongoing pap testing.
The panel discusses Arabella's diagnosis and the uptake of HPV
vaccination in NSW.
Arabella follow up visit
Arabella's pap test shows an early cancer of the cervix. She is
referred to a gynaecological oncologist to determine the correct
treatment. Arabella requests fertility-sparing surgery.
The panel discusses Arabella's follow up visit.
Arabella - reality sinks in
Arabella meets with a social worker after surgery, and discusses
financial and relationship anxieties.
The panel discuss the psychological impacts of a cancer
diagnosis.
Jane has to start treatment and see a fertility specialist
A repeat pap test confirms an invasive adenocarcinoma of the
cervix. The gynaecological oncologist recommends chemo-radiation,
followed by brachytherapy.
The hypothetical consultation involves three sessions:
- Jane has an initial consultation with a radiation oncologist to
explain the diagnosis and treatment plan.
- Jane meets with a reproductive endocrinologist, to discuss
fertility preservation options.
- Jane discusses radiotherapy issues with her radiation
oncologist.
The panel discusses the various issues related to treatment.
Anna is referred to a gynaecological oncologist
After her first pap test, Anna is diagnosed with a high-grade
dysplasia but refuses to be examined by a male doctor.
The panel discuss appropriate referrals for patients depending
on their situation.
Part Two - Survivorship,
recurrence and palliative care
Introduction
Dr Norman Swan introduces the new members of the
multidisciplinary panel of experts.
Jane's treatment follow up
Jane has a follow up consultation with the radiation oncologist
one year post treatment, to discuss side effects she is
experiencing. These include lymphoedema, bowel dysfunction,
menopausal symptoms and sexual dysfunction.
The panel discusses therapies to control treatment side
effects.
Arabella - two years later
It's two years after Arabella has had a trachelectomy:
- Arabella has another consultation with her gynaecological
oncologist.
- Arabella is referred to a clinical nurse consultant.
- Arabella is referred to a clinical psychologist.
The panel discusses various psychosocial issues.
Jane - two and a half years later
Jane visits her radiation oncologist two and a half years after
being diagnosed, and reports flu-like symptoms and swollen glands.
Jane is referred for a CT scan to investigate the possibility of a
cancer recurrence.
The panel discusses various follow-up issues such as referral to
palliative care.
Jane gets bad news
Jane is diagnosed with recurrent adenocarcinoma and her imaging
suggests liver metastases. She meets with her radiation oncologist
to understand treatment options to control her incurable
disease.
The panel discusses Jane's treatment options.
Jane sees her GP during hard times
Jane visits her GP to discuss a shooting pain in her hip, lower
back and pelvis.
The panel discusses support in the primary sector for advanced
cancer patients.
Jane sees a palliative care physician
Jane meets with a palliative care physician to discuss ways to
manage the pain she's experiencing.
The panel discusses pain management and other palliative care
issues.
Jane has home visit from palliative care nurse
Jane is aware that she is dying and is unsure how to tell her
children. She discusses this at home with a palliative care
nurse.
The panel discusses various end of life issues.
Arabella five year follow up
Arabella meets with her gynaecological oncologist five years
after being diagnosed.
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