Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• With deep invasion and one positive node (stage IV), there's pretty good chance of recurrence, either local or distant.
• Radiation and surgery alone can lead to compromised vascular supply to the distal one third of the ureters.
• The distal portion of the ureters may become necrotic.
• There may be loss of peristalsis producing a "functional" ureteral obstruction.
• Outcome could be hydronephrosis and renal failure.
• Distant metastatic sites include lung and bone.
• Her likelihood of 5 year survival is 10-15%

• Should the lab that read the initial PAP smear (the one at the time of her second delivery) have done more to get her back for follow-up? The lesion could have been a stage I back then.