A 43 year old female is diagnosed of having carcinoma of cervix with obstruction of both ureters on imaging studies. What is the treatment of choice in this patient?
## **Core Concept**
The question revolves around the management of a patient with carcinoma of the cervix complicated by bilateral ureteral obstruction. Carcinoma of the cervix can cause ureteral obstruction due to local tumor spread or metastasis, leading to hydronephrosis and renal failure. The management involves addressing both the cancer and the ureteral obstruction.
## **Why the Correct Answer is Right**
In a patient with carcinoma of the cervix and bilateral ureteral obstruction, the primary goal is to relieve the obstruction and manage the cancer. The most effective way to address both issues simultaneously is through **nephrostomy** or more specifically, **percutaneous nephrostomy** (PCN) or **stenting** of the ureters to relieve the obstruction, followed by definitive management of the cervical cancer. However, given the context of the question and standard practices, **radiation therapy** or **chemoradiation** is often the treatment of choice for managing the cervical cancer itself, especially if the obstruction is due to local tumor effects. But immediate relief of obstruction is crucial.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, so we cannot assess its accuracy.
- **Option B:** This option is not provided, so we cannot assess its accuracy.
- **Option D:** This option is not provided, so we cannot assess its accuracy.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that in cases of cervical cancer with ureteral obstruction, **relieving the obstruction** is critical to prevent renal failure. **Chemoradiation** is a common treatment approach for locally advanced cervical cancer and can help manage the tumor causing the obstruction. However, immediate procedures like **percutaneous nephrostomy** may be required to manage acute renal failure.
## **Correct Answer:** C.