Mrs. AJ has experienced irregular vaginal bleeding, including bleeding after intercourse and heavy menstrual periods. She has a history of chronic pelvic pain and recent weight loss. She has had no previous Pap smears and is unsure of her HPV vaccination status. Mrs. AJ is married with five children. There is no known family history of cervical cancer.

Mrs. AJ lives in an urban area of Dakar and works as a market vendor. She has limited access to healthcare and has not had a routine gynaecological examination in several years. She smokes about 10 cigarettes per day and drinks alcohol occasionally. Her diet includes a variety of local foods, with minimal fruits and vegetables.

On physical examination, Mrs. AJ appears fatigued and uncomfortable. A pelvic examination reveals an irregularly shaped cervix with a visible ulcerative lesion.

A Pap smear shows high-grade squamous intraepithelial lesions (HSIL). A colposcopy and cervical biopsy confirm invasive cervical carcinoma. CT imaging of the abdomen and pelvis indicates the cancer has spread to nearby lymph nodes but no distant metastasis.

Invasive cervical cancer with regional lymph node involvement.

1. Treatment:
- Chemoradiotherapy: Initiate concurrent chemoradiotherapy using cisplatin-based chemotherapy combined with external beam radiation therapy due to regional lymph node involvement and the extent of the disease.
- Surgical Option: Consider radical hysterectomy if the tumour is resectable and the disease is localized without significant lymph node involvement.

2. Palliative Care:
- Manage symptoms such as pain and discomfort with appropriate medications.
- Provide nutritional support and counselling to help Mrs. AJ cope with treatment side effects.

- Schedule regular follow-up visits for monitoring treatment response, managing side effects, and conducting imaging studies to check for disease progression.
- Educate Mrs. AJ on the importance of continued surveillance and early detection of any recurrence.