Cervix BT - 2016

At Diagnosis At BT

Vag. Disease Ant: ___ cm Post: ___ cm RT Lat: ___cm LT Lat: ___cm

h = ___ cm t = ___ cm w = ___ cm

NMD (R)=___cm NMD (L)=___cm

Name/ Initials:

ID:

FIGO Stage: Tumor Type: Expansive / Infiltrative / Combined Clinico-radiological distances from central canal

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MAX

RT LT ANT P0ST

w