218 vulvar and cervical malignancy

Question 1

What are the most important carcinogenic factors of high-risk HPV?

Answer 1

E6 (loss of p53), E7 (loss of Rb)

Question 2

What are the symptoms of vulvar cancer?

Answer 2

itching, dyspareunia, soreness, burning

Question 3

According to recent guidelines, when should pap smear sreening stop?

Answer 3

stop after age 65 if adequate screening and no recent history of CIN >2

Question 4

Categorize CIN1, CIN2, CIN3, LGSIL, and HGSIL.

Answer 4

increasing grade/infiltration

as CIN grade increases, the risk of severe neoplasia progression increases

Question 5

Describe the surgical management of vulvar carcinoma based upon the location of the lesion.

Answer 5

take a punch biopsy first for analysis

may need to remove cancerous lesions from the vagina, cervix, anus, rectum, pelvic wall, and groin

treat with triple excision vulvectomy with possible lymph node dissection, radical vulvectomy (if infiltrating into perineal membrane/periosteum

consider neoadjuvant chemo for advanced disease