Cancers of Lower Genital Tract Flashcards by Peter Savage

How does vulval cancer present?

Vulval itch/irritation not eased with treatment
Pain and burning
Bleeding
Lump/ulcer

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What is the the typical age of vulval cancer patients?

> 60years

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What are the risk factors for vulval cancer?

Neoplasia/cancer at other lower genital site
Lichen sclerosus
Smoking
Immunosuppression

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How is Vulval cancer staged?

Size of legion

Lymph node involvement

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Which lymph nodes are involved in vulval cancer?

Inguinal and upper femoral

Pelvic

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What vulval intraepithelial neoplasia is associated with HPV?

Usual type VIN
Younger women
Multifocal/zonal

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What vulval intraepithelial neoplasia is not associated with HPV?

Differentiated VIN

Older women

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Differentiated VIN is associated with what?

Non-HPV
Lichen Sclerous
Older women
Cancer at first diagnosis

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Usual type VIN is associated with what?

HPV infection
Younger women
Immunosuppression
Hx Intraepithelial neoplasia

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What is stage 1 vulval cancer?

<2cm size

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What is stage 2 vulval cancer?

> 2cm size

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What is stage 3 vulval cancer?

Local spread

Unilateral nodes

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What is stage 4 vulval cancer?

Distant spread
Advanced local spread
Pelvic nodes

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How is vulval cancer treated?

Surgery
- Local excision
- Unilateral/bilateral node dissection
RT/Chemo

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Which nodes are removed in groin node dissection?

Iguinal + upper femoral

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Groin node dissection is associated with what?

Morbidity:

Wound infection
Lymphocysts
Nerve damage

What is the role of groin node dissection?

Remove nodal disease

Staging

Cervical cancer is associated with what?

Age 45-55
HPV 16 + 18
Multiple partners
Early first intercourse
Older age partner
Cigarette smoking

Cervical cancer symptoms?

Abnormal vaginal bleeding
Post-coital bleeding
Intermenstrual bleeding
Discharge
Pain

How is cervical cancer diagnosed?

Examination
Biopsy (LLETZ) Transformation zone
Screening

What are the most common cancers of the cervix?

Squamous carcinoma (80%)
Adenocarcinoma

How is stage 1A cervical cancer identified?

Microscopically

What is stage 2 cervical cancer?

Contained to vagina

What lymphatic nodes do cervical cancer spread to?

Pelvic nodes

To what does cervical cancer metastasise?

Liver Lungs Bone

What is stage 3 cervical cancer?

Contained to lower vagina, pelvis

How is cervical cancer examined for staging?

PET-CT | MRI

How is cervical cancer stage 1a treated?

Excision of cervical transformation zone

How is cervical cancer stage 1b-2a treated?

Radical hysterectomy | Chemo-radiotherapy

What is removed in radical hysterectomy?

Uterus, cervix, upper vagina Parametria Pelvic nodes Ovaries conserved

What is the non-surgical management of cervical cancer?

Radiotherapy - External beam x20 Chemotherapy - 5 cycles of Cisplatin Caesium Insertion

What is FIGO stage 1A1?

Depth <3mm, <7mm wide

What is FIGO stage 1A2?

Depth <5mm. width <7mm

Why is radiotherapy not indicated in cervical cancer for young women?

Radiation effect on ovaries may trigger menopause

What staging is used for cervical/vulval cancer?

FIGO staging (NOT TNM)§

What is Lichen Sclerosus?

Inflammatory skin condition which can pre-dispose to cancer

Differentiated type VIN is always what grade?

Always high grade