Cancers of Lower Genital Tract Flashcards
How does vulval cancer present?
Vulval itch/irritation not eased with treatment
Pain and burning
Bleeding
Lump/ulcer
What is the the typical age of vulval cancer patients?
> 60years
What are the risk factors for vulval cancer?
Neoplasia/cancer at other lower genital site
Lichen sclerosus
Smoking
Immunosuppression
How is Vulval cancer staged?
Size of legion
Lymph node involvement
Which lymph nodes are involved in vulval cancer?
Inguinal and upper femoral
Pelvic
What vulval intraepithelial neoplasia is associated with HPV?
Usual type VIN
Younger women
Multifocal/zonal
What vulval intraepithelial neoplasia is not associated with HPV?
Differentiated VIN
Older women
Differentiated VIN is associated with what?
Non-HPV
Lichen Sclerous
Older women
Cancer at first diagnosis
Usual type VIN is associated with what?
HPV infection
Younger women
Immunosuppression
Hx Intraepithelial neoplasia
What is stage 1 vulval cancer?
<2cm size
What is stage 2 vulval cancer?
> 2cm size
What is stage 3 vulval cancer?
Local spread
Unilateral nodes
What is stage 4 vulval cancer?
Distant spread
Advanced local spread
Pelvic nodes
How is vulval cancer treated?
Surgery
- Local excision
- Unilateral/bilateral node dissection
RT/Chemo
Which nodes are removed in groin node dissection?
Iguinal + upper femoral
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
