CPC Of Cancer At Lower Genital Tract

Question 1

What is the natural history of lower genital tract malignancy?

Answer 1

Lower genital tract cancer may be predisposed by intraepithelial neoplasia or cancer at other genital tract site, lichen sclerosus, smoking, immunosuppression

Question 2

What is the epidemiology of vulval cancer and how is it diagnosed?

Answer 2

Epidemiology: 27-97yo, 75% >60yo

Presents: pain, itch, bleeding, lump/ulcer

Staging is surgical-pathological: size and lymph node involvement.

HPV related VC: usual type vulval intraepithelial neoplasia, younger, multifocal, multizonal, immunosuppression, past history of VIN

Non HPV related: differentiated vulval intraepithelial neoplasia, older, lichen sclerosus, often presents as cancer at first diagnosis

Investigated with biopsy (punch or excisional)

Treated with surgery (indivualised, local excision, unilateral or bilateral node dissection) and radiotherapy/chemotherapy.

Question 3

What is the epidemiology of cervical cancer and how is it diagnosed?

Answer 3

Epidemiology: 45-55yo, HPV related, multiple partners, early age at first intercourse, older age of partner, smokers. Bimodal distribution. Early then late age. Most deprived.

Symptoms: abnormal bleeding, post coital bleeding, intermenstrual bleeding, post menopausal bleeding, discharge, (pain)

Diagnosis is clinically, screen detected or biopsy.

Histology: 80% squamous carcinoma, adenocarcinoma is rising. Spread can be local or metastases.

Staging: PETCT, MRI, biopsy

Treatment: staged. Excision of cervical TZ or hysterectomy -> Radical hysterectomy or chemo-radiotherapy -> Chemo-radiotherapy.