Lower Genital Tract Cancer Flashcards
What are the risk factors for cervical cancer?
- Peak age 45-55 years
- HPV related (16 & 18)
- Multiple partners
- Early age at first intercourse
- Older age of partner
- Cigarette smoking
What are the symptoms of cervical cancer?
- Abnormal vaginal bleeding
- Post coital bleeding
- Intermenstrual bleeding/PMB
- Discharge
- Pain (less common)
How is cervical cancer diagnosed?
Can be clinical, detected by screening (remember screening aims to detect pre-cancerous disease not cancer) or on biopsy
What kinds of cancer can develop in the cervix?
80% of malignancies of the cervix are squamous cell carcinomas. Adenocarcinoma makes up the other 20% and has cervical glandular intraepithelial neoplasia (CGIN) as its precursor lesion rather than CIN
How is cervical cancer staged?
FIGO staging is used to assess the extent of the tumour and is assigned as follows:
• IA1: depth < 3mm, width < 7mm
• IA2: depth < 5mm, width < 7mm
• IB: if clinically visible tumour or greater size than IA
• Stage 2: spread to vagina (upper 2/3),
• Stage 3: spread to lower vagina, pelvis,
• Stage 4: spread to bladder, rectum
How can cervical cancer metastasise?
Metastases of cervical cancer can be lymphatic to the pelvic lymph nodes or through the blood to the liver, lungs and bone
What investigations can be helpful in staging cervical cancer?
PET-CT or MRI
How is cervical cancer treated?
- Stage IA1- type 3 excision of the cervical transformation zone or hysterectomy
- Stage IB-IIA- Radical hysterectomy or chemo-radiotherapy
- IIB-IV- chemo-radiotherapy
What is removed during a radical hysterectomy?
- Uterus, cervix, upper vagina
- Parametria
- Pelvic nodes
- Ovaries conserved
How is radiotherapy given for cervical cancer?
External beam
How is chemotherapy given for cervical cancer?
Cisplatin
What are the common presentation of vulval cancer?
Pain
Itch
Bleeding
Lump/ulcer
What are the risk factors for vulval cancer?
Age (75% diagnosed in >60) Intraepithelial neoplasia or cancer at other lower genital tract site Lichen sclerosus Smoking Immunosuppression
How is vulval cancer staged?
Using FIGO staging as follows:
Stage 1- <2cm with no node involvement
Stage 2- >2cm with no node involvement
Stage 3- Local spread with unilateral node involvement
Stage 4- Distant or advanced local spread with pelvic node involvement
What are the survival rates for the stages of vulval cancer?
Stage 1- 97%
Stage 2- 85%
Stage 3- 46%
Stage 4- 50%
What are the two types of vulval cancer?
HPV related and non-HPV related
What are the characteristics of HPV related vulval cancer?
- Usual type VIN
- Younger women
- Multifocal
- Multizonal
- Immunosuppression
- Past history of intra-epithelial neoplasia
What are the characteristics of non-HPV related vulval cancer?
- Differentiated VIN
- Older women
- Lichen Sclerous
- Often presents as cancer at first diagnosis
How can a biopsy of a vulval cancer be obtained?
Punch or excisional biopsy
What are the possible diagnoses of a suspected vulval cancer?
- Inflammatory, including lichen sclerosus
- Dysplasia- VIN
- Malignant- squamous cell carcinoma
What is vulvar intraepithelial neoplasia?
Vulvar intraepithelial neoplasia is an abnormal proliferation of squamous epithelium that can progress to carcinoma
What is the difference between usual type and differentiated type VIN?
The usual type has a classical warty appearance and is associated with HPV infection. It can be low grade (VIN 1) or high grade (VIN 2 or 3). There is also a differentiated type that is more common in older women, is not HPV related and is always high grade.
How is vulval cancer treated?
Surgery in vulval cancer is generally quite individualised. It usually takes the form of local excision with unilateral or bilateral node dissection as required. Chemotherapy or radiotherapy can also be given. Groin node dissection of the inguinal and upper femoral nodes can be done for staging and removal of nodal disease
What are the risks of groin node dissection?
Associated with significant morbidity due to wound infection, lymphocysts and nerve damage
