Premalignant + malignant disease of lower genital tract

Question 1

What are the high and low risk HPVs

Answer 1

High risk 16+18
Low risk 6+13
Part of quadrivalent vaccine

Question 2

What is the precancerous state of cervix called?

And what are the grades?

Answer 2

Cervical intraepithelial neoplasia

1-3 2 and 3 are considered HIGH GRADE

Question 3

What is the correlation between cytology and CIN grade

Answer 3

There’s some degree of relationship between cytological grade and CIN grade

Question 4

What is the UK’s HPV screening programme

Answer 4

All women with cervix are screened between 25-64 every 3-5 years
If screen picks up ‘high risk HPV’ then they do cytology
If positive refer to colposcopy
If negative refer through normal pathway

Question 5

HPV stains

Answer 5

Acetic acid - stains cells with increased cell turnover white
Iodine - stains normal cells, abnormal cells are unstained

Question 6

How does CIN staging in colposcopy work

Answer 6

If low grade then come back in 6 months for colopscopy and cytology
If high grade treat there excision or ablation

Question 7

Mx of CIN

Answer 7

CIN 1 - repeat smear in 1 year
CIN2,3 - LLETZ or cone biopsy
Surgical - 
LLETZ - 
Cone biopsy (need to be under GA)
Cold coagulopathy
Do test of cure after 6 months 
if negative see in 3 years
If positive do colposcopy and high risk HPV again

Question 8

Presentation of cervical cancer

Answer 8

Bleeding: post-coital, intermenstrual, PMB
Advanced disease
Anaemia
Incontinnece - vesicovaginal fistula
anaemia
Ureteric obstruction

Question 9

Types of cervical cancer

Answer 9

SCC (70%)

adenocarcinoma - precursor is CIN

Question 10

Spread of cervical ca

Answer 10

parametrium, rectum, vagina, bladder
mets - pelvic + para-aortic nodes
lungs and liver

Question 11

What staging is used

Answer 11

FIGO

Question 12

Principles of cervical ca mx

Answer 12

If tumour is small take out

If tumour is 2-4 radio is preferred (as disease has spread and there are problems with fertility)

Question 13

Two forms of radio for cervical ca

Answer 13

External beam 
Internal beam (selenium rods)

Question 14

Vulval tumours

Answer 14

90% SCC

rest BCC, malignant melanoma, adenocarcinoma of Bartholin’s gland

Question 15

What are the two types of SCC vulval cancers

Answer 15

HPV associated - (young women) these start as vulval intraepithelial neoplasia
non-HPV associated - (old women) associated with lichen sclerosus

Question 16

Mx of vulval cancers

Answer 16

IA1 (microinvasive) - conservative
IA2 - IIA (early) - <4cm radical hysterectomy + lymphadenopathy
IIB-IVA (locally advanced) - chemoradiotherapy (external or internal beam and chemo - cisplatin)
IVB - metastatic - combination chemo

Question 17

complications of radical hysterectomy

Answer 17

bladder dysfunction (atony)
sexual dysfunction
lymphoedema (removal of pelvic lymph nodes)

Question 18

Risks of radio

Answer 18

bowel + bladder urgency
skin erythema
fibrosis
vaginal stenosis
menopause