Vulval and cervical cancer

Question 1

Describe the presentation of vulval cancer

Answer 1

75% diagnosed over 60

bleeding
Lump/ulcer
Itch
Pain

Question 2

What are the risk factors of vulval cancer

Answer 2

intraepithelial neoplasia or cancer
Lichen sclerosus
Smoking
Immunosuppresion

Question 3

What are the two types of vulval cancer?

Answer 3

HPV related and non HPV related

Question 4

Describe HPV related vulval cancer?

Answer 4

Usual type VIN
Younger woman
Multifocal 
Multizonal
immunosuppresion
Past history of intra-epithelial neoplasia

Question 5

What is non -HPV related vulval cancers presentation?

Answer 5

Differentiated VIN
Older women
Lichen sclerous
Often presents as cancer at first diagnosis

Question 6

How do you stage vulva cancer?

Answer 6

Stage 1- <2cm, no nodes, survival 97%
Stage 2- >2cm, no nodes, 85% survival
Stage 3- local spread, unilateral nodes 46%
Stage 4- distant or advanced local spread, unilateral nodes pelvic nodes, 50% 1

Question 7

How is vulval cancer treated?

Answer 7

Individualised surgery
Local excision
Unilateral or bilateral node dissection
Radiotherapy/chemotherapy

Question 8

What is groin node dissection

Answer 8

dissection of inguinal and upper femoral nodes to stage nodal disease
Associated with significant morbidity (wound infection, lymphocyts, nerve damage

Question 9

Where is the vulva?

Answer 9

Outer parts of the female genitals

Question 10

What are the risk factors for cervical cancer?

Answer 10

Peak age 45-55 years
HPV related (16&18)
Multiple partners
early age at first intercourse
Older age of partner 
Cigarette smoking

Question 11

What are the symptoms of cervical cancer?

Answer 11

Abnormal vaginal bleeding
Post coital bleeding
Inter menstrual bleeding
Discharge
pain

Question 12

Describe the histology of cervical cancer?

Answer 12

Tumour cells from epithelium invade into underlying stroma.
Majority squamous carcinoma (80%)
Adenocarcinoma (endocervical) rising in relative incidence

Question 13

Describe the staging of cervical cancer?

Answer 13

Stage 1A- invasive cancer identified only microscopically <3,, depth and <7 mm diam, microinvasive
Stage IA2<5mm =7
Stage 1B- Clinical tumours confined to the cervix
Stage 2- vagina (upper 2/3)
Stage 3- lower vagina, pelvis
Stage 4- bladder, rectum

Question 14

Where does cervical cancer spread to?

Answer 14

Lymphatic- pelvic nodes

Blood- liver, lungs and bone

Question 15

How do you stage cervical cancer?

Answer 15

PET-CT

MRI

Question 16

What are the tretaments of cervical cancer?

Answer 16

Stage 1a- type 3 excision of the cervical TZ or hysterectomy
Stabe 1b- radical hysterectomy or chemo-radiotherapy
Stage 1b+ radiotherapy

Question 17

What is a radical hysterectomy?

Answer 17

Exploration of pelvic and para-aortic space
Removal of uterus, cervix, upper vagina
Parametria
Pelvic nodes
Ovaries conserved

Question 18

What are the other treatments of cervical cancer

Answer 18

radiotherapy- external beam x 20 fractions
Chemotherapy- 5 cycles of cisplatin
Caesium insertion (24 hours)