Gynaecological Oncology Flashcards
Screening programmes, Cervical, endometrial, ovarian and vulval malignancy, Endometrial hyperplasia, CIN, lichen sclerosis et atrophicus, postmenopausal bleeding (164 cards)
1
Q
Cervical cancer numbers peak at what age?
A
Reproductive years
2
Q
80% of cervical cancers are what type?
A
Squamous cell Carcinoma
3
Q
80% of cervical cancers are squamous cell carcinomas. The next most common type are:
A
Adenocarcinoma
4
Q
Cervical cancer is strongly associated with…
A
Human Papillomavirus (HPV)
5
Q
To reduce the risk of cervical cancer, children aged 12-13 years are vaccinated against…
A
HPV
6
Q
Vaccinating children aged 12-13 against HPV helps to…
A
reduce the risk of cervical cancer
7
Q
Cervical screening with smear tests screens specifically for:
A
precancerous and cancerous changes to the cells of the cervix
8
Q
Why is cervical screening beneficial?
A
early detection of precancerous changes to the cervix enables prompt treatment to prevent the development of cervical cancer
9
Q
The most common cause of cervical cancer is:
A
Infection with Human Papillomavirus (HPV)
10
Q
Different cancers associated with HPV:
A
- cervical
- anal
- vulval
- vaginal
- penis
- mouth
- throat
11
Q
HPV is a ___ ___ infection
A
sexually transmitted
12
Q
The strains of HPV responsible for 70% of cervical cancers and the ones targeted with the HPV vaccine are:
A
Type 16 and 18
13
Q
Treatment for HPV infection?
A
there is NO treatment. Most cases resolve spontaneously within 2 years, whilst some persist
14
Q
England, Wales and Scotland are using HPV primary screening for cervical cancer which is:
A
testing the cervical cells for the HPV virus first and then the lab will look to see if you have high-risk HPV. If high-risk is found, the lab will test samples for cell changes
15
Q
The NHS cervical screening programme invites women from age ___ to ___for cervical screening
A
25 to 64
16
Q
Women get an invite for cervical screening every ___ to ___ years, depending on age and where you live
A
3 to 5
17
Q
You get a cervical screening invite every ____ years if you are aged 25-49
A
3
18
Q
You get an invite for cervical screening every ____ years if you are aged 50-64
A
5
19
Q
If a woman tests positive for HPV from their cervical screening, they are then invited for a…
A
Colposcopy
20
Q
The cervical changes seen on colposcopy are called
A
Dyskaryosis
21
Q
The HPV vaccine is offered to girls aged
A
12-13
22
Q
CIN stands for
A
Cervical Intraepithelial Neoplasia
23
Q
Cervical Intraepithelial Neoplasia is
A
abnormal changes to the cells of the cervix that is not cancerous but can progress to become cancerous (often caused by persistent HPV)
24
Q
Invasive cervical cancer occurs when
A
when the basement membrane of the epithelium has been breached
25
Most common sites of metastasis in cervical cancer:
* lung
* liver
* bone
* bowel
26
The low risk serotypes of HPV that just cause genital warts are:
HPV 6 and 11
27
Oncogenic function of HPV 16 and 18:
They produce proteins which inhibit the tumour suppressor protein p53 in cervical epithelial cells, allowing for uncontrolled cell division
28
General categories of cervical cancer risk factors:
* ones that increase the risk of catching HPV
* Later detection of precancerous and cancerous changes (non-engagement with screening)
* Other risk factors
29
Risk factors for cervical cancer associated with an increased risk of catching HPV?
* early sexual activity
* increased no. of sexual partners
* sexual partners who have had more partners
* not using condoms
30
Other risk factors for cervical cancer apart from HPV?
* smoking
* HIV
* COCP use for more than 5 years
* increased no. of full-term pregnancies
* Family history
* exposure to diethylstilbestrol during fetal development (was previously used to treat miscarriage before 1971)
31
How often are patients with HIV offered a smear test and why?
every year, bc it is a risk factor for cervical cancer
32
Presenting symptoms of cervical cancer:
* can be asymptomatic** often**
* abnormal vaginal bleeding of any kind (intermenstrual, post-coital or post-menopausal) **most common**
* vaginal discharge (blood-stained, foul-smelling)
* pelvic pain
* dyspareunia (pain or discomfort in sex)
* weight loss
33
Abnormal appearances of the cervix that can be suggestive of cancer:
* ulceration
* inflammation
* bleeding
* visible tumour
34
Cervical cancer advanced disease symptoms (due to cancer invading nearby structures) :
* oedema
* loin pain
* rectal bleeding
* radiculopathy
* haematuria
35
Clinical examinations for suspected cervical cancer:
* speculum exam (for bleeding, discharge & ulceration)
* bimanual exam (for pelvic masses)
* GI exam (for hydronephrosis, hepatomegaly, rectal bleeding, mass on PR)
36
Cervical cancer can cause urinary issues because
it can invade its nearby structures and eg. can cause ureter blockage etc
37
Differential diagnosis for abnormal vaginal bleeding:
* STIs
* cervical ectropion
* polyp
* fibroids
* pregnancy-related bleeding
post-menopausal- always exclude endometrial carcinoma
38
initial investigations for cervical cancer in pre-menopausal women
* Test for chlamydia trachomatis (if positive, treat it. If symptoms persist after treatment=more investigations)
* colposcopy
* biopsy
39
initial investigations for cervical cancer in post-menopausal women
* urgent colposcopy and biopsy
40
A colposcopy is where
a colposcope (modified microscope) is used to produce a magnified view of the cervix. Acetic acid is used to stain dysplastic areas and a biopsy is taken
41
Further investigations required after a confirmed diagnosis of cervical cancer
* basic blood tests
* CT chest-abdo-pelvis (looking for mets)
* Further staging scans eg. MRi pelvis, PET
* +/- exam under anaesthesia with further biopsies
42
CIN is diagnosed at
colposcopy (NOT with cervical screening)
43
The grades of CIN:
CIN I: mild dysplasia
CIN II: moderate dysplasia
CIN III: severe dysplasia (also known as cervical carcinoma in situ)
44
Dysplasia is found during ____
Dyskaryosis is found on ____
1. colposcopy
2. dyskaryosis
45
Exceptions to the normal cervical screening programme schedule:
* women with HIV are screened annually
* women over 65 may request a smear if they've not ahd one since aged 50
* women with previous CIN may require additional tests eg. test of cure
* certain groups of immunocompromised women may have additional treatment (cytotoxic drugs or undergoing organ transplant)
* pregnant women due a smear should wait until 12 weeks post-partum
46
Other infections that can be indentified and reported on in a smear result
* bacteria vaginosis
* candidiasis
* trichomoniasis
47
during a smear on a women with an IUD ____ are often discovered
Actinomyces-like organisms (don't require treatment unless symptomatic)
48
If smear results are HPV positive with normal cytology, what happens next?
repeat the HPV test after 12 months
49
If smear results are HPV positive with abnormal cytology, what happens next?
refer for colposcopy
50
If smear results come back as an inadequate sample, what happens next?
repeat the smear after at least three months
51
If smear results come back as HPV negative, what happens next?
continue routine screening
52
A large loop excision of the transformation zone (LLETZ) procedure is also called a ......
Loop biopsy
53
Process of LLETZ to get a tissue sample in cervical biopsy
It involves using a loop of wire with electrical current (diathermy) to remove abnormal epithelial tissue on the cervix. The electrical current cauterises the tissue and stops bleeding.
54
Ways to get a biopsy of tissue during coloscopy:
Punch Biopsy or large loop excision of the transformational zone (LLETZ)
55
____ and ____ should be avoided after an LLETZ procedure to reduce the risk of infection
Intercourse and Tampon use
56
A cone biopsy is a treatment for
cervical intraepithelial neoplasia (CIN) and very early-stage cervical cancer.
57
What is the cone biopsy process?
It involves general anaesthetic and the surgeon removes a cone-shaped piece of the cervix using a scalpel. This sample is sent for histology to assess for malignancy.
58
Risks of cone biopsy
* Pain
* Bleeding
* Infection
* Scar formation with stenosis of the cervix
* Increased risk of miscarriage and premature labour
59
Staging of Cervical Cancer
International Federation of Gynaecology and Obstetrics (FIGO) staging system
Stage 0: carcinoma in situ
Stage 1: Confined to the cervix
A) identified only microscopically
B) gross lesions, clinically indetifiable
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis (metastases)
60
Surgical treatment of CIN and early-stage 1a cervical cancer:
LLETZ or cone biopsy
61
Surgical treatment of stage 1B-2A Cervical cancer
Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
62
Surgical treatment of stage 2B-4A cervical cancer
Chemotherapy and radiotherapy
63
Surgical treatment of stage 4B cervical cancer
Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care
64
Pelvic exenteration is
an operation that may be used in advanced cervical cancer. It involves removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum. It is a vast operation and has significant implications on quality of life.
65
____ is the gold standard treatment for stage 1b to 3 cervical cancer
Chemoradiation therapy
66
Chemotherapy in cervical cancer is often ____-based
cisplatin
67
Cervical smear testing is no longer valid after
radiotherapy
68
Bevacizumab (Avastin) is
a monoclonal antibody that may be used in combination with other chemotherapies in the treatment of metastatic or recurrent cervical cancer.
69
Bevacizumab (Avastin), the Monoclonal antibody used to help treat cervical cancer, targets ....
the development of new blood vessels
70
Bevacizumab (Avastin), the monoclonal antibody that can be used to help treat cervical cancer, is also used to treat...
wet age-related macular degeneration,
where it is injected directly into the patient eye to stop new blood vessels forming on the retina.
71
The name of the HPV vaccine in the UK is:
Gardasil
72
Gardasil protects against 4 strains of HPV, which are:
* strains 6 and 11 that cause genital warts
* strains 16 and 18 that cause cervical cancer
73
Endometrial cancer is
Cancer of the endometrium, the lining of the uterus
74
Around 80% of endometrial cancers are
Adenocarcinomas
75
What is meant by endometrial cancer being an oestrogen-dependent cancer?
Oestrogen stimulates the growth of endometrial cancer cells
76
For exams, any woman presenting with postmenopausal bleeding has ____ cancer until proven otherwise. The key risk factors to remember are ____ and ____.
endometrial
obesity and diabetes
77
Endometrial hyperplasia is
a precancerous condition involving thickening of the endometrium
78
The risk factors, presentation and investigations of endometrial hyperplasia are similar to
endometrial cancer
79
Most cases of endometrial hyperplasia
will return to normal over time. Only 5% progress to endometrial cancer
80
2 types of endometrial hyperplasia to be aware of:
1. Hyperplasia without atypia
2. Atypical hyperplasia
81
Treatment of endometrial hyperplasia:
Using progestogens, with either:
* Intrauterine system (eg. Mirena coil)
* Continuous Oral Progestogens (eg. levonorgestrel or medroxyprogesterone)
82
Unopposed oestrogen refers to
oestrogen without progesterone
83
How does unopposed oestrogen increase the risk of endometrial hyperplasia and cancer?
Unopposed oestrogen stimulates the endometrial cells
84
The risk of developing endometrial cancer is associated with the amount of unopposed oestrogen the endometrium is exposed to during the patient’s life and so the risk factors reflect this:
the amount of unopposed oestrogen the endometrium is exposed to during the patient’s life and so the risk factors reflect this.
85
Risk factors for endometrial cancer
Things that increase lifetime exposure to unopposed oestrogen:
* increased age
* earlier onset of menstruation
* late menopause
* oestrogen only HRT
* no or fewer pregnancies
* obesity
* PCOS
* Tamoxifen
86
PCOS leads to increased exposure to unopposed oestrogen due to:
a Lack of Ovulation
87
For endometrial protection, women with PCOS should have one of:
* The combined contraceptive pill
* An intrauterine system (e.g. Mirena coil)
* Cyclical progestogens to induce a withdrawal bleed.
87
How does a lack of ovulation in PCOS lead to an increased exposure to unopposed oestrogen and therefore endometrial cancer risk?
Usually, when ovulation occurs, a **corpus luteum** is formed in the ovaries from the ruptured follicle that released the egg. It is this **corpus luteum that produces progesterone**, providing **endometrial protection **during the luteal phase of the menstrual cycle (the second half of the menstrual cycle). Women with polycystic ovarian syndrome are less likely to ovulate and form a corpus luteum. Without developing a corpus luteum during the menstrual cycle, progesterone is not produced, and the endometrial lining has more exposure to unopposed oestrogen.
87
How does obesity increase risk of exposure to unopposed oestrogen and therefore endometrial cancer?
**Adipose tissue (fat) is a source of oestrogen**. Adipose tissue is the primary source of oestrogen in postmenopausal women. Adipose tissue contains **aromatase,** which is an **enzyme that converts androgens such as testosterone into oestrogen.** Androgens are produced mainly by the adrenal glands. In women with more adipose tissue, and therefore more aromatase enzyme, more of these androgens are converted to oestrogen. This **extra oestrogen is unopposed in women that are not ovulating (e.g. PCOS or postmenopause), because there is no corpus luteum to produce progesterone.**
88
Why does Tamoxifen increase the risk of endometrial cancer?
Tamoxifen has an anti-oestrogenic effect on breast tissue, but an oestrogenic effect on the endometrium. This increase the risk of endometrial cancer.
89
Additional risk factors for endometrial cancer, not related to unopposed oestrogen are:
* Type 2 diabetes
* Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome
90
Why is type 2 diabetes a risk factor for endometrial cancer?
Type 2 diabetes may increase the risk of endometrial cancer due to the increased production of insulin. **Insulin may stimulate the endometrial cells and increase the risk of endometrial hyperplasia and cancer. **PCOS is also associated with insulin resistance and increased insulin production. **Insulin resistance further adds to the risk of endometrial cancer in women with PCOS.**
91
Protective factors against endometrial cancer:
* COCP
* Mirena Coil
* Increased pregnancies
* cigarette smoking
92
How does smoking protect against endometrial cancer
Smoking appears to be protective against endometrial cancer in postmenopausal women by being **anti-oestrogenic**. Interestingly, it is not protective against other oestrogen dependent cancers, such as breast cancer (where it increases the risk). Smoking may have anti-oestrogenic effects in several ways:
* Oestrogen may be metabolised differently in smokers
* Smokers tend to be leaner, meaning they have less adipose tissue and aromatase enzyme
* Smoking destroys oocytes (eggs), resulting in an earlier menopause
93
What is the number one presenting symptom of endometrial cancer?
Postmenopausal bleeding
94
Possible presenting symptoms of endometrial cancer:
* Postmenopausal bleeding
* Postcoital bleeding
* Intermenstrual bleeding
* Unusually heavy menstrual bleeding
* Abnormal vaginal discharge
* Haematuria
* Anaemia
* Raised platelet count
95
The referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer is:
Postmenopausal bleeding (more than 12 months after the last menstrual period)
96
# Endometrial cancer
NICE also recommends referral for a transvaginal ultrasound in women over 55 years with:
* Unexplained vaginal discharge
* Visible haematuria plus raised platelets, anaemia or elevated glucose levels
97
3 investigations for diagnosing and excluding endometrial cancer:
1. Transvaginal ultrasound for endometrial thickness (normal is less than 4mm post-menopause)
2. Pipelle biopsy, which is highly sensitive for endometrial cancer making it useful for excluding cancer
3. Hysteroscopy with endometrial biopsy
98
# Endometrial cancer
A pipelle biopsy involves
a speculum examination and inserting a thin tube (pipelle) through the cervix into the uterus. This small tube fills with a sample of endometrial tissue that can be examined for signs of endometrial hyperplasia or cancer. Pipelle biopsy is a quicker and less invasive alternative to hysteroscopy for excluding cancer in lower-risk women.
99
Staging for endometrial cancer:
The International Federation of Gynaecology and Obstetrics (FIGO) staging system is used to stage endometrial cancer:
Stage 1: Confined to the uterus
Stage 2: Invades the cervix
Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes (still confined to pelvis)
Stage 4: Invades bladder, rectum or beyond the pelvis
100
Usual treatment for stage 1 and 2 endometrial cancer:
The usual treatment for stage 1 and 2 endometrial cancer is a total abdominal hysterectomy with bilateral salpingo-oophorectomy, also known as a TAH and BSO (removal of uterus, cervix and adnexa).
101
Other treatment options for endometrial cancer aside from TAH and BSO
Other treatment options depending on the individual presentation include:
A radical hysterectomy involves also removing the pelvic lymph nodes, surrounding tissues and top of the vagina
Radiotherapy
Chemotherapy
Progesterone may be used as a hormonal treatment to slow the progression of the cancer
102
The peak incidence of endometrial cancer is
between 65 and 75 years
103
# Endometrial cancer
Differential diagnosis of post-menopausal bleeding:
* Vulval causes – vulval atrophy, vulval pre-malignant or malignant conditions.
* Cervical causes – cervical polyps, cervical cancer
* Endometrial causes – hyperplasia without malignancy, benign endometrial polyps, endometrial atrophy.
104
What endometrial thickness finding requires a biopsy?
If an endometrial thickness of ≥4mm in a postmenopausal woman is identified, an endometrial biopsy should be obtained.
105
# Endometrial cancer
Of the endometrial hyperplasias, which one has the highest rate of progression to malignancy?
Atypical Hyperplasia
106
# ovarian cancer
Why does ovarian cancer often present late?
It usually has very non-specific symptoms
107
# ovarian cancer
Why does ovarian cancer usually have a worse prognosis?
It often presents late due to non-specific symptoms
108
# ovarian cancer
More than 70% of patients with ovarian cancer presents after it has
spread beyond the pelvis
109
# ovarian cancer
____are the most common type of ovarian cancer
Epithelial cell tumours (tumours arising from the epithelial cells of the ovary)
110
# ovarian cancer
Most common subtype of epithelial cell ovarian tumours (most common type)
Serous Tumours
111
# ovarian cancer
Examples of subtypes of epithelial cell tumours
* Serous tumours (the most common)
* Endometrioid carcinomas
* Clear cell tumours
* Mucinous tumours
* Undifferentiated tumours
112
# ovarian cancer
What are the benign ovarian tumours called?
Dermoid cysts/germ cell tumours/teratoma
113
# ovarian cancer
Teratomas come from ____ cells
Germ cells
114
# ovarian cancer
Types of tissues found in teratomas/dermoid cysts
skin, teeth, hair and bone
115
# ovarian cancer
Dermoid cysts/germ cell tumours/teratomas are particularly associated with ovarian ____
torsion
116
# ovarian cancer
Germ cell tumours may cause a raised ____ and ___
Alpha-fetoprotein (a-FP) and Human Chorionic Gonadotrophin (hCG)
117
# ovarian cancer
Sex Cord-Stromal Tumours are rare ovarian tumours arising from the ____ or ____
Stroma (connective tissue) or Sex cords (embryonic structures associated with the follicles)
118
# ovarian cancer
Types of sex cord-stromal tumours
* Sertoli-Leydig cell tumours
* Granulosa Cell Tumours
119
A Krukenberg tumour refers to
A metastasis in the ovary
120
# Ovarian tumours
Krukenberg tumours usually metastasise from
The GI tract, particularly the stomach
121
# Ovarian tumours
Krukenberg tumours have characteristic ____ on histology, which look like ____ on under a microscopy.
Krukenberg tumours have characteristic **“signet-ring” cells** on histology, which look like **signet rings **on under a microscopy.
122
Risk Factors for Ovarian cancer
* Age (peaks age 60)
* BRCA1 and BRCA2 genes (consider the family history)
* Increased number of ovulations
* Obesity
* Smoking
* Recurrent use of clomifene
123
Factors that increase the number of ovulations, increase the risk of ovarian cancer. (bc increased surface epithelial irritation) .These include:
* Early-onset of periods
* Late menopause
* No pregnancies
124
Factors that ____ ovulation or ____the number of lifetime ovulations, reduce the risk of ovarian cancer
Stop ovulation or reduce the number of lifetime ovulations
125
Factors that stop ovulation or reduce the number of lifetime ovulations and so reduce the risk of ovarian cancer:
* Combined contraceptive pill
* Breastfeeding
* Pregnancy
126
Symptoms that may indicate ovarian cancer:
* Abdominal bloating
* Early satiety (feeling full after eating)
* Loss of appetite
* Pelvic pain
* Urinary symptoms (frequency / urgency)
* Weight loss
* Abdominal or pelvic mass
* Ascites
127
An ovarian mass may present by pressing on the ____ nerve and therefore...?
**Obturator nerve** and cause **referred hip or groin pain.** The obturator nerve passes along the inside of the pelvic, lateral to the ovaries, where an ovarian mass can compress it.
128
NICE suspected cancer 2 week wait referal criteria for ovarian cancer:
Refer directly on a 2-week-wait referral if a physical examination reveals:
* Ascites
* Pelvic mass (unless clearly due to fibroids)
* Abdominal mass
129
What are the inital investigations done before referral for a women presenting with possible ovarian cancer?
CA125 Blood test
Pelvic USS
130
Which symptoms of possible ovarian cancer would prompt a CA125 blood test?
* New symptoms of IBS / change in bowel habit
* Abdominal bloating
* Early satiety
* Pelvic pain
* Urinary frequency or urgency
* Weight loss
131
The ____ estimates the risk of an ovarian mass being malignant
risk of malignancy index (RMI)
132
The risk of malignancy index (RMI) takes into account 3 things:
1. Menopausal status
2. Ultrasound findings
3. CA125 level
133
Further secondary care investigations for ovarian cancer
*** CT scan **to establish the diagnosis and stage the cancer
* **Histology** (tissue sample) using a CT guided biopsy, laparoscopy or laparotomy
* **Paracentesis (**ascitic tap) can be used to test the ascitic fluid for cancer cells
134
# Ovarian cancer
What tumour markers would they look for for a possible germ cell tumour?
* Alpha-fetoprotein (α-FP)
* Human chorionic gonadotropin (HCG)
135
In what group of women would tumour markers for a possible germ cell tumour be required to be tested?
Women under 40 years with a complex ovarian mass
136
CA125 is
a tumour marker for epithelial cell ovarian cancer. It is not very specific, and there are many non-malignant causes of a raised CA125:
137
Non-malignant causes of raised CA125
* Endometriosis
* Fibroids
* Adenomyosis
* Pelvic infection
* Liver disease
* Pregnancy
138
The ____ staging system is used to stage ovarian cancer
FIGO staging system (International Federation of Gynaecology and Obstetrics)
139
What are the different stages in the FIGO staging system for ovarian cancer?
Stage 1: Confined to the ovary
Stage 2: Spread past the ovary but inside the pelvis
Stage 3: Spread past the pelvis but inside the abdomen
Stage 4: Spread outside the abdomen (distant metastasis)
140
Who manages ovarian cancer?
a specialist gynaecology oncology MDT.
141
What does the management of ovarian cancer usually involve?
Surgery (eg. staging laparotomy) and Chemo (platinum based)
Follow up monitering of CA125 levels
142
A simple ovarian cyst is
one that contains fluid only
143
A complex ovarian cyst is
one that is not simple! It can be irregular and can contain solid material, blood or have septations or vascularity.
144
Examples of functional ovarian cysts?
Follicular cyst- represents the developing follicle in the 1st half of the menstrual cycle
Corpus Luteal cyst- occur during luteal phase of menstrual cycle after formation of corpus luteum
145
What is an endometrioma?
A cyst (also known as a chocolate cyst) that is associated with endometriosis
146
Investigations for women with cysts:
CA125 (cancer)
lactate dehydrogenase, alpha-fetoprotein and hCG (germ cell)
USS
persistent= laparoscopic cystectomy or oophorectomy
147
Around 90% of vulval cancers are
squamous cell carcinomas (less commonly are malignant melanomas)
148
Risk factors for vulval cancer
Advanced age (particularly over 75 years)
Immunosuppression
Human papillomavirus (HPV) infection
**Lichen sclerosus **
149
Around 5% of women with lichen sclerosus get
vulval cancer.
150
# Vulval Cancer
Vulval intraepithelial neoplasia (VIN) is
a premalignant condition affecting the squamous epithelium of the skin that can *precede vulval cancer.*
151
# Vulval Cancer
VIN is similar to
the premalignant condition that comes before cervical cancer (cervical intraepithelial neoplasia (CIN))
152
# Vulval Cancer
High grade squamous intraepithelial lesion is
a type of VIN associated with HPV infection that typically occurs in younger women aged 35 – 50 years.
153
# vulval cancer
Differentiated VIN is
an alternative type of VIN associated with lichen sclerosus and typically occurs in older women (aged 50 – 60 years).
154
# vulval cancer
A ____is required to diagnose VIN.
biopsy
155
# vulval cancer
Treatment options for VIN (vulval intraepithelial neoplasia)
* Watch and wait with close followup
* Wide local excision (surgery) to remove the lesion
* Imiquimod cream
* Laser ablation
156
Vulval cancer may present with symptoms of:
* Vulval lump
* Ulceration
* Bleeding
* Pain
* Itching
* Lymphadenopathy in the groin
157
Vulval cancer most frequently affects the
labia majora
158
Appearance of vulval cancer
* Irregular mass
* Fungating lesion
* Ulceration
* Bleeding
159
Suspected vulval cancer should be referred on a
2 week wait urgent cancer referral
160
Establishing the diagnosis and staging of vulval cancer involves:
* Biopsy of the lesion
* Sentinel node biopsy to demonstrate lymph node spread
* Further imaging for staging (e.g. CT abdomen and pelvis)
161
Vulval cancer is staged using the
The International Federation of Gynaecology and Obstetrics (FIGO) system
162
Possible management options of vulval cancer depending on the stage
* Wide local excision to remove the cancer
* Groin lymph node dissection
* Chemotherapy
* Radiotherapy
