Gynaecology (Quesmed) Flashcards

Question

What is the main differential for Ectopic Pregnancy?

Answer 1

Miscarriage is the main differential, but in an ectopic pregnancy, the pain is often the first and dominant symptom and the vaginal bleeding is often minor compared to miscarriage

Answer 2

A Pregnancy Test Transvaginal Ultrasound to locate the pregnancy

Answer 3

If the patient has minimal/ no symptoms Do repeat B-hCG tests and if the levels are not falling at a satisfactory rate, then active management is advised

Answer 4

One-off dose of Methotrexate The criteria for Methotrexate treatment (3) (low hCG level, ability to attend follow up, adherence to avoiding pregnancy for a period following treatment) If the initial dose does not work, then a second dose or surgical management may be necessary

Answer 5

4 Criteria for Surgical Management - Significant amount of pain - Adnexal mass of 35mm or more - B-hCG levels are 5000IU or more - Ultrasound identifies a foetal heartbeat Surgical Management- Salpingectomy (fallopian tube containing the Ectopic Pregnancy is removed)- if they only have one Fallopian Tube and wish to remain fertile then a Salpingotomy can be done The risk with Salpingotomy is that sometimes not all of the tissue is removed, so B-hCG measurements are done to make sure no trophoblastic tissue is left

Answer 6

Late Menopause Early Menarche Obesity Nulliparity Oestrogen-only hormone replacement therapy Polycystic Ovary Syndrome

Answer 7

Postmenopausal bleeding Abnormal Vaginal bleeding (Intermenstrual bleeding) Dyspareunia Pelvic Pain Abdominal discomfort/ bloating Weight loss Anaemia Enlarged Uterus on Bimanual Pelvic Examination, or this may be normal as the gross uterus size may be unchanged

Answer 8

Transvaginal ultrasound to look for the abnormal thickening of the endometrium Biopsy of the endometrium

Answer 9

Depends on the stage Limited to uterus- Hysterectomy with Bilateral Salpingo-Oophorectomy is curative Spread outside the uterus- Surgery, Radiotherapy and Chemotherapy

Answer 10

Dysmenorrhoea Dyspareunia Subfertility Pelvic Examination may reveal Tender, Nodular masses on the ovaries or the ligaments surrounding the uterus Rarely, Endometrial tissue can grow outside the female reproductive system, such as the Bowel- which leads to Cyclical Rectal Bleeding

Answer 11

(Other causes of Dysmenorrhoea) Primary Dysmenorrhoea Uterine Conditions (fibroids, adenomyosis) Adhesions Pelvic Inflammatory Disease

Answer 12

Trans-vaginal Ultrasound (which is usually normal)- sometimes can identify an Ovarian Endometrioma (cyst made of Endometrial Tissue) Diagnostic Laparoscopy is Gold-Standard but it carries complications (Bowel Perforation)- so it is not First Line

Answer 13

Analgesia (Paracetamol or NSAIDs) Hormonal Therapy (3) - Combined Oral Contraceptive Pill - Medroxyprogesterone Acetate - Gonadotrophin-releasing Hormone Agonists

Answer 14

Diathermy of Lesions Ovarian Cystectomy (for Endometriomas (cysts in the ovaries)) Adhesiolysis Bilateral Oophorectomy (sometimes with Hysterectomy) (For managing Infertility, menstrual suppression would be unsuitable, so ablation or surgery is more appropriate)

Answer 15

Often Asymptomatic When symptoms occur, they involve menstrual dysfunction in the form of Menorrhagia and Dysmenorrhoea If large enough, the fibroids may distort the Uterine Cavity and interfere with Fertility If large, the fibroids may be palpable on abdominal examination such as a suprapubic mass. Pelvic examination may reveal and irregularly enlarged uterus

Answer 16

(Other causes of Menorrhagia and Dysmenorrhoea) Endometrial Polyps Endometriosis

Answer 17

Transvaginal Ultrasound (used to assess size and location of fibroids) MRI is used if Ultrasound is not detailed enough to assess the fibroid for surgery If there is any doubt over the diagnosis, a Biopsy may be taken to differentiate the fibroid from other differentials such as Endometrial Cancer

Answer 18

If <3cm with no Uterine Distortion - NSAIDs - Anti-fibrinolytics - Combined Hormonal Contraception - Levonorgestrel-releasing intrauterine system (Mirena) - Mirena is first-line, however other treatments may be selected depending on the patient's wishes to remain fertile

Answer 19

Myomectomy (generally Fertility-sparing) Ablation involves Laser or Radiofrequency (generates heat) to induce Necrosis of the Fibroid, so the dead vessels no longer bleed Uterine Artery Embolisation may provide a targeted degeneration of the Fibroid and may also preserve Fertility Hysterectomy involves removing the Uterus- Effective but does not preserve Fertility

Answer 20

Anterior Vaginal Wall - Cystocele= bladder (may lead to stress incontinence) - Urethrocele= urethra - Cystourethrocele= both bladder and urethra Posterior Vaginal Wall - Enterocele= Small intestine - Rectocele= Rectum Apical Vaginal Wall - Uterine Prolapse= Uterus - Vaginal vault Prolapse= Roof of Vagina (common after a hysterectomy)

Answer 21

Oestrogens- function to overcome oestrogen deficiency- Oral, Transdermal or Topically (Intravaginal Creams, Gels and Pessaries for Urogenital Symptoms only) Progestogens- for Endometrial protection from unopposed systemic Oestrogens. Oral, Transdermal or Intrauterine (via Mirena)

Answer 22

Cyclically- for perimenopausal women who are still having menstrual periods Continuous- if postmenopausal

Answer 23

Relief of Vasomotor Symptoms Relief of Urogenital Symptoms Reduced risk of Osteoporosis

Answer 24

Increased risk of Breast Cancer Increased risk of Endometrial Cancer if Oestrogen is given alone Increased risk of Venous Thromboembolism

Answer 25

80% if - woman is under 40 years old - they do not use contraception - they have regular intercourse

Answer 26

Age Obesity Smoking Alcohol Drugs Tight fitting underwear (males) Anabolic Steroid use

Answer 27

Genetic- - Turner's (XO) - Kleinfelter's (XXY) Endocrine- - Polycystic Ovary Syndrome - Pituitary tumours - Sheehan's Syndrome (Pituitary Infarction as a result of Haemorrhagic Shock during Labour) - Hyperprolactinaemia - Cushing's Syndrome - Premature Ovarian Failure Tubal- - Congenital Anatomical Abnormalities - Adhesions following Pelvic Inflammatory Disease- secondary to Chlamydia or Gonorrhoea Uterine- - Bicornate Uterus - Fibroids - Asherman's Syndrome (Adhesions of Uterus) Cervical - - Cervical Damage- after Biopsy or LLETZ Testicular Disorders- - Cryptorchidism - Varicocele - Testicular Cancer - Congenital Testicular Defects Ejaculatory- - Obstruction of Ejaculatory System (congenital or acquired) - Disorders of Ejaculation (retrograde or premature ejaculation)

Answer 28

Device can stay in for up to 10 years. When it is removed, fertility returns to normal Not suitable for women with current pelvic infection or a distorted uterus. Women with a repeat history of STIs are also unsuitable for this If fitted after 40, the device can stay until the woman has her menopause. They need to be taught how to check if their device is in the right place Contraindications- unexplained bleeding and an abnormal cervix

Answer 29

It is the Most Effective form of Emergency Contraception It can be used for up to 120 hours after the Unprotected Sex has occurred or after the earliest expected date of Ovulation It is not recommended to be used within 28 days after giving birth Some women may experience Spotting and Period Type Pains Women should visit the doctor 3-4 weeks later to check that they are not pregnant and discuss future contraception

Answer 30

Pelvic Examination (Speculum +/- smear test) Pregnancy Test Pelvic Ultrasound (if the examination findings are suggestive (such as fibroids) Cervical Biopsy if the smear is abnormal +/- abnormal findings on examination Endometrial biopsy if Endometrial Pathology is suspected

Answer 31

Combined Oral Contraceptive Pills- to regulate Menstrual Cycle Mirena Intrauterine system- to reduce Overall Bleeding Norethisterone- taken on cycle days 5-26to prevent bleeding Progestogens- to reduce Amenorrhoea but can not be used long term (like Medroxyprogesterone acetate)

Answer 32

White patches which may scar around anal and genital areas Pain may occur when the area is irritated during Urination or Sexual Intercourse

Answer 33

Topical Steroids Avoidance of Soaps in the Affected Areas Emollients to relieve Dryness and Itchiness

Answer 34

Vasomotor (hot flushes, night sweats) Sexual Dysfunction (vaginal dryness, reduced libido, problems with orgasm, dyspareunia) Psychological (depression, anxiety, mood swings, lethargy, reduced concentration)

Answer 35

They are fertile for at least 2 years after their last menstrual period if they are <50 years old, and for 1 year after their last menstrual period if they are >50 years old In general, they are no longer fertile after the age of 55

Answer 36

HRT or Non Hormonal Management (5)- - Lifestyle measures (regular exercise, weight loss (if overweight), clothing alterations, stress reduction and avoiding triggers (spicy food, caffeine, smoking), good sleep hygeine) - SSRIs or SNRIs - Clonidine (alpha-2 adrenergic receptor agonist) - Cognitive Behavioural Therapy - Vaginal Moisturisers

Answer 37

Blood loss during a period, to the point where a woman's quality of life is affected

Answer 38

Bleeding disorders Hypothyroidism Liver and Kidney Disease Obesity

Answer 39

FBC to eliminate Iron Deficiency Anaemia Clotting studies if bleeding elsewhere Transvaginal Ultrasound- to look for things like Fibroids/ Endometrial Polyps Other tests for Endocrine Diseases (TFTs) should only be done if indicated

Answer 40

Mirena Coil Mefenamic Acid Tranexamic Acid Hormonal contraception (COCP) If it is refractory- Endometrial Ablation or Hysterectomy

Answer 41

Foetal- - Genetic Disorder - Abnormal Development - Placental Failure Maternal- - Poorly controlled Diabetes - Anti-Phospholipid Syndrome - Poorly controlled Thyroid Disease - Cervical Incompetence - Uterine Abnormality - Polycystic Ovary Syndrome

Answer 42

Vaginal Bleeding Pain- Worse than usual pain of period Vaginal tissue loss

Answer 43

Loss of pregnancy prior to 24 weeks Gestation

Answer 44

Vaginal bleeding prior to 24 weeks of Gestation= Ectopic Pregnancy (but in Ectopic, the pain is the presenting complaint and the bleeding is minimal)

Answer 45

Threatened Miscarriage - Mild symptoms of bleeding and Foetus is retained within the Uterus, as the Cervical OS is closed. so there is the Threat of a Miscarriage but it is Not Certain. There is Little or No Pain. Ultrasound reveals that the foetus is present Intrauterine Inevitable Miscarriage - Heavy bleeding and pain, where the foetus is Intrauterine BUT the Cervical OS is open. Hence it is inevitable. Ultrasound reveals that the foetus is present Intrauterine Complete Miscarriage - There was an Intrauterine Pregnancy which has now fully miscarried, with all products of conception expelled, and the Uterus is now Empty. The OS is usually closed. The patient may have been alerted to the miscarriage by the pain and bleeding Missed Miscarriage - Uterus still contains Foetal Tissue but the Foetus is no longer Alive. This is called Missed as the woman does not realise it. the Cervical OS is closed

Answer 46

Transvaginal Ultrasound to establish whether there are Any Foetal Components and whether a Foetal Heartbeat can be detected When these are Not present- serial hCG measurements may be indicated. Serial Serum hCG measurements 48 hours apart can give an indication of the location and prognosis of the pregnancy - if the levels fall then it suggests that the foetus will not develop or there has been a miscarriage - if there is only a slight increase or a plateau in hCG, then this indicates an Ectopic Pregnancy - normal increase in hCG suggests the foetus is growing normally but does not exclude Ectopic Pregnancy

Answer 47

Miscarriage can not be stopped or prevented Expectant management- waiting for contents to be expelled naturally Medical management- Misoprolol Surgical management- Dilatation and Curettage If the woman is Rhesus Negative, they may require anti-D prophylaxis

Answer 48

Blood tests (Antiphospholipid Antibodies, Thrombophilia Screens) Cytogenetic Analysis of Products of Conception (if abnormal then the Parents should be Karyotyped) Pelvic Ultrasound (to identify Uterine Abnormalities)

Answer 49

Genetic Disorder- refer to Clinical Geneticist for Genetic Counselling. Options include continuing pregnancy attempts with a Prenatal Diagnosis or using a Donor Egg/Sperm Uterine Structure Abnormality- Surgically treat this Cervical Incompetence- Regular Ultrasound monitoring of the Cervix. May use Cervical Cerclage Polycystic Ovary Syndrome- pathophysiology is not fully understood Antiphospholipid Syndrome- Heparin or Low-dose Aspirin Thrombophilia- Heparin Diabetes- improves Glycaemic Control

Answer 50

Epithelial Ovarian Cancer - Originate from the Epithelium- which lines the Fimbria of the Fallopian Tubes/ Ovaries - Epithelial tumours are partly cystic and the cysts can contain fluid - The initial metastatic spread involves the Peritoneal Cavity, with seeding particularly affecting the bladder, paracolic gutters and the diaphragm Germ Cell Tumour - Originate from the Germ Cells in the Embryonic Gonad -These tumours grow rapidly and spread via the lymphatic route - Germ cell tumours most commonly arise in Young Women, which is atypical for most cases of Ovarian Cancer - Tumour markers for this type of cancer include AFP and sometimes B-hCG Sex Cord Sex Cord Stromal Tumours - Originate from the Connective Tissue - They are rare (<5% of Ovarian Tumours). They are less aggressive than Epithelial Tumours - Ovarian Cancer can be secondary to cancer elsewhere. Krukenberg Tumour= a "signet ring" subtype of tumour (usually from the GI System) which spreads to the Ovaries

Answer 51

Old Age Smoking Greater number of Ovulations (Early Menarche and Late Menopause) Obesity HRT BRCA1 and 2 genes Parity Breastfeeding Early Menopause COCP

Answer 52

Symptoms develop late in the course of cancer and involve Abdominal Discomfort, Bloating, Early Satiety, Urinary Frequency or Change in Bowel Habit The cancer can produce vascular growth factors which Increase Vessel Permeability, leading to Ascites in Late Disease Other symptoms of Late Disease include Back, Pelvic and Abdominal Pain There may be a Palpable Mass where the cancer is growing

Answer 53

GI Conditions (like IBS) Other causes of masses (Fibroids, Ovarian Cysts, other cancers (Bladder, Endometrial))

Answer 54

CA125 Pelvic and Abdominal Ultrasound (These two are used to calculate the Risk of Malignancy Index) CT Scans for Staging AFP and B-hCG for Young Women who have Germ Cell Tumours Laparotomy for Tissue Biopsy

Answer 55

Stage I (limited to the ovaries): Stage IA: limited to one ovary, the capsule is intact Stage IB: limited to both ovaries, capsules intact. Stage IC: tumour limited to one or both ovaries with any of the following: capsule ruptured, tumour on ovarian surface, malignant cells in ascites or peritoneal washings. Stage II involving one or both ovaries with pelvic extension and/or implants: Stage IIA: extension and/or implants on the uterus and/or Fallopian tubes. No malignant cells in ascites or peritoneal washings Stage IIB: extension to and/or implants on other pelvic tissues. No malignant cells in ascites or peritoneal washings Stage IIC: pelvic extension and/or implants (Stage IIA or Stage IIB) with malignant cells in ascites or peritoneal washings. Stage III involving one or both ovaries with microscopically confirmed peritoneal implants outside the pelvis: Stage IIIA: microscopic peritoneal metastasis beyond pelvis (no macroscopic tumour) Stage IIIB: macroscopic peritoneal metastasis beyond pelvis <2 cm Stage IIIC: peritoneal metastasis beyond pelvis >2 cm and/or regional lymph node metastasis. Stage IV ovarian cancer is tumour involving one or both ovaries with distant metastasis.

Answer 56

Surgery - If Early Disease, surgery can include the removal of the Uterus, Ovaries, Fallopian Tubes and Infracolic Omenectomy - If Advanced Disease, debulking surgery can be performed Chemotherapy - Adjuvant Chemotherapy in Combination with Surgery - Intraperitoneal Chemotherapy may be performed at the time of operation

Answer 57

Can be Asymptomatic Otherwise, Acute Unilateral Pain or Intra-peritoneal Haemorrhage with Haemodynamic Compromise

Answer 58

Ovarian Torsion and Ectopic Pregnancy GI causes such as Appendicitis can also be considered

Answer 59

Pregnancy Test to exclude an Ectopic Pregnancy Diagnostic Laparoscopy may be needed in an Unstable patient

Answer 60

Mainly Conservative but may require Surgery

Answer 61

It results from Detrusor Muscle Hyperactivity It manifests as Urinary Urgency, Nocturia and Incontinence

Answer 62

Urinalysis with or without Culture to rule out a potential Infection Frequency/ Volume Charts Urodynamics

Answer 63

Behavioural Modification- reduce Oral Fluid Intake, avoid things like Caffeine and Alcohol which are diuretics Bladder Retraining- to Increase the Interval between Voids and suppress the Urinary Urge Anticholinergic Drugs (Oxybutynin, Solifenacin) Vaginal Oestrogens if Urogenital Atrophy is a likely Contributory Factor Botulism Toxin- which is used for Refractory Cases

Answer 64

39% of cases are caused by Chlamydia and 14% are caused by Gonorrhoea

Answer 65

Bilateral Abdominal Pain Discharge Post-Coital Bleeding Adnexal Tenderness Cervical Motion Tenderness on Bimanual Examination Fever (10% have RUQ pain due to inflammation of Liver, secondary to the PID (known as Fitz Hugh Curtis Syndrome)- LFTs are normal but Abdominal Ultrasound should be done to exclude Gallstones anyway)

Answer 66

Pelvic Examination Pregnancy Test Swabs for Gonorrhoea and Chlamydia Bloods Transvaginal Ultrasound

Answer 67

Ofloxacin and Metronidazole Analgesia may be required If ANY woman presents with bilateral lower abdominal pain with adnexal tenderness should be treated for PID

Answer 68

Subfertility Hirsuitism Acne Mood Swings/ Depression/ Anxiety Obesity Male Pattern Baldness Oligomenorrhoea Acanthosis Nigricans (secondary to Insulin Resistance)

Answer 69

LH:FSH ratio>2 (can also help exclude Menopause where the ratio is normal) Total Testosterone- normal or high Fasting/ Oral Glucose Tolerance Tests (helps to diagnose Insulin Resistance which is seen in POS) Transabdominal and Transvaginal Ultrasound to see the cysts themselves Other Pathologies- TFTs- for Thyroid function 17-Hydroxyprogesterone Levels- for CAH Prolactin- for Hyperprolactinaemia DHEA-S and Free Androgen Index (Androgen Secreting Tumours) 24 hour Urinary Cortisol (for Cushing's)

Answer 70

Polycystic Ovaries (>12 on Imaging or Ovarian Volume >10 cubic cm) Oligo/anovulation Clinical or Biochemical Features of Hyperandrogenism

Answer 71

General Advice- - Weight Loss and Exercise Control - Education about Increased Cardiovascular, Diabetes and Endometrial Cancer risks Not Wishing to Conceive- - Co-cyprindrol- Used for Reducing Hirsutism and Inducing Regular Menstruation - Metformin- Used for Reducing Hirsutism and Inducing Regular Menstruation AND Acne - COCP- Reduces Irregular Bleeding and protects against Endometrial Cancer Wishing to Conceive- - Clomiphene- Induces Ovulation and Improves Conception Rates - Metformin- Can be used with or without Clomiphene to Increase the chances of pregnancy - Ovarian Drilling- 2nd Line Laparoscopic Surgical Procedure- used to damage the Hormone-producing cells of the Ovary - Gonadotrophins- can induce Ovulation if Clomiphene and Metformin have failed

Answer 72

Cervical Ectropion- Often Asymptomatic Endocervical and Cervical Polyps- Often Asymptomatic but may have Vaginal bleeding, Intermenstrual bleeding or Menorrhagia. Diagnosed via Speculum Examination Cervical Cancer- can cause Post-Coital Bleeding as well as bleeding at other times such as Urination. There will also be Urinary Symptoms and Vaginal Discomfort STIs- Discharge and Pelvic Pain will be seen Atrophic Vaginitis- Most common cause of Post-coital bleeding in Postmenopausal women

Answer 73

Endometrial Cancer- this is often the Only Symptom Vaginal Atrophy- It can cause Pruritus, Dyspareunia and Vaginal Discharge Cyclical Combined HRT- it is common to experience Breakthrough Bleeding when on HRT Bleeding Disorders- if there is frequent bleeding elsewhere/ family history

Answer 74

Psychological, Behavioural and Physical Symptoms that occur in the Luteal Phase of the Menstrual Cycle

Answer 75

Pharmacological- - COCP - Danazol - Transdermal Oestrogen - GnRH Analogues (to induce a Menopausal State) - Antidepressants (SSRIs and SNRIs) Non-Pharmacological- - Dietary modifications (Reduce Fat, Sugar, Caffeine and Increase Fibre, Fruit and aim for more Frequent Snacks) - Increasing Exercise - Vitamin Supplementation (for Vitamin B supplementation) - Stress Induction (Relaxation) - CBT

Answer 76

A positive pregnancy test but negative ultrasound - Early Viable or Failing Intrauterine Pregnancy - Complete Miscarriage - Ectopic Pregnancy

Answer 77

Serial Serum B-hCGs 48 hours apart - If the levels fall- Foetus will NOT develop or there is a Miscarriage - Slight increase or Plateau- Ectopic Pregnancy - Normal increase- Foetus is growing normally but does NOT exclude Ectopic Transvaginal Ultrasound- as foetus may be too small to identify in early days of Gestation

Answer 78

Menopause in a women under 60 years old - Vasomotor- Hot Flushes and Night Sweats - Sexual Dysfunction- Vaginal Dryness, Reduced Libido, Problems with Orgasm, Dyspareunia - Psychological- Depression, Anxiety, Mood Swings, Lethargy, Reduced Concentration

Answer 79

Diagnosed- Reduced FSH levels indicate Menopause. The levels should be repeated at least once to exclude Anomalies Management- HRT until the normal age of Menopause unless the risks outweigh the benefits

Answer 80

It is the failure of Menstrual Periods to start by the time the female is 15 years old if they have Normal Growth and Secondary Sexual Characteristics It may be diagnosed at 13 years old if there is no Pubertal Maturation and No Menses - Constitutional Delay in Puberty - Chromosomal or Genetic Abnormalities such as Turner's Syndrome (45 XO), Kallmann Syndrome and Androgen Insensitivity - Disruption of the functioning of the Hypothalamus and the Pituitary Glands due to: Anorexia, Excessive Exercise, Extreme Physical or Psychological Stress - Structural Abnormalities of the Genital Tract such as: an Imperforate Hymen obstructing Menstrual Flow (leading to Haematocolpos), Uterine Agenesis - Pregnancy

Answer 81

GI Causes- (5) Acute Appendicitis, Mesenteric Adenitis, Inflamed Meckel's Diverticulum, Diverticulitis (although this is more common on the left) and Inflammatory Bowel Disease (Crohn's) Gynaecological Causes- (5) Ectopic Pregnancy, Ovarian Torsion, Ovarian Cyst Growth, Ovarian Cyst Rupture, Pelvic Inflammatory Disease Urological Causes- (2) Pyelonephritis, Ureteric Colic

Answer 82

The absence of periods in a woman who had previously had them for 6 months or more - Pregnancy (most common cause) - Breastfeeding - Menopause - Pituitary Gland Pathology (Sheehan Syndrome or Hyperprolactinaemia) - Hypothyroidism or Hyperthyroidism - Physical Stress, Excess Exercise and Weight Loss -PCOS - Intrauterine Adhesions causing Outflow Tract Obstruction (Asherman's Syndrome) -Drug Induced Amenorrhoea (Contraceptive Use)

Answer 83

It is a condition where the Foetal Vessels run near to or across the internal Cervical os These vessels are likely to rupture in Vasa Praevia during the rupture of membranes as the vessels are UNSUPPORTED by the Umbilical cord or Placental tissue. This can lead to Foetal Haemorrhage or Foetal Death - Painless Vaginal Bleeding - Rupture of Membranes - Foetal Bradycardia (or resulting Foetal Death)

Answer 84

Transabdominal or Transvaginal Ultrasonography and most cases can now be diagnosed Antenatally It is managed through Elective Caesarean Section prior to the Rupture of the Membranes. This is usually arranged at 35-36 weeks gestation. If the mother ruptures her membranes or goes into labour then Emergency Caesarean Section should be started asap

Answer 85

Squamous Cell Carcinoma - Vulval Pain - Itching - Non-healing Ulcer - Lump with or without Lymphadenopathy

Answer 86

Examination of the vulvar can raise suspicion if there is a lump or Ulceration After Inspection, the diagnosis can be confirmed with a Biopsy Management- The main treatment option is Surgery. In simple cases of primary vulvar cancer, Radical/ Wide Local Excision can be used. If it is a multi-focal disease, then Radical Vulvectomy is preferred If advanced, Radiotherapy is used with or without Chemotherapy

Gynaecology (Quesmed) Flashcards

(110 cards)