Vulval and vaginal cancer Flashcards Preview

Gynaecology > Vulval and vaginal cancer > Flashcards

Flashcards in Vulval and vaginal cancer Deck (23):
1

What is Lichen simplex?

Chronic inflammatory skin condition of the vulva, presents with severe intractable pruritis, especially at night

2

What causes a bartholin's gland cysts? When does an abscess form?

*Blockage of the duct causes cyst formation
*If infection occurs (commonly staph or E.coli) abscess forms

3

Presentation of a barthlin's gland cysts?

Acutely painful and large tender red swelling is evident

4

Treatment of bartholin's gland cysts?

*Incision and drainage
*Marsupialization =incision is sutured open to reduce risk of re-formation

5

What is Vaginismus? Presents how? Caused by?

*Involuntary muscle spasm prevent vaginal penetration
*often results in pain with attempts at sex
*generally a fear that penetration will hurt

6

What is vulval intraepithelial neoplasia (VIN)? How is is divided?

Presence of atypical cells in the vulval epithelium, considered premalignant stage

Types:
*Usualy type VIN
*Differentiated type VIN

7

What is usual type VIN present with? Associated with?

Clinically it may be multifocal and appearances vary widely: red, white or pigmented, plaques, papules or patches
*can be warty, basaloid or mixed

Associated:
*common in 35-55years old
*HPV
*CIN
*smokers
*Chronic immunosuppresion

8

What is differentiated type VIN?

*rare
*lesion unifocal, ulcer or plaque
*linked to kertinizing sqaumous cell carcinomas
*risk of progression to cancer higher

Associated:
*lichen sclerosis

9

How does VIN present?

*pruritis of the vulva
*pain of the vulva

10

Treatment of VIN?

*emollients
*mild topical steroid
*gold standard is local surgical excision to reliev symptoms, confirm histology and exclude invasive disease

11

What is the epidemiology of vulval carcinoma?

*5% of genital tract cancers
*Most common after the age of 60

12

What is the histology of vulval carcinomas?

*95% are sqaumous cell carcinomas
*Other types: melanomas, basal cell carcinomas, adenocarcinomas

13

What is vulval carcinoma risk factors?

*lichen sclerosis
*VIN
*immunosuppression
*smoking
*Paget's disease of the vulva
*HPV

14

What is Paget's disease of the vulva?

Adenocarcinoma in situ
*risk of malignancy and invasion high

15

What is the clinical presentation of vulval carcinoma?

History:
*Pruritis
*bleeding
*discharge
*mass felt

Examination
*Ulcer or mass most commonly on the labia majora or clitoris
*inguinal lymph nodes may be enlarged, hard and immobile

16

What is the staging of vulval carcinoma?

Stage 1:
Tumour confined to vulva/perineum

Stage 2:
Tumour of any size with adjacent spread (lower urethra/vagina or anus), negative nodes

Stage 3:
Tumour of any size with positive inguinofemoral nodes

Stage 4:
Tumour invades upper urethra/vagina, rectum, bladder, bone or distant metastases

17

What justifies referral if suspician of vulval cancer is present?

Urgent 2 week referral if:
*Woman presenting with unexplained vaginal lump
*Woman with unexplained vulval bleeding or ulceration

18

For a woman who presents with vulval puritis or pain, how should they be managed?

*Treat, watch and wait
*However if persistent symptoms then they should be referred for gynae opinion

19

What investigations are completed if vulval carcinoma is suspected?

*biopsy to allow diagnosis
*assessment of fitness for surgery

20

What is the treatment of vulval carcinoma?

*Stage 1a, wide local excision is adequate, without inguinal lymphadenectomy
*Other stages, injection of blue dye injected around tumour and any sentinel node identified biopsied to assess presence of metastasis
*radiotherapy with or without chemo
*reconstructive surgery often undertaken

21

What are the complications of surgery for vulval carcinoma?

*wound break down and infection
*Introital stenosis
*urinary/faecal incontinence
*lymphoedema

22

What is the epidemiology of vaginal carcinoma?

*2%
*affects older women

23

Presentation of vaginal carcinoma?

*bleeding
*discharge
*mass or ulcer evident