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Cervical cancer

Pathology

Peaks 35-44 and 75-85 Squamous (70%) Adenocarcinoma (12%) Adenosquamous (12%) Direct spread - anatomical

Clinical features at presentation


Abnormal bleeding

PCB,IMB,PMB

Abnormal smears

Advanced disease related offensive PV discharge neuropathic pain renal failure DVT

Clinical Staging +/- investigations

Visible tumour PV/PR to check spread to parametrial/rectovaginal space EUA, cystoscopy +/- Sigmoidoscopy,proctoscopy MRI CXR FBC,U&E,LFT PET?

Ovarian cancer

Ovarian cancer

Killer disease 60-75% stage 3 or 4 Incidence increases with age, plateaus by 60 Early imaging - More lesions identified About 6% of all ovarian cysts are malignant

Presentation

Asymptomatic Pelvic mass (diff. diagnosis) Pressure symptoms/abdominal distension/GI symptoms Pain Abnormal bleeding Hormonal effects

Screening & Diagnosis


Clinical examination CA-125 & Transvaginal scan/Abd. Scan Other tumour markers - CEA, CA 19-9 CT/MRI abdomen & pelvis FBC,U&E, LFT, CXR Overlap between benign and malignant

Endometrial / Uterine cancer

Presentation

Postmenopausal bleeding (PMB) 10% of women with PMB have endometrial cancer Postmenopausal PV discharge/pyometra Peri/premenopausal women with IMB especially if do not respond to hormonal treatment. Glandular abnormalities on smear

Investigations

Examination Transvaginal scan endometrial thickness > 4 mms (5 mms) considered significant endometrial biopsy required all cases endometrial thickness < 4 mms

Endometrial biopsy

Pipelle - outpatient Hysteroscopy OP/IP and curettage

CXR, (MRI)

Vulvar intraepithelial neoplasia (VIN)

Presentation

Pruritus Asymptomatic During investigations for CIN/ VaIN Lesions may be raised/flat/sing/multiple/diffuse/discrete Investigation by vulvoscopy +/- acetic acid Adequate biopsies 8 mm punch

Treatment

Multifocal Discomfort/mutilation VIN 3 may progress to cancer life time risk up to 9% Single lesions excised Multiple lesions excision or individualised depending upon location Photodynamic therapy- research HPV vaccine / Topical Imiquimod

Follow up

Vulvoscopy every 6 months until 2 years then individualised Colposcopy and smears as routine (unless CIN identified)

Vulvar cancer

Vulval cancer

Uncommon Elderly >65 years 90% squamous Other types - more aggressive Associated with smoking, cervical neoplasia, immunosupression

Presentation

Longstanding vulval pruritus Pain, discharge, bleeding Most common on labia majora Exophytic, ulcerated or flat Younger patients - multicentric disease Diagnosis - Vulvoscopy and punch biopsy or excision biopsy (single lesion< 2 cms)

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