Professional Documents
Culture Documents
Pathology
Peaks 35-44 and 75-85 Squamous (70%) Adenocarcinoma (12%) Adenosquamous (12%) Direct spread - anatomical
Abnormal bleeding
PCB,IMB,PMB
Abnormal smears
Advanced disease related offensive PV discharge neuropathic pain renal failure DVT
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
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
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
CXR, (MRI)
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)