OBG506 — Gynaecological Oncology: Lecture Note

About this lecture note

This is the complete lecture note for OBG506 Gynaecological Oncology. You can read it online below, open it in the full viewer, or download the PDF for offline study. It pairs with the course's video lectures, so you can read and watch together.

Preview: opening of the note

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: OBG 506 Course title: Gynaecological Oncology Course credit load: 1 Unit Series 1: Vulval and Vaginal Lesions • Part 1.1: Vulval Anatomy and Benign and Pre-malignant Lesions o Sub Part 1.1.1: Anatomy of the vulva, femoral triangle, and lower abdominal wall o Sub Part 1.1.2: Benign lesions of the vulva o Sub Part 1.1.3: Pre-malignant lesions of the vulva and pruritus vulvae • Part 1.2: Malignant Lesions of the Vulva o Sub Part 1.2.1: Epidemiology and aetiology of vulval cancer o Sub Part 1.2.2: Histopathology and clinical presentation of vulval cancer o Sub Part 1.2.3: Principles of treatment of vulval cancer • Part 1.3: Diseases of the Vagina o Sub Part 1.3.1: Vaginal discharge and benign lesions of the vagina o Sub Part 1.3.2: Pre-malignant lesions of the vagina o Sub Part 1.3.3: Malignant lesions of the vagina Introduction Picture a woman referred to a gynaecological oncology clinic with a persistent vulval lesion she has been quietly worried about for months. Whether her diagnosis turns out to be entirely benign, a pre-malignant condition requiring surveillance, or something more serious, your ability to recognise, investigate, and explain it begins with a solid grasp of vulval and vaginal anatomy and pathology. This Series lays that essential foundation for the whole of this course on gynaecological oncology, before we turn in later Series to the cervix, uterus, ovary, and the specific therapies used to treat gynaecological cancer. The aim of this Series is to equip you with a thorough understanding of vulval anatomy, the benign, pre-malignant, and malignant lesions of the vulva, and the diseases of the vagina. We shall commence this Series by examining vulval anatomy and its benign and pre-malignant lesions. Next, we will consider malignant lesions of the vulva, including vulval cancer

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS epidemiology, histopathology, and treatment. Finally, we will conclude by examining diseases of the vagina, from benign discharge through to pre-malignant and malignant lesions. Series Learning Outcomes Upon completing this Series, you should be able to: • SLO 1.1: describe the anatomy of the vulva, femoral triangle, vaginal region, and lower abdominal wall, including blood supply, nerve distribution, and lymph drainage, • SLO 1.2: describe benign and pre-malignant lesions of the vulva, including pruritus vulvae, • SLO 1.3: illustrate the epidemiology and aetiology of vulval cancer, • SLO 1.4: identify the histopathology and list the principles of treatment of vulval cancer, • SLO 1.5: describe benign and pre-malignant lesions of the vagina, and • SLO 1.6: describe malignant lesions of the vagina. 1.1 Vulval Anatomy and Benign and Pre-malignant Lesions 1.1.1 Anatomy of the vulva, femoral triangle, and lower abdominal wall The vulva comprises the mons pubis, labia majora and minora, clitoris, vestibule, and Bartholin's and Skene's glands, with blood supply principally from the internal and external pudendal arteries, branches of the internal iliac and femoral arteries respectively, and sensory innervation from the pudendal nerve alongside contributions from the ilioinguinal and genitofemoral nerves. Lymphatic drainage of the vulva is of particular clinical importance given its direct relevance to the staging and surgical management of vulval cancer, draining principally to the superficial inguinal lymph nodes within the femoral triangle, then to the deep inguinal and femoral nodes, and subsequently to the external iliac and pelvic nodes, with the femoral triangle itself bordered by the inguinal ligament, sartorius muscle, and adductor longus muscle, and containing the femoral artery, vein, and nerve alongside these superficial inguinal nodes. Fill in the blank: Sensory innervation of the vulva arises principally from the ________ nerve, alongside contributions from the ilioinguinal and genitofemoral nerves. Lymphatic drainage of the vulva passes principally to the superficial inguinal lymph nodes within the femoral ________. 1.1.2 Benign lesions of the vulva

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Benign vulval lesions include Bartholin's cyst (accumulation of secretions within an obstructed gland duct), sebaceous cysts, vulval varicosities (particularly common in pregnancy given increased pelvic venous pressure), and vulval dermatoses such as lichen sclerosus (a chronic inflammatory condition causing thinning, whitening, and scarring of the vulval skin) and lichen simplex chronicus (thickened skin from chronic scratching), each requiring careful clinical assessment and, where the diagnosis remains uncertain, biopsy. Lichen sclerosus carries a small but genuinely important increased risk of subsequent vulval squamous cell carcinoma, meaning any woman with this diagnosis warrants regular follow-up and a low threshold for biopsy of any new, persistent, or atypical-appearing area, distinguishing this specific benign dermatosis from most other benign vulval conditions, which do not carry a comparable malignant potential. Fill in the blank: Lichen sclerosus is a chronic inflammatory condition causing thinning, whitening, and ________ of the vulval skin. Lichen sclerosus carries a small but genuinely important increased risk of subsequent vulval squamous cell ________. 1.1.3 Pre-malignant lesions of the vulva and pruritus vulvae Vulval intraepithelial neoplasia (VIN) is the pre-malignant precursor to vulval squamous cell carcinoma, classified into a usual type (strongly associated with persistent high-risk human papillomavirus infection, typically affecting younger women) and a differentiated type (associated with lichen sclerosus and typically affecting older women), each with a somewhat different natural history and risk of progression to invasive malignancy if left untreated. Pruritus vulvae (vulval itching) is a common, non-specific symptom with a broad differential diagnosis, including infective causes (candidiasis, other infections), dermatological conditions (lichen sclerosus, lichen simplex chronicus, contact dermatitis), and, less commonly, VIN or invasive malignancy itself, meaning any woman with persistent, unexplained pruritus vulvae warrants careful examination and, where clinically indicated, biopsy of any visible abnormality rather than reflexive symptomatic treatment alone. Fill in the blank: Vulval intraepithelial neoplasia is classified into a usual type associated with high-risk human ________ infection, and a differentiated type associated with lichen sclerosus. Persistent, unexplained pruritus vulvae warrants careful examination and, where indicated, ________ of any visible abnormality.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Figure 1.1: Vulval anatomy, the femoral triangle, and lymphatic drainage pathway. Pilot questions 1.1 1. Describe the anatomical structures comprising the vulva and their blood supply and innervation. (Linked to SLO 1.1) 2. Describe the lymphatic drainage of the vulva and its clinical relevance. (Linked to SLO 1.1) 3. Describe the common benign lesions of the vulva. (Linked to SLO 1.2) 4. Explain the malignant potential of lichen sclerosus. (Linked to SLO 1.2) 5. Describe vulval intraepithelial neoplasia and its two classified types. (Linked to SLO 1.2) 1.2 Malignant Lesions of the Vulva 1.2.1 Epidemiology and aetiology of vulval cancer Vulval cancer is a relatively uncommon gynaecological malignancy, predominantly affecting older, postmenopausal women, though a genuinely significant minority of cases occur in younger

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS women, typically associated with persistent high-risk human papillomavirus infection and usual-type vulval intraepithelial neoplasia rather than the lichen sclerosus-associated pathway more typical of older women. Recognised risk factors for vulval cancer include persistent high-risk HPV infection, smoking (which acts synergistically with HPV to increase risk), immunosuppression, a history of lichen sclerosus, and a previous history of cervical or vaginal intraepithelial neoplasia or cancer, reflecting the broadly shared aetiological pathway of persistent HPV infection across much of the lower genital tract. Fill in the blank: Vulval cancer predominantly affects older, postmenopausal women, though a significant minority of cases occur in ________ women. Smoking acts synergistically with ________ infection to increase the risk of vulval cancer. 1.2.2 Histopathology and clinical presentation of vulval cancer Squamous cell carcinoma accounts for the great majority of vulval cancers, arising either from HPV-associated usual-type VIN or from lichen sclerosus-associated differentiated VIN, with less common histological subtypes including melanoma, Bartholin's gland carcinoma, and basal cell carcinoma, each carrying somewhat different clinical behaviour and prognosis. Vulval cancer typically presents with a persistent vulval lump, ulcer, or area of skin change, frequently accompanied by pruritus, bleeding, or pain, though presentation can be genuinely non-specific, and delayed presentation, sometimes reflecting embarrassment or reluctance to seek attention for a genital symptom, remains a recognised, important contributor to more advanced disease at diagnosis in some women. Fill in the blank: Squamous cell carcinoma accounts for the great majority of vulval cancers, arising from either usual-type or ________-associated differentiated VIN. Delayed presentation of vulval cancer remains a recognised, important contributor to more advanced ________ at diagnosis. 1.2.3 Principles of treatment of vulval cancer Surgical management is the primary treatment for early-stage vulval cancer, with wide local excision, achieving an adequate margin of normal tissue around the tumour, together with assessment of inguinofemoral lymph nodes, either by sentinel lymph node biopsy in appropriately selected early-stage disease or formal inguinofemoral lymphadenectomy, given the direct relevance of nodal status to both prognosis and further adjuvant treatment decisions. Radiotherapy and chemoradiotherapy are used for more advanced disease, where surgery alone would be unlikely to achieve adequate margins or would result in unacceptable functional or

This is the opening of the note. Read the full note or download the PDF to continue.