Makindo Medical Notes

Related Subjects: |Causes of abnormal Vaginal bleeding |Vaginal Carcinoma |Cervical cancer |Antepartum haemorrhage |Trauma: Traumatic Brain Head Injury (TBI) |Post Menopausal Bleeding |Postpartum haemorrhage

About

• A largely detectable and preventable disease.
• Causes about 1,500 deaths annually in the UK.

Aetiology

• Primarily caused by infection with Human Papillomavirus (HPV), especially types 16 (squamous cell carcinoma), 18 (adenocarcinoma), and 33.
• Inactivation of key tumor suppressor genes, Rb and p53, plays a role in development.
• Histology: predominantly squamous cell carcinoma, less commonly adenocarcinoma.
• Spreads through local tissue invasion, lymphatic system, and metastasis.
• Local spread: involves pelvic sidewall (laterally), bladder base (anteriorly), rectum (posteriorly), and vagina (inferiorly).
• Distant metastasis: lung, liver, bone, and brain involvement.

Risk Factors

• Multiple sexual partners or a partner with many other partners, especially if uncircumcised.
• High parity and other STDs.
• Early first coitus.
• Immunocompromised status (e.g., HIV infection).
• Smoking (particularly for squamous cell carcinoma).

Clinical Features

• Early stages are usually asymptomatic.
• Vaginal bleeding, particularly post-coital bleeding, may occur in progressive stages.
• Late-stage symptoms relate to local invasion and distant metastasis.

Staging and Management

Investigations

• Blood tests: Full blood count (FBC), urea and electrolytes (U&E) for renal function.
• Imaging: Intravenous pyelogram (IVP), CT abdomen and pelvis, MRI, and PET scans.
• Endoscopic assessment: Cystoscopy and sigmoidoscopy may be needed for staging.

Management

• Preinvasive disease: Managed with colposcopy. Cervical intraepithelial neoplasia (CIN) can be treated using cryosurgery, laser therapy, or loop excision of the transformation zone. Cone biopsy may be performed if needed, especially for suspected adenocarcinoma.
• Invasive disease: Primarily squamous cell carcinoma. Cisplatin-based chemotherapy and radiotherapy are mainstays of treatment; radiotherapy may lead to vaginal stenosis.