- Lichen sclerosis is an autoimmune loss of vulval collagen, leading to a thin epithelium. It is commonest in postmenopausal women. Affected lesions appear shiny, white and tight, and may be itchy or painful. Areas of lichen sclerosis should be biopsied, as there is a 5% risk of progression to vulval intraepithelial neoplasia (VIN) and eventually vulval squamous cell carcinoma. VIN has less malignant potential than CIN, so lesions tend to undergo observation. The exception is symptomatic VIN3, which is treated with laser therapy or topical chemotherapy
- Vulval cancer accounts for 5% of gynaecological cancers, with a wide presenting age range. 90% are squamous carcinomas, with rarer forms including Bartholin's gland adenocarcinomas and Paget's disease of the vulva
- Vulval carcinomas can present with pruritus, bleeding, pain/dyspareunia or a mass. Lesions spear slowly to local tissues with lymphatic spread to femoral nodes. Treatment varies from wide local excision to radical vulvectomy with bilateral node dissection. Local or systemic chemotherapy may also be effective
Ovarian
- Ovarian cancer is the commonest cause of gynaecological cancer death in westernised society. This is mainly due to its late, and often advanced presentation and no current population screening. Endometrial cancer is the commonest malignancy of the female genital tract.
Cervical
- There has been a recent rise in the incidence of cervical cancer among younger females. Some people blame increased promiscuity and thus more widespread infection with human papillomavirus, for this change. The younger age group has a worse prognosis.
Endometrial
- Endometrial tumours are oestrogen dependent - hence many risk factors involve unopposed oestrogen exposure. Risk factors include not using exogenous oestrogen, obesity, nulliparity, late menopause, diabetes and pelvic irradiation for cervical cancer.
Fallopian tube
- Fallopian tube cancer is rare, accounting for <0.3% of gynaecological cancers
- Intermittent colicky pain settling with sudden vaginal discharge of watery fluid
- Spread is local, via the peritoneum and lymphatics, and with metastases being present in around 50% of cases
- The treatment options are much the same as for ovarian cancer
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