Multidisciplinary approach to management of multifocal neoplasia in women Nathan M, Gibbon K, Cuming T, Wijeyekoon S, Rosenthal A and Thaha M. Homerton University Hospital, Barts Health and Queen Mary, University of London, UK P003 Introduction Multifocal lower anogenital neoplasia transcends several disciplines and their care may get delayed during inter- disciplinary referrals. In East London, specialists in colorectal surgery, gynaecology oncology, vulval dermatology and high resolution anoscopy formed a collaborative group to fast-track care of complex lower anogenital neoplasia (LAGN), to enable seamless flow of patients during their care. Results Methods Conclusions Base-line characteristics Cancer group (A) (12) Non-cancer group (B) (14) Age Mean 49.6 yrs (25 – 70) Mean 44.6 yrs (22 – 79) Immune -suppressed 5 9 Duration of disease before referral Mean 8.3 yrs (1.0 – 24) Mean 5.9 yrs (0 – 18) Cervical disease Cervical cancer CIN2/3 1 5 0 5 Vaginal disease VaIN 2/3 2 5 Vulvar disease Cancer VIN 2/3 4 6 0 10 Perianal disease Cancer PAIN 2/3 10 2 0 11 Anal canal disease Cancer AIN 2/3 3 5 0 7 No of multifocal sites 4 3 2 2 8 2 2 5 5 Follow-up (yrs) Mean 2.7 (0.7 – 9.25) Mean 3.8 (0.5 – 12) Twenty six cases with multifocal neoplasia were identified. Nine cases had a previous cancer diagnosis before referral while 3 had cancer at their first visit. Three incident cancers occurred during treatment and follow-up, 2 in those with previous cancer (group A), while one in those with no history of cancer (group B). The latter occurred in a yet untreated area of PAIN3. Aggressive ablative treatment of pre-invasive multifocal anogenital neoplasia is feasible without major complications. While these cases represent late presentations of large volume disease, the number of cases is small and follow-up period short, to conclude on cancer prevention. More prospective data is needed. Objective: To evaluate the outcomes of care in a population at high-risk for cancer within our network. Method: Retrospective case note review of a cohort of women with LAGN managed within the East London collaboration. Laser ablation was instituted to high-grade disease on vaginal, vulval, perianal and anal canal epithelia. Each attempt consisted of 6x6cm area. Once the treated area has healed further treatment was carried out until all disease had been cleared.

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Multidisciplinary approach to management of multifocal neoplasia in womenNathan M, Gibbon K, Cuming T, Wijeyekoon S, Rosenthal A and Thaha M.

Homerton University Hospital, Barts Health and Queen Mary, University of London, UK

P003

IntroductionMultifocal lower anogenital neoplasia transcends several disciplines and their care may get delayed during inter-disciplinary referrals. In East London, specialists in colorectal surgery, gynaecology oncology, vulval dermatology and high resolution anoscopy formed a collaborative group to fast-track care of complex lower anogenital neoplasia (LAGN), to enable seamless flow of patients during their care.

Results

Methods

Conclusions

Base-line characteristics Cancer group (A)(12)

Non-cancer group (B)(14)

Age Mean 49.6 yrs (25 – 70) Mean 44.6 yrs (22 – 79)

Immune -suppressed 5 9

Duration of disease before referral

Mean 8.3 yrs (1.0 – 24) Mean 5.9 yrs (0 – 18)

Cervical disease Cervical cancer

CIN2/315

Vaginal diseaseVaIN 2/3 2 5

Vulvar diseaseCancerVIN 2/3

010

Perianal diseaseCancer

PAIN 2/3102

011

Anal canal diseaseCancerAIN 2/3

No of multifocal sites 432

282

255

Follow-up (yrs) Mean 2.7 (0.7 – 9.25) Mean 3.8 (0.5 – 12)

Twenty six cases with multifocal neoplasia were identified. Nine cases had a previous cancer diagnosis before referral while 3 had cancer at their first visit. Three incident cancers occurred during treatment and follow-up, 2 in those with previous cancer (group A), while one in those with no history of cancer (group B). The latter occurred in a yet untreated area of PAIN3.

Aggressive ablative treatment of pre-invasive multifocal anogenital neoplasia is feasible without major complications. While these cases represent late presentations of large volume disease, the number of cases is small and follow-up period short, to conclude on cancer prevention. More prospective data is needed.

Objective: To evaluate the outcomes of care in a population at high-risk for cancer within our network.Method: Retrospective case note review of a cohort of women with LAGN managed within the East London collaboration.Laser ablation was instituted to high-grade disease on vaginal, vulval, perianal and anal canal epithelia. Each attempt consisted of 6x6cm area. Once the treated area has healed further treatment was carried out until all disease had been cleared.