Differential Diagnosis for Abnormal Vaginal Discharge and Intermenstrual Bleeding
- Single Most Likely Diagnosis
- Cervical Cancer: The presence of a raised, ulcerative lesion on the cervix, intermenstrual bleeding, and increased clear, watery vaginal discharge are highly suggestive of cervical cancer. The patient's history of smoking (24-pack-year) also increases her risk for cervical cancer.
- Other Likely Diagnoses
- Cervicitis: Inflammation of the cervix could cause the observed discharge and intermenstrual bleeding. The absence of pruritus or dysuria and the presence of a lesion on the cervix make this less likely than cervical cancer but still a consideration.
- Human Papillomavirus (HPV) Infection: Given the patient's sexual history (5 lifetime partners) and the presence of a cervical lesion, an HPV infection is possible. HPV is a common cause of cervical lesions and can lead to cervical cancer.
- Do Not Miss Diagnoses
- Chlamydia or Gonorrhea Infection: Although the patient uses condoms, the risk of sexually transmitted infections (STIs) cannot be entirely ruled out, especially with multiple lifetime partners. These infections can cause cervicitis and increase the risk of more severe conditions if left untreated.
- Endometrial Cancer: Although less likely given the patient's age and the specific findings on pelvic examination, endometrial cancer can cause intermenstrual bleeding. It is essential to consider this diagnosis due to its potential severity.
- Rare Diagnoses
- Vaginal or Cervical Sarcoma: These are rare tumors that could present with similar symptoms, including abnormal vaginal discharge and a cervical mass.
- Metastatic Disease to the Cervix: Although extremely rare, metastases from other primary cancers can occur in the cervix and present with abnormal bleeding and discharge.