18. Vulval Iintraepithelial Neoplasia / Cancer

Question 1

What does

1. VIN stand for?
2. VaIN stand for?

Answer 1

1. Vulval Intraepithelial Neoplasia

2. Vaginal Intraepithelial Neoplasia

Question 2

What is happening to the Age of Presentation of an Intraepithelial Neoplasia?

Answer 2

It has decreased to 36:

1. Younger women - Multifocal / HPV+
2. Older women - Uni-Focal / HPV-

Question 3

What are the Risk Factors for developing Vulval Intraepithelial Neoplasia?

Answer 3

1. Smoking
2. Other Genital Intraepithelial Neoplasia
3. Previous Related Malignancy
4. Immunosuppression

Question 4

What is the Clinical Appearance of Vulval Intraepithelial Neoplasia?

Answer 4

1. Raised Papular / Plaque Lesions
2. Erosions / Nodules / Warty
3. Keratotic Roughened Appearance
4. Sharp Border - Differentiation in VIN tends to be Unifocal ULcer or Plaque
5. Discolouration - Red / White / Brown / Pigmented

Question 5

How is a Diagnosis of Vulval Intraepithelial Neoplasia made?

Answer 5

Punch Biopsy under Local Anaesthetic - Histological Diagnosis

Question 6

What are the aims of Management of Vulval Intraepithelial Neoplasia?

Answer 6

1. Prevent Cancer - 4% risk in treated / 20-40% if not
2. Eliminate Symptoms
3. Preserve Sexual Function
4. Preserve Body Image

Question 7

What is the Management of Vulval Intraepithelial Neoplasia?

Answer 7

1. Surveillance - Lower Genital Tract Emolliants
2. Surgery
3. Topical Treatments
4. CO2 Laser Ablation
5. Follow-up

Question 8

When are Topical Treatments used in the Management of Vulval Intraepithelial Neoplasia?

Answer 8

Multiple Lesions - Tissue Preservation

Note - Unknown effect on Sexual Function / Long Term Recurrence Rates

Question 9

What Topical Treatments are available in the Management of Vulval Intraepithelial Neoplasia?

Answer 9

1. Imiquimod
2. Photodynamic Therapy
3. 5FU
4. Alpha Interferon
5. Cidofivir

Question 10

What are the Features of CO2 Laser Ablation to manage Vulval Intraepithelial Neoplasia?

Answer 10

1. Improved Cosmetic Result
2. Miss Occult Invasion
3. 75% can be treated at 1 session
4. Suitable for Mucosal Skin
5. 40-70% Recurrence Rate

Question 11

What are the Features of the Follow-Up Consultation after management of Vulval Intraepithelial Neoplasia?

Answer 11

1. Dedicated Clinic to this
2. Colposcopy
3. Frequence / Duration may change, dependent on Vulval Intraepithelial Neoplasia Features

Question 12

What can Vulval Intraepithelial Neoplasia go on to form?

Answer 12

Vulval Cancer

Note - This is an uncommon cancer in the UK

Question 13

What are the Histological Types of Vulval Cancer?

Answer 13

1. Mostly Squamous Cell Carcinoma - Vulval Intraepithelial Neoplasia / Lichen Sclerosis
2. Basal Cell Carcinoma
3. Melanoma
4. Bartholin’s Gland

Question 14

What is the Average Age to be Diagnosed with Vulval Cancer?

Answer 14

1. 74
2. Age range is 27-97
3. 75% of cases are Diagnosed > 60 years old

Question 15

How does Vulval Cancer present?

Answer 15

1. Pain
2. Itch
3. Bleeding
4. Lump / Ulcer

Question 16

How is Vulval Cancer staged?

Answer 16

Surgical-Pathological:
1a - Microinvasion - <1mm
1 - <2cm - 97% Survival Rate
2 - >2cm - 85% Survival Rate
3 - Local Spread to Unilateral Nodes 46% Survival Rate
4 - Distant or Advanced Local Spread to Pelvic Nodes - 50% Survival Rate

Question 17

What is the Treatment of Vulval Cancer?

Answer 17

1. Individualised Surgery - Radical Local Excision / Unilateral or Bilateral Node Dissection
2. Radiotherapy
3. Chemotherapy

Question 18

What are the features of Node Dissections done in the Management of Vulval Cancer?

Answer 18

1. Inguinal and Upper Femoral Nodes
2. Separate Node Incisions
3. Staging and Remove Nodal Disease
4. Associated with Significant Morbidity:
5. a) Wound Infection
6. b) Lymphocysts
7. c) Nerve Damage